} SURGICAL TECHNOLOGY
knee
the forgotten
...with natural motion, you might forget it’s been replaced
by Matthew Clayton, M.D.
Multiple studies have documented that up to 95% of patients report good to excellent pain relief after undergoing a total knee replacement. Unfortunately, only about 85% of patients report that they are fully satisfied with the outcome of their new knees. This begs the question, what is the cause of these patients’ dissatisfaction despite their pain relief ? I believe that this interesting difference between pain relief and satisfaction is likely due to two important factors. The first factor is that patients may have unrealistic expectations of their surgery. One of the most important tasks that a surgeon should complete prior to performing a surgery is to fully explain the likely outcomes and expected recovery from the surgery they are recommending. When realistic expectations are set and clearly understood by the patient, they will be very unlikely to report that they are dissatisfied when the expectations are met. However, if grand expectations are presented to the patients and the outcomes, while still good, fall slightly short, patients will likely report that they are not fully satisfied with their outcomes. As the saying goes, if you promise the stars and the moon and only deliver the stars, they will still long for the moon. The second factor, which has significantly affected my personal practices in total knee replacement, is that many of the knees on the market today are designed to provide stable motion, 22
that often times does not recreate the natural motion of our knees. While the idea of manufacturing a total knee implant that will allow for a natural motion sounds intuitive, very few knee implants are able to accomplish this goal. It is because of this unnatural kinematic motion that I believe patients with pain free total knees may still report that they are not fully satisfied. This is also what has led me to use a knee implant that allows for the most natural kinematic motion of any knee prosthesis on the market today. The Microport Evolution total knee system was designed to mimic patients’ natural knee. It provides great stability to the inside of the knee, while allowing for rotation along the outside of the knee, which is how our knees normally function. This is commonly referred to as a “medial pivot” knee. When you provide this natural motion with a pain-free knee, I have found that you are more likely to
Inside Medicine | februar y-march 2017
have a patient with what I refer to as a “forgotten knee.” This occurs when the knee replacement feels so natural that they forget it has been replaced. This is the best outcome possible after knee replacement surgery. While this is my personal goal for all of my patients, it is not what I tell them to expect. I explain that they can expect a pain-free knee. When this goal is achieved, I have a satisfied patient. Thankfully, since I have started using a knee implant that provides a natural motion, more patients are forgetting that their knee has been replaced. If you are considering a knee replacement surgery, I strongly recommend that you look for a surgeon that you trust. Don’t be afraid to ask questions about the procedure and the expected outcomes. Inquire what implant they will use and why they will use it. Once your questions have been answered and you have made the decision to move forward with surgery, be confident in your decision. A confident, positive patient in the hands of a skilled surgeon will produce a great outcome.
