Surgeon's Skill More Important Than Implant Design

While the choices of knee implants are plentiful, the success of customized total knee replacement (TKR) surgery is dependent on the surgeon's skill, according to a new study.

Researchers at Henry Ford Hospital (Detroit, MI, USA) collected data from more than 20 joint replacement surgeons at an orthopedic specialty hospital, identifying several surgical techniques that take into account a patient's individual knee characteristics and ensure that the implant is properly aligned and balanced with ligaments and soft tissue. The researchers found that utilizing a series of common but nuanced surgical techniques is far more important to customizing the fit of a patient's implant than the implant's design, and can be effectively performed without the inventory or cost associated with gender- or patient-specific implants.

Some of the techniques described include gap balancing, a procedure that provides better stability and overall functional performance. Several techniques aim to restore the "soft tissue personality" of the knee beyond just bone replacement. Another technique involves resecting the femur so the implant does not loom over the two sides of the bone. The researchers also suggested techniques that offer ways to enable surgeons to downsize safely components intraoperatively when needed, while improving the balance of the knee. The study was presented at the annual meeting of the American Academy of Orthopedic Surgeons, held during February 2011 in San Diego (CA, USA).

"Customized knee implants will not replace the need for precise, methodical surgical skill,” said lead author Jason Davis, MD. "While improving outcomes will continue to evolve, getting back to the basics of surgery is still paramount to successful knee replacement.”

More than 580,000 TKRs are performed each year in the United States alone, with an estimated two-thirds of patients being female. More than 150 implant designs are currently available, including several that are gender and patient specific.

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