Where should I put a knee replacement and how do I get it there? These are questions that knee surgeons think about. We go to conferences, we listen to companies, we read journal articles. On top of all that we throw in our personal experience. From all of it we try to develop a plan and a technique which works for us and our patients.
Somehow we all end up with different answers. There are dozens of different ways of putting in a knee replacement. Then there are thousands of more individual variations which surgeons have developed over time. The reasons why are an exercise in psychology as much as a study of the evidence.
I have to admit to becoming a little obsessed with alignment, and in particular femoral rotation, over the last 10 years. I have published four peer-reviewed publications and presented on it at conferences over 20 times in the last few years. I’ve patented a rotational alignment guide. I work in Melbourne, Australia and perform a couple of hundred knee replacements each year. From this experience I have developed an understanding of the research on alignment in knee replacement. There is a huge amount of information out there. Some is very good, but there is a lot that needs to interpreted with caution or disregarded completely.
I’m sure you have all been to conferences and sat in largely empty halls listening to people trying to cram years of thought on complicated subjects into 5 minutes of Powerpoint. I’m looking for a better way to condense the literature, to share my ideas and start a discussion.
I’m going to try and put out an article each week. Each one should only take a few minutes to read. They are aimed at Orthopaedic surgeons who are performing knee replacements so I will try and skip through the basic concepts pretty quickly to get to the discussion and my recommendations. I will include illustrations, photos and videos. I will put in key references at the end of each article.
My disclosures. I have designed an instrument and I do get a (small amount) of royalties from its sale. I’ll describe it to you at some stage but it is not the focus of this blog. The lessons I learned around designing and commercializing it will also be discussed. I have done some consulting and instrument design work for a couple of companies but none of it is relevant.
Finally, I would love to start a discussion about this topic. Any comments, contributions, questions or advice would be gratefully accepted. I am always looking for new papers, so if you can suggest something I’ve missed let me know.