Total Joint Replacement Educational Series Part 1: Gender Specific Knee Replacement - What is All the Hype About?
Background Information
As you may have seen on the news or in magazines, orthopaedic companies have started marketing a knee replacement made specifically for women. They claim that it will fit women better, feel better, and improve knee mechanics. The companies are basing this claim on the fact that women TYPICALLY have narrower knees from side to side, a thinner knee in the front, and a greater angle at which the knee cap tracks the best. Implant companies have been marketing the "female specific" knee, which may address the above differences between men and women.
SO WHAT IS FACT FROM FICTION?
THEORETICAL BENEFITS:
- The new implant is designed to "better" match the anatomic differences of females
- An implant that is not as wide
- Different angle to improve knee cap tracking
- Wider range of smaller sizes
- The companies believe that these slight changes in the implant will improve outcomes for women
WHAT'S THE PROBLEM?
- Implant companies are charging a lot more money for the implants even though the "new" design has only slight changes in the geometry
- There is no evidence that the female implant improves knee function, range of motion, or pain levels
- There are no long term studies which show improved overall outcomes, including better patient satisfaction
- There is no evidence that the subtle anatomic differences between men and women even warrant separate implants
- Every patient undergoing a knee replacement undergoes precise measurements to be fit for the prosthesis, so patients get a personalized knee, rather than one associated with gender
- There are many other factors that are likely more important than these very minor changes in the implant, such as surgical technique, pain management, rapid rehab protocols, and your involvement in the process,
- Studies have shown that patient and family centered care (the holistic approach to a joint replacement from start to finish) can improve overall outcomes, and for all implants
*AS ALWAYS, CONSULT YOUR ORTHOPAEDIC SURGEON ON THE PROS AND CONS OF THIS INTERVENTION.
0 TrackBacks
Listed below are links to blogs that reference this entry: Total Joint Replacement Educational Series Part 1: Gender Specific Knee Replacement - What is All the Hype About?.
TrackBack URL for this entry: http://amd3.org/cgi-sys/cgiwrap/caosusa/managed-mt/mt-tb.cgi/13
I believe women are the target of all of the the commercialism of the gender specific knee because women are more likely to go to their doctors when a problem any arises.Men tend to wait longer.
As a patient with two new knees , I am glad I have the ones fitted just for me. I can't tell if it is male or female. All I know is that it works for me. I can't even tell they are implants anymore, they feel like my real knees and function wonderfully.
I disagree that the women's knee is all hype. The literature clearly suggests that women are more likely to suffer from OA of the knee, but most never seek treatment. Yes, clever marketing can make any product the "hype" of the day like the whole "avoid total knee" campaign. Not everyone is a candidate for the extra large components, but companies wouldn't dare not have them available! As far as cost, the hospital contracts for the cost so this is never an issue for the patient. I do not work for the orthopedic company, but I am a nurse and I am excited that women are not still treated with the one size fits all mentality. I am sure once your manufacturer starts providing a similar impant, as all companies will eventually do, then you will be the first to sing their praises!!
I always find it interesting to hear surgeons who DO NOT use the gender specific implants saying negative things about these implants. I would like to ask the doctor whether he uses right and left sided femoral components during knee replacement. Approximately 20-25 years ago certain companies started manufacturing right and left sided components and many surgeons declared that this was unnecessary, more expensive, and there was no data to justify it. Now there is not an orthopedic surgeon in the USA who does not use right and left sided components. Patients will realize that when all the companies are making gender specific components, it will become the standard of practice. Until that time, however, those surgeons who do not want to use the components, many times for financial reasons, will find reasons to criticize their use.
Patients should remember that although implant design is an important factor, that the techniques and care processes are at least as important and maybe more important than the actual implant used! This is why patients need to make sure that their doctors are performing a significant number of these procedures and they work in a hospital that also takes care of many patients who need a joint replacement.
We are very fortunate that there has been a lot of design work in the area of total knees over the last 20 years. One of the side effects of all this work is that all TKR designs have converged to very good designs for all patients - women and men! This is all to the benefit of patients. But also remember that there have been many size options for both men and women from ALL implant companies. In fact, no matter what the system, surgeons make special measurements during the actual surgery and can select from several sizes to best fit the bone. In addition, we can also make special sizing considerations for the femoral side and the tibial side and "mix and match" for both sides of the joint. There are also several size kneecap buttons that fit with any size total knee too. This is all true for all of the modern systems now available.
The concerning issue is that may companies have these same options and without doing a single change in the implants offered as far as design changes, just started advertising that they are "gender specific!" Plus the companies are asking for significantly more dollars for these implants when there are really very little changes in design and NO increased costs associated with manufacturing them!! Although patients do not directly pay for any implants, in the end we ALL end up paying because we will have fewer dollars to take care of other patients too!
In fact, there is not a single clinical study yet in the orthopaedic literature that shows improved function or outcomes using a "gender specific" design for a TKR and in fact, there are studies that show NO differences......
I think that it is good that the direct to consumer advertising is generating discussion and an education process so that (men or women) are less fearful of this life altering procedure in both hip and knee replacements!!
In the end, we are fortunate to have options for TKR for both men and women in this modern age of joint replacement, but too much attention and emphasis is being placed on the implants and not enough on the surgical techniques, experience and care processes!
Remember that the most important factors in the best outcomes that you can achieve are the surgeon you chose to do the surgery and the place that you decide to have the surgery!! The correct implant (both company, size, etc.) will take care of itself if you make the right choice for your surgeon!!
Tony D.