Unfortunately, total hip and knee manufacturers have taken to advertising directly to the public. The hope is not just that the public will bring this preference to the surgeon, but that the surgeon will have to accede to the preference or take the time to explain why the preference is wrong for the patient. The other factor is that these manufacturers point patients, especially on the web, to certain surgeons with whom they have relationships, some disclosed and some informal, thereby directing business to those surgeons who hopefully will be grateful to that implant manufacturer. Other inducements may also be in play.
Obviously, the patient does not have the education or training to ascertain the best choice.
2 recent efforts may illustrate the point. You may be familiar with these advertisements.
The Round Knee
A relatively new ad features cars and bicycles with oblong wheels to sell the idea of a round knee prosthesis, by ridiculing the oblong shape. The idea of a round prosthesis is not new. It was popular in the infancy of knee replacements in the 60’s and 70’’s, but was completely discredited as we learned that the knee does not function as a simple “round” hinge. Round knees overload the kneecap and don’t do well. The idea of a round knee was abandoned by the mid 1980’s. But it takes a lot of valuable time to explain the chicanery to a patient.
The Female Knee
For a number of years, two manufacturers of total knees made only a small number of sizes, typically small, medium, large and extra-large. The prostheses had no side to side or front to back ratio adjustments as the size went up. The result was that the implants did not fit well in smaller patients, mostly women. The ratio of front to back dimension(antero-posterior) to the side/side dimension (medial-lateral) changes as we grow bigger. There were many unhappy female patients. The manufacturers were forced to retool their factories and adjust their product. Then they undertook an advertising campaign to “spin” the change.
For 15 years we have been using a manufacturer that offered 9 sizes which adjusted the A/P to M/L dimension according to size. As a consequence we did not have any problems fitting the “Female Knee”. The advertising was simply deceitful but it took a lot of my time to educate patients from the disinformation they had received.
The best rule of thumb is that if the company is direct marketing to you then they are having difficulty selling the product to the doctors … Beware!