man hitting off tee at golf course  - best knee replacement surgeons in Portsmouth, New Hampshire
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  • Posted 08/05/2021

What Are The Most Important Factors For A Good Outcome In Total Knee Replacement?

Although knee replacement has been performed for over 40 years and numerous advances have been realized in implant design, material wear, surgical technique, perioperative management and now surgical navigation, about 20-25% of patients are still not entirely happy with their outcome. This number has changed little over the past 2 decades despite the improvements that have been made. Engineers working together with surgeons have largely fixed the problems of long-term fixation and implant durability so that a well-performed knee replacement can be expected to last over 20-25 years in a majority of cases. While this is an astounding accomplishment given the increasing demand that today’s joint replacement patient places on their implant, durability alone does not translate into patient reported positive outcomes. Nor does objective measures of range of motion, swelling, stability or limb istalignment. Many patients with great looking x-rays and what appear to be well functioning knees continue to report only satisfactory rather than good to excellent outcomes. This fact debunks the modern marketing or advanced technologies such as robotics which promise that perfect implant sizing and alignment automatically translate into good results. 

This is simply not the case. A surgeon can perform what appears to be a near perfect surgery but multiple factors can lead to stiffness and pain. These include: 1) improper patient selection; 2) insufficient patient education and expectation management; 3) poor perioperative pain and medical management; 4) lack of good follow-up care to manage potential problems as they occur. The surgeon must manage the entire process of care well – not just the surgery itself. This is particularly true because knee replacement outcomes are so heavily dependent on patient commitment to a structured therapy program.

Charles Neer, MD, the father of shoulder replacement, remarked that the joint replacement simply sets the stage for the patient to achieve their functional goals through a dedicated rehabilitation program. There is no implant design or surgical technology that can overcome this fact. Robotic total knee replacement does include a comprehensive care management paradigm that is so critical to good outcomes

Our AVATAR program is designed to maximize patient engagement in the entire process of knee replacement as well as to manage all of the critical assets to a good outcome that go beyond the operating room. This includes preoperative patient education and optimization, advanced anesthetic and pain management techniques, less invasive surgical techniques, postoperative immediate continuous range of motion, select physical therapists who we most trust to achieve our goals for recovery and close communication with the entire care team so that any problems can be addressed prior to an adverse outcomes. We strongly believe that AVATAR (Alignment of Vital Assets to Accelerate Recovery) can lead to far more predictable, reproducible and satisfying outcomes than any specific technology that is so heavily marketed to patients with the intent of sales and profit for the implant company. 

Our advice for anyone undergoing joint replacement is: Pick your surgeon not your technology. The surgeon you trust will employ implants and technology that best lead to good and reproducible outcomes in his/her hands. Remember that there is no golf club that can guarantee a perfect shot. It is the swing that matters most. 


If you are interested in learning more about our expertise in knee replacement surgery, please contact our knee, hip and shoulder center here.

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