The Moment of Realization

I was taken aback during our first large conference when a hush descended over the bustling lobby. Whispers of “There he is, there he is” filled the air, directed at Fred. I had no idea he was akin to a Mick Jagger in the orthopedic realm, whose mere presence could evoke such excitement. Over time, I discovered that his innovations were truly groundbreaking.

For the past twenty-five years, I’ve supported his career while managing a full client load in my psychotherapy practice. Thankfully, my background in a medical family—my father being an oral pathologist—made it easier for me to grasp the medical terminology and concepts that filled my life. Dinner conversations often revolved around:

• Highlights from the day’s tumor clinic.
• The risks associated with sun exposure.
• The potential for throat ulcers from oral sex.

The latter was likely a scare tactic aimed at my teenage sister and me. It’s often said that those who pursue mental health careers are drawn to opportunities for self-healing, often prioritizing their patients’ needs over their own. I’m pleased to report that I’ve managed to address any lingering concerns stemming from my father’s alarming comments.

Currently, I am a retired psychotherapist. My husband’s profession exposed me to a new demographic to observe—doctors who, due to their extensive education, sometimes miss critical phases of personal development. This isn’t true for all physicians, but it remains a valid observation, making them an intriguing and intellectually stimulating group to engage with.

Throughout our travels to prestigious orthopedic conferences across the globe, I was fortunate to immerse myself in various cultures and meet a fascinating array of predominantly male doctors. The insight into advanced orthopedic concepts, surgical techniques, and scientific findings was nothing short of awe-inspiring.

Gaining Knowledge on Joint Replacement

Over the years, I developed a solid understanding of key principles related to orthopedic joint replacements. I could often anticipate the questions posed by young surgeons to Fred during international congresses, which brought a smile to my face, even though I recognized my knowledge was superficial—lacking any surgical proficiency.

However, one crucial realization emerged: there is a significant gap in patient education regarding essential information necessary for selecting a surgeon for joint replacement. This is a gap I am determined to address.

Typically, people seek recommendations from friends, family, and acquaintances when considering knee replacement. Recommendations often come from those who have had successful surgeries. Yet, if you were to inquire about the specific implant used, the response would often be a blank stare. This is a perplexing situation.

Let's take knee implants as a prime example. There are over twenty designs based on various principles, and orthopedic surgeons generally utilize the implant system they were taught during their residency. Different designs come with distinct scientific data, and the champions of these designs promote their products vigorously, much like politicians rallying for support. The medical joint-replacement industry is indeed a lucrative enterprise.

Among the various knee design systems, several key philosophies exist, building upon one another. The new knee system can either be un-cemented, allowing the body to naturally bond to the implant during healing, or cemented in place during surgery.

All implant designs feature a smooth, shaped polyethylene bearing that articulates with the metal components of the implant. This aspect is crucial; improperly designed implants can lead to the release of microscopic polyethylene particles into surrounding tissues, triggering inflammatory responses that cause bone deterioration—known as osteolysis.

In 1977, Drs. Buechel and Pappas introduced the first mobile-bearing total knee system, pioneering the concept of low contact stress to the medical field. It’s hard to believe that before the early 1960s, when Sir John Charnley developed the initial use of high-density polyethylene for hip replacements, plastic bearings were even considered for joint replacements. Since then, advancements have enabled the development of plastic bearings that can endure the significant stresses generated by human joints, particularly during activities such as running or heavy lifting.

While small machine gear teeth adhere to engineering stress loading parameters, polyethylene bearings within the body did not. The contact stress requirements were meticulously designed by Fred and Mike. Dr. Buechel noted that this was essential "to avoid premature wear or fatigue failure (breakage) of the bearing surfaces, which would lead to joint replacement failure."

Although their mobile bearing patent is no longer active, the principles they established remain relevant today.

Conclusion: Take Charge of Your Health

You must take control of your health journey:

• Ask your doctor questions.
• Research information online.
• Be aware of the contact stresses in the system your doctor selects.
• Understand whether the implant features a mobile or constrained bearing.

Remember, you have the option to find another doctor if necessary. A knee implant can dramatically improve the quality of life for those in need, alleviating pain and enhancing enjoyment. Ultimately, we all strive for happiness and comfort, and this journey involves making informed decisions.

Note that this article was crafted with valuable insights from Dr. Buechel, Sr., whose edits were minimal yet impactful.

As you embark on your knee replacement journey, may you be equipped with the knowledge needed to navigate this process. I’ll return to yet another dinner filled with medical discussions and rich insights.

The second video titled "Comparing Partial Knee and Total Knee Replacement" offers a detailed examination of the differences between these two types of procedures, helping patients understand their options better.