Knee replacement surgery is an increasingly common procedure worldwide. In the United States, approximately one million patients undergo this surgery every year. The rapid advance of technology has allowed medical device companies to regularly introduce new implants designed for durability and better functioning, thus improving patient satisfaction.
Traditionally, the choice of the medical device to be implanted relied mainly on surgeons, who incorporated the newest devices from their preferred provider into their surgeries. However, it is the patient who will carry this implant with them, therefore, the final decision on which device to use should be the patient's.
What makes an implant right for you?
At the time of performing an orthopedic implant, there are different factors that condition the medical device and the surgical technique to be used. These factors include decisions such as the implant materials (metal, polyethylene or ceramic), the support structures used, the implant fixation methods and the type of surgical incision.
The variations based on the characteristics of the device and the surgical technique are immense, therefore, most surgeons work with a small number of implants and improve their technique to obtain better results with said device. This situation is an important condition in the surgeon's preference. Therefore, some surgeons do not individualize the selection of implants, although there is a wide range of options for each patient in the market.
In some medical conditions, the choice of devices may be reduced. For example, in patients older than 75 years, the risk of dying in the years following surgery is ten times greater than the risk that the prosthesis presents a failure. Therefore, older patients are unlikely to obtain additional benefits from a state-of-the-art implant that provides greater longevity, since they have a higher risk of presenting surgical complications if re-intervention is necessary. This suggests that traditional devices whose complication rates have been well studied may be the best option.
Beyond the differences between the brands and the designs available, the surgeon must explain to the patient why the chosen device is the best for their particular case. However, if the patient is not convinced by the surgeon's recommendations and prefers to use another device, he/she is fully entitled to seek another provider that offers a different set of implants.
It is clear that young and active patients can benefit from newer and more durable devices, therefore, the options are broader.
Patients may differ with the surgeon in terms of the device chosen and its possible risks and benefits, so it is recommended that the doctor request the patient's opinion and discuss possible options. This incorporation of a shared decision-making framework generates a stronger relationship with the doctor.
The Right Device should be decided on a Conversation
To mitigate the tension between the views of the doctor and the patient, the ideal is for the surgeon to assess the individual needs of each patient and notify any information they deem pertinent about the procedure to be performed.
This approach allows shared decision-making, in which the experience of the doctor and the patient's preferences are integrated to define the selection of the device to be used, so that both are as compliant as possible. This allows establishing a patient-centered process in which their particular characteristics are taken into account and their opinion is considered in the selection of the treatment.
Some may consider that the details of the medical device to be implanted are too complex for most patients to understand and discuss with the doctor. In fact, a considerable number of patients want this type of decision to be left to the surgeon. This should also be respected, but the patient will also be offered the opportunity to get involved in decision making and share their preferences and concerns with the surgeon. However, some patients may still allow surgeons to make the final decision, always considering the options that best fit the patient's needs.
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