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Advertising in Orthopaedics - Truth Vs. Fiction

We live in the age of marketing. Truth and Marketing are two words that do not belong in the same sentence. In the past, companies who made orthopaedic implants marketed directly to orthopaedic surgeons and the surgeons could make an informed decision as to what implant to use based on their knowledge, experience and known literature. Producers of total knee and total hip implants now recognize that the aging of our population is resulting in record numbers of total joint replacements being performed and their profits are becoming astounding. The "information" we see in advertising is commonly written by marketing consultants and in most cases, the products have little if any "track record". In other words, a new product with no published studies, no proven record of performance is released and marketed directly to the consumer based on a marketing perception that patients will want their particular product. Let me give you some examples;

  • The Sulzer Hip which was advertised as so good it was "guaranteed for life". This hip was not proven superior to other implants, I choose not to use it even though I lost a few patients who went elsewhere to get it. In a short time, these "guaranteed for life" hips were failing miserably, they were the subject of the largest recall in history and the resultant law suits forced the company into bankruptcy. Many of the patients who had this hip implanted had to undergo one or more additional surgeries to fix the problem.
  • The Gender Specific knee. This is a knee replacement which is advertised to be specifically for females. When the orthopaedic surgeon plans your total knee, he or she has the capability of using any of dozens of different styles and types of total knee implants, each of which comes in a wide variety of sizes. We have clear plastic overlays (templates) we can use on your x-rays to specifically choose an implant to fit your knee. The differences in the male and female knee are very subtle and in most instances in surgery, even your orthopaedist cannot tell the difference between the male and female knee! Now we have excellent, large published studies which show that there is absolutely NO DIFFERECE in outcomes! The Gender Specific knee is a good knee, but it in fact could be used in a male or female, give good results, but no better than any other modern knee replacement.
  • HIGH FLEX KNEE - this is basically a knee which has been around for a while in which the shape was changed in order to try to achieve greater flexion. This is particularly attractive for patients whose culture or religion require squatting or kneeling. This knee was aggressively marketed prior to clinical studies. Unfortunately, good studies have revealed that there is no better flexion with this knee when compared to the knee from which it's design originated.
  • Anterior Hip Approach - This is a technique where the incision is placed on the front of the hip to perform a hip replacement. This technique has existed since the 1800's. We have used it for the past 24 years with good success in selected cases, although we use the posterior (incision toward the buttocks) in most cases. The "anterior approach" became the focus of marketing when one of the manufacturers of surgical tables designed a very expensive table specific for anterior approach and started pushing it to the hospitals. The anterior approach was claimed to "not cut muscles" and result in immediate recovery from the surgery. Again, good comparative studies have shown that the recovery rate is the same for the two different approaches, blood loss is similar, and in fact some complications of surgery such as fracture of the femur and development of heterotopic ossification (abnormal bone in the muscle) may be higher in the anterior approach.
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