What implant should I or my family member get?

Being in the medical device testing industry allows me to see many kinds of implants, made by different manufacturers both domestic and international. Sometimes designs are unique, sometimes they closely mimic already existing technology, sometimes they are made of different materials (although implant materials are relatively boring and consistent). Some have their own spin on what is important, others are the brainchild of a surgeon, and some are quite frankly, not up to par. With so many options, a common question I get asked by family members, friends, or people I meet is "so and so is getting a hip/knee/shoulder replacement/deformity correction/stent, what is the best implant for them to get?" This is an interesting question.

In the mechanical lab, I would say of implants that can be directly compared, probably 75% of them have similar results (or results that can be used for equivalence with the FDA). At Element, we do see lots of trial concepts but I'm not counting those. The remaining 25% is split between the upper and lower performance, but knowing the best performing implant doesn't mean it is what you should try to get, or that it is the best implant for you. First of all, each medical condition is unique and while I can tell you that there are companies who have very robust, consistent processes and deliver high quality products that probably perform above average clinically, it doesn't mean that is it will perform successfully for you. Your surgeon has years of experience and uses the products he/she is comfortable with and that provide their interpretation of the best solution to your unique condition. When I am asked that question, I always say "find a surgeon that has performed thousands of these cases, then ask some questions about why they use what they use, and then trust their experience" Feel free to get a second opinion as well and compare responses. I don't hear a lot of people after a successful surgery walking around saying, "Yea, I'm sporting Stryker's Triathlon Tritanium, I'm really impressed by the surface roughness of the patellar groove. My resurfaced patella just glides so much smoother. Did you know it performed x% better during contact stress distribution testing against so and so in this study? and that fatigue performance? I can really feel the difference. Glad I went with Stryker!"

That just doesn't happen.

Also, that example was made up. Non-disclosure and all that.

You can take the best performing implant and put it in the hands of a surgeon that just completed training on the device or has a high complication rate and get a poor result, but you could also get a positive result. You can put a lower performing knee in the hands of a surgeon that has done thousands of similar cases, and you will probably get a more positive outcome. If a strong performing implant is installed or positioned incorrectly, there is a good chance you will have continued issues. If a lower performing implant is aligned and installed correctly, it can easily outlast the previous example. Obviously, complications arise but I'm speaking in general terms. My Linkedin feed is littered with surgical x-rays where there are multiple opinions on a surgical solution and there may be different options and maybe multiple potential positive outcomes. Now, is a positive outcome guaranteed? Absolutely not but I hope you get my point about the implant performance.

In my opinion, what's more critical: the implant performance or the surgeon experience? I'll go with surgeon experience every time. Is one implant better than another? Maybe. Can a specific implant show better clinical performance from surgeon to surgeon? I'm sure it could. Should you ask what they use and how many they've done? I would. Should you ask about their complication rates? Probably. Can you do research on your device? Sure, especially if it helps give you peace of mind. Could you ask me if its safe? Sure, I'll say it was cleared by FDA against some criteria and predicate, and I'd be more than happy to talk more with you.

Should you tell your surgeon that has been trained on and done 6,000 cases using a specific device that you don't like the traditional plasma spray coating on the device and would rather prefer new additive technology which promotes osseointegration so you would appreciate if they'd switch to that one for your surgery? Probably not.

Agree? Disagree? Let me know!