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Opinion & Analysis

Golfers benefit from new knee replacement technology

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Last fall, my father-in-law joined the more than 650,000 total knee replacement patients of 2013[1]. He is a long-time golfer and had been struggling to play due to his moderate to severe knee pain for several years. Finally, the pain was too much to handle and he decided it was time for a knee replacement.

The most common reason golfers have knee replacement surgery is due to osteoarthritis. This is a mechanical condition where the “cushion” of the knee, called cartilage, wears out and the bone rubs against the bone with movement. Osteoarthritis can be very painful and highly agitated by the action of the golf swing.

Despite major advance and modern technology, Jim was one of the growing number of patients that would describe his experience as “traumatic” and “highly disappointing.” Enduring months of severe pain, a revision surgery and still being unable to return to golf after eight months, Jim is now struggling with the decision of whether or not to have his other knee replaced. Is it worth it?

Studies have shown that between 14 and 39 percent of people who have had a knee replacement are “dissatisfied” with their implant or reported “results below their expectations.” (Noble, P et al., Bourne, R et al., Scott, C et al.)

With the demand for total knee replacements expected to rise by 673 percent by the year 2030[2], it is highly likely that you or someone you know will soon be considering your surgical options.

Will you be able to return to an active lifestyle that includes pain free golf or will you be one of the 54,000 U.S. patients needing additional surgery for revisions?

knee replacement complication rateChart from www.healthline.com

Fortunately for us, science and technology continue to advance and we can now benefit from a major breakthrough in knee replacements. I recently had the pleasure to interview Dr. Gregory Martin. Dr. Martin is a board certified orthopaedic surgeon who specializes in hip and knee arthritis and other painful disorders and is one of a growing number of surgeons who traded in the traditional total knee protocol in favor of a fully customizable procedure through Conformis Customized Knee Replacements.

Q&A with Martin

In the past, a “custom fit knee replacement” meant that the instruments for fitting the knee were custom for the patient but that the actual knee was an off-the-shelf implant that comes in only a few different sizes. How is Conformis different?

“It’s no different than the fit of a suit coming in a variety of sizes versus the precise fit of a custom suit. Only with a suit, being off in fit by a small amount may not matter, but with an implant, precision fit is critical. People come in all different shapes and sizes and Conformis believes so should their knee implants. Conformis is different because they make customized, individually made implants along with instrumentation specifically made for the patient that helps the surgeon put the implant in correct.

Also, the knee has three parts to it and sometimes they are not all damaged. With Conformis, because a CT SCAN is taken as part of the process, if the patient is found to have damage in only one part or two parts of the knee, then a customized partial knee can be made. Partial knees have had a resurgence in popularity because of the ease of recovery and improved satisfaction.

How can custom fit components make a difference in the outcomes for patients?

Although total knee replacement helps most people, studies show as many as 1 in 5 patients remain not satisfied with their outcome after surgery. Persistent pain after surgery is a major factor in these patients. We now know that implant size plays a significant role in causing persistent pain.

Studies have shown that if an implant is too big by just 3 millimeters, it can double the risk of persistent pain after knee surgery. By making the implants fit precisely, the hope is that we will see higher satisfaction rates, which is what I am seeing in my early data.

What differences can patients expect to experience during rehabilitation?

I have seen my customized knee patients recover in about half the usual time. What I am used to seeing at three months, I now see at six weeks. The patients have less swelling, improved range of motion and function sooner. Why? Because bleeding around the knee and swelling after total knee surgery makes rehabilitation painful and difficult.

With the customized knees, the instrumentation and surgical technique is less traumatic, less bone is removed, and all of the bone that is cut is covered with implant because the fit is precise. So what we see is significantly less bleeding and swelling. Blood transfusions that are fairly common with non-customized total knees (around 10 to 20 percent in most studies) are quite rare with customized total knees (1 percent or less).

knee replacement big numberswww.healthline.com

Can patients expect a difference in time in regards to returning to normal daily activities? Returning to more active activities?

Return to daily activities varies from patient to patient, but as a whole, I would say that my customized knee patients generally recover much sooner. I typically can get the customized knee patients out of the hospital either the afternoon of surgery or after one night, versus two to four nights for my non-customized knee patients. I see a lot more people doing activities that they enjoy at six weeks after surgery than I ever saw before.

One patient, who I recently saw at his six-week follow up, comes to mind. He had a non-customized knee I did a few years ago and he did well but took him at least three months to get back to a normal life. When I did his other knee with the Customized implant and saw him back at his six week follow up, he had just got back from a cruise and was dancing with his wife and happier than ever.

For partial knee patients, I have seen many golfing at four to six weeks and total knees at six to eight weeks. This level of activity would be unusual this early for my non-customized knee patients.

What are the advantages of choosing a Conformis custom knee replacement over an off-the-shelf replacement, specifically for golfers wanting to return to sport?

Although recovering quickly is important and we should always look for ways to get people better sooner, what really is more critical is the long-term outcome. Although many patients after total knee replacement are out of pain, they may not be able to do the things that they want to do like golf or other activities. They say the knee doesn’t feel right, it doesn’t feel like their knee.

The thought behind Conformis customized total knees is that by making the implant sized and shaped like the individuals own knee before it was damaged, the knee will feel more natural and allow people to resume more activities that they love to do.

Can you briefly talk about the technological advances that had to occur to allow for a process such as what Conformis is using to advance knee replacements?

Conformis was founded with the idea that modern technology and imaging techniques can be utilized to make better implants. A CT scan is taken to get precise pictures of the knee. The data in that scan is sent to the company and computer automated design (CAD) technology is used to map the knee and create an implant.

The instrumentation, which is all single use and disposable, is created on 3D printers (as opposed to traditional knee instruments which are re-used and must constantly go through re-sterilization). With Conformis, the entire kit is shipped to the hospital in a sterile box with the implant and the instruments. It is 21st Century technology at its best.

osteoarthritis and golfwww.healthline.com

Is there anyway to know, prior to surgery, if a person is a better candidate for a custom knee (anyway to know if an off-the-shelf knee would be difficult to fit perfectly)?

We know that people come in all different shapes and sizes on the outside, and their knees look just as different on the inside. Other implant companies have realized this over the years and have created gender specific implants and have increased the number of sizes available with their non-customized knees. However, this may help fit more patients, but will never fit all patients.

Only true customized technology can achieve a perfect fit. After talking with my patients and giving them choices of implants, invariably they wish to have a customized knee. But there are some patients where a customized knee is not appropriate at this time (eg. cases with severe deformities, damage to major knee ligaments, or loss of bony landmarks which would make recreating the knee difficult).

Is there any difference in cost to the consumer when compared to traditional total knee replacement procedure?

Typically in the United States, implant costs are negotiated and covered by the hospitals or insurance companies. Generally, with the exception of any related co-pays for the CT scan required, there are no additional costs to the patient receiving a customized knee implant.

If someone was interested in having a customized knee replacement with the Conformis knee, how should they proceed? 

Visit www.myconformisknee.com to learn more about the technology, hear patient’s real experiences and utilize the “find a doctor” feature to find a surgeon using the technology

If patients are interested in your service, what is the best way to contact you or your office?

My practice is in Palm Beach County, Fla., and my information can be found at www.floridajointreplacement.com

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In conclusion, the overall success rate of total knee replacements are good. But in my years of physical therapy, I have experienced both the good and the bad. If you are considering a total knee replacement, we have found that the success of the surgery is largely dependent on two factors: the quality of the product and the skill of the surgeon.

As a result, the advice that I always give to golfers considering knee replacement is this:

  1. Visit www.myconformisknee.com to find surgeons in your area using this technology.
  2. Get surgeon referrals from two to three local physical therapists who treat patients recovering from total knee replacements. Physical therapists have extensive experience treating the patients of local surgeons and will know which ones have the best results.

If you have any questions or comments, please respond below and we will be happy to respond.

[1] Knee Replacement Statistics: http://www.healthline.com/health/total-knee-replacement-surgery/statistics-infographic

[2] Arthritis Related Statistics CDC: http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm

Doctor of Physical Therapy and Certified Golf Performance Specialist, Dr. Ryan York has been working exclusively with golfers between the ages of 50-75 since 2008. York co-directs Age Defying Golf at http://agedefyinggolf.com/ which is dedicated to improving Golf Performance, reducing the effects of “age”, and resolving golf related pain in golfers between the ages of 50-75.

7 Comments

7 Comments

  1. ROBERT

    Mar 30, 2016 at 5:44 pm

    I went thru a four year period getting uflexxa shots before i knew the only solution to getting back to great golf again was a PKR. I consulted six doctors. I had done my research and knew i only needed a Partial. but the first four doctors i went to tried talking me into a full replacement. Witha full they cut your ACL, MDL and remove your PCL. It will always feel artificial and the recovery is brutal. I was golfing after six weeks. I had a lateral PKR on my right knee-i was bone to bone from a torn worn down menicus. I know have a perfect working right knee that i can “load’ into again and have regained 20 plus yards on my drives and 10 MPH on my swing speed. I hope to regain my scratch hdcp soon.

  2. Pingback: In the News | The Joint Replacement Center of Scottsdale

  3. Patrick

    Jul 2, 2014 at 8:44 pm

    I have had my right knee and left hip replacement. First was my left hip due to a sports injury. I had to donate blood and took a couple of shots of EPO prior to surgery . Great surgeon but having been a professional athlete I was very disciplined on recovery and rehab. My initial goal was to walk without limping. Next was my right knee.
    This was number five on the right knee due to a botched initial surgery 30 years ago. Subsequent surgeries were for cartilage remove and then the dreaded night tibial osteotomy.
    So honestly both surgeries took the better part of five years to be mostly pain free and more importantly, I could walk and golf without pain.
    My advice for those considering either, lose weight and do exactly what the surgeon says. Look at this as an opportunity to get your mobility back. Surgeons are very good these days and want you to do well.

  4. Jim

    Jun 30, 2014 at 3:58 pm

    I’ve had both my knees replaced and am playing as well as I ever have. First, as Nat said, find a good surgeon. I did and I talked to several before choosing. I’ve had no complications at all. Also I agree with Nat that doing your rehab is VITAL. This means at HOME as well as the therapy center. You have to do most rehab on your own. I have good old standard knee replacements but with the modern liners to last longer. My doctor fitting them perfectly and I too was back hitting balls with wedges in about 6 weeks.

  5. Nat

    Jun 29, 2014 at 9:31 am

    I had TKR in November, was back hitting balls in 6 weeks, walking 18 in 3-4 months. I was 50, had no cartilage in my knee since 20 due to college sports injury. This is the best thing I’ve ever done. I am back to elliptical 1 hr a day and golf, typically walking. I won’t lie….it was a hard recovery, but I was extremely diligent with my therapy and stretching. My advice: be in best shape you can be prior to surgery; be prepared to be in pain and work very hard in rehab. It only lasts 3-6 weeks, but the pain is there. Not ouch pain, just generalized discomfort; last, donate blood ahead of time. You lose a lot, and you’ll likely needed a transfusion.
    Also, you do not need a custom knee. That is a gimmick. You need a skilled surgeon who does a lot, a great physical therapist, and a caring spouse.

  6. Pingback: Golfers benefit from new knee replacement technology | Spacetimeandi.com

  7. Pingback: Golfers benefit from new knee replacement technology - I'd Rather Be Golfing

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Opinion & Analysis

The 2 primary challenges golf equipment companies face

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As the editor-in-chief of this website and an observer of the GolfWRX forums and other online golf equipment discourse for over a decade, I’m pretty well attuned to the grunts and grumbles of a significant portion of the golf equipment purchasing spectrum. And before you accuse me of lording above all in some digital ivory tower, I’d like to offer that I worked at golf courses (public and private) for years prior to picking up my pen, so I’m well-versed in the non-degenerate golf equipment consumers out there. I touched (green)grass (retail)!

Complaints about the ills of and related to the OEMs usually follow some version of: Product cycles are too short for real innovation, tour equipment isn’t the same as retail (which is largely not true, by the way), too much is invested in marketing and not enough in R&D, top staffer X hasn’t even put the new driver in play, so it’s obviously not superior to the previous generation, prices are too high, and on and on.

Without digging into the merits of any of these claims, which I believe are mostly red herrings, I’d like to bring into view of our rangefinder what I believe to be the two primary difficulties golf equipment companies face.

One: As Terry Koehler, back when he was the CEO of Ben Hogan, told me at the time of the Ft Worth irons launch, if you can’t regularly hit the golf ball in a coin-sized area in the middle of the face, there’s not a ton that iron technology can do for you. Now, this is less true now with respect to irons than when he said it, and is less and less true by degrees as the clubs get larger (utilities, fairways, hybrids, drivers), but there remains a great deal of golf equipment truth in that statement. Think about it — which is to say, in TL;DR fashion, get lessons from a qualified instructor who will teach you about the fundamentals of repeatable impact and how the golf swing works, not just offer band-aid fixes. If you can’t repeatably deliver the golf club to the golf ball in something resembling the manner it was designed for, how can you expect to be getting the most out of the club — put another way, the maximum value from your investment?

Similarly, game improvement equipment can only improve your game if you game it. In other words, get fit for the clubs you ought to be playing rather than filling the bag with the ones you wish you could hit or used to be able to hit. Of course, don’t do this if you don’t care about performance and just want to hit a forged blade while playing off an 18 handicap. That’s absolutely fine. There were plenty of members in clubs back in the day playing Hogan Apex or Mizuno MP-32 irons who had no business doing so from a ballstriking standpoint, but they enjoyed their look, feel, and complementary qualities to their Gatsby hats and cashmere sweaters. Do what brings you a measure of joy in this maddening game.

Now, the second issue. This is not a plea for non-conforming equipment; rather, it is a statement of fact. USGA/R&A limits on every facet of golf equipment are detrimental to golf equipment manufacturers. Sure, you know this, but do you think about it as it applies to almost every element of equipment? A 500cc driver would be inherently more forgiving than a 460cc, as one with a COR measurement in excess of 0.83. 50-inch shafts. Box grooves. And on and on.

Would fewer regulations be objectively bad for the game? Would this erode its soul? Fortunately, that’s beside the point of this exercise, which is merely to point out the facts. The fact, in this case, is that equipment restrictions and regulations are the slaughterbench of an abundance of innovation in the golf equipment space. Is this for the best? Well, now I’ve asked the question twice and might as well give a partial response, I guess my answer to that would be, “It depends on what type of golf you’re playing and who you’re playing it with.”

For my part, I don’t mind embarrassing myself with vintage blades and persimmons chasing after the quasi-spiritual elevation of a well-struck shot, but that’s just me. Plenty of folks don’t give a damn if their grooves are conforming. Plenty of folks think the folks in Liberty Corner ought to add a prison to the museum for such offences. And those are just a few of the considerations for the amateur game — which doesn’t get inside the gallery ropes of the pro game…

Different strokes in the game of golf, in my humble opinion.

Anyway, I believe equipment company engineers are genuinely trying to build better equipment year over year. The marketing departments are trying to find ways to make this equipment appeal to the broadest segment of the golf market possible. All of this against (1) the backdrop of — at least for now — firm product cycles. And golfers who, with their ~15 average handicap (men), for the most part, are not striping the golf ball like Tiger in his prime and seem to have less and less time year over year to practice and improve. (2) Regulations that massively restrict what they’re able to do…

That’s the landscape as I see it and the real headwinds for golf equipment companies. No doubt, there’s more I haven’t considered, but I think the previous is a better — and better faith — point of departure when formulating any serious commentary on the golf equipment world than some of the more cynical and conspiratorial takes I hear.

Agree? Disagree? Think I’m worthy of an Adam Hadwin-esque security guard tackle? Let me know in the comments.

@golfoncbs The infamous Adam Hadwin tackle ? #golf #fyp #canada #pgatour #adamhadwin ? Ghibli-style nostalgic waltz – MaSssuguMusic

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Podcasts

Fore Love of Golf: Introducing a new club concept

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Episode #16 brings us Cliff McKinney. Cliff is the founder of Old Charlie Golf Club, a new club, and concept, to be built in the Florida panhandle. The model is quite interesting and aims to make great, private golf more affordable. We hope you enjoy the show!

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Opinion & Analysis

On Scottie Scheffler wondering ‘What’s the point of winning?’

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Last week, I came across a reel from BBC Sport on Instagram featuring Scottie Scheffler speaking to the media ahead of The Open at Royal Portrush. In it, he shared that he often wonders what the point is of wanting to win tournaments so badly — especially when he knows, deep down, that it doesn’t lead to a truly fulfilling life.

 

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“Is it great to be able to win tournaments and to accomplish the things I have in the game of golf? Yeah, it brings tears to my eyes just to think about it because I’ve literally worked my entire life to be good at this sport,” Scheffler said. “To have that kind of sense of accomplishment, I think, is a pretty cool feeling. To get to live out your dreams is very special, but at the end of the day, I’m not out here to inspire the next generation of golfers. I’m not out here to inspire someone to be the best player in the world, because what’s the point?”

Ironically — or perhaps perfectly — he went on to win the claret jug.

That question — what’s the point of winning? — cuts straight to the heart of the human journey.

As someone who’s spent over two decades in the trenches of professional golf, and in deep study of the mental, emotional, and spiritual dimensions of the game, I see Scottie’s inner conflict as a sign of soul evolution in motion.

I came to golf late. I wasn’t a junior standout or college All-American. At 27, I left a steady corporate job to see if I could be on the PGA Tour starting as a 14-handicap, average-length hitter. Over the years, my journey has been defined less by trophies and more by the relentless effort to navigate the deeply inequitable and gated system of professional golf — an effort that ultimately turned inward and helped me evolve as both a golfer and a person.

One perspective that helped me make sense of this inner dissonance around competition and our culture’s tendency to overvalue winning is the idea of soul evolution.

The University of Virginia’s Division of Perceptual Studies has done extensive research on reincarnation, and Netflix’s Surviving Death (Episode 6) explores the topic, too. Whether you take it literally or metaphorically, the idea that we’re on a long arc of growth — from beginner to sage elder — offers a profound perspective.

If you accept the premise literally, then terms like “young soul” and “old soul” start to hold meaning. However, even if we set the word “soul” aside, it’s easy to see that different levels of life experience produce different worldviews.

Newer souls — or people in earlier stages of their development — may be curious and kind but still lack discernment or depth. There is a naivety, and they don’t yet question as deeply, tending to see things in black and white, partly because certainty feels safer than confronting the unknown.

As we gain more experience, we begin to experiment. We test limits. We chase extreme external goals — sometimes at the expense of health, relationships, or inner peace — still operating from hunger, ambition, and the fragility of the ego.

It’s a necessary stage, but often a turbulent and unfulfilling one.

David Duval fell off the map after reaching World No. 1. Bubba Watson had his own “Is this it?” moment with his caddie, Ted Scott, after winning the Masters.

In Aaron Rodgers: Enigma, reflecting on his 2011 Super Bowl win, Rodgers said:

“Now I’ve accomplished the only thing that I really, really wanted to do in my life. Now what? I was like, ‘Did I aim at the wrong thing? Did I spend too much time thinking about stuff that ultimately doesn’t give you true happiness?’”

Jim Carrey once said, “I think everybody should get rich and famous and do everything they ever dreamed of so they can see that it’s not the answer.”

Eventually, though, something shifts.

We begin to see in shades of gray. Winning, dominating, accumulating—these pursuits lose their shine. The rewards feel more fleeting. Living in a constant state of fight-or-flight makes us feel alive, yes, but not happy and joyful.

Compassion begins to replace ambition. Love, presence, and gratitude become more fulfilling than status, profits, or trophies. We crave balance over burnout. Collaboration over competition. Meaning over metrics.

Interestingly, if we zoom out, we can apply this same model to nations and cultures. Countries, like people, have a collective “soul stage” made up of the individuals within them.

Take the United States, for example. I’d place it as a mid-level soul: highly competitive and deeply driven, but still learning emotional maturity. Still uncomfortable with nuance. Still believing that more is always better. Despite its global wins, the U.S. currently ranks just 23rd in happiness (as of 2025). You might liken it to a gifted teenager—bold, eager, and ambitious, but angsty and still figuring out how to live well and in balance. As much as a parent wants to protect their child, sometimes the child has to make their own mistakes to truly grow.

So when Scottie Scheffler wonders what the point of winning is, I don’t see someone losing strength.

I see someone evolving.

He’s beginning to look beyond the leaderboard. Beyond metrics of success that carry a lower vibration. And yet, in a poetic twist, Scheffler did go on to win The Open. But that only reinforces the point: even at the pinnacle, the question remains. And if more of us in the golf and sports world — and in U.S. culture at large — started asking similar questions, we might discover that the more meaningful trophy isn’t about accumulating or beating others at all costs.

It’s about awakening and evolving to something more than winning could ever promise.

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