Foreword: Total Knee Arthroplasty—Improving Outcomes and Fulfilling Patient Expectations

Today, the patient having a total knee replacement is younger, more active, and heavier than those in the past so that the durability and performance of the implant is critical to this population. While typically we judged success by 15-year survivorship and Knee Society scores, those metrics have been shown to be inadequate. Patients want and expect their knee replacement to return them to full, normal activities and last a lifetime.

High patient expectations in the 21st century are fueled by direct marketing campaigns, print and television advertising, and the quintessential “non peer-reviewed” vehicle, the Internet. For example, if one typed the phrase “Total Knee Replacement” in the Google search engine on January 29, 2011, it resulted in 1,070,000 sites to visit. Many of these sites appear high up in the rankings, simply by paying for their position, and others as a result of “search engine optimization” by public relations marketing firms. The ranking is not necessarily on the basis of quality and outcomes. While providing a wealth of good information, the Internet is clearly a two-edged sword.

Primary reasons for patient dissatisfaction after total knee arthroplasty are that unrealistic goals are often set or offered and expectations are left unfulfilled. Fulfilling these expectations can only be accomplished by a collaborative effort between surgeons, hospitals, and industry to better educate potential knee arthroplasty patients.

The purpose of this Journal of Knee Surgery Special Focus Section is to present some of the ways that clinicians, scientists, and researchers are addressing these issues. First, I would like to thank Jim Stannard for his vision and commitment to The Journal of Knee Surgery, and especially for allowing me the privilege of serving as Associate Editor for Joint Arthroplasty. I must also thank my friends and colleagues Mark Kester, Tony Hedley, Ananth Gopalakrishnan, Aaron Essner, Lizeth Herrera, Phillip Hughes, and Ken Greene for their insight and hard work on these manuscripts.

As you can see from the authors' disclosures, most are consultants or employees of a manufacturer of orthopaedic implants. In this era of full disclosure it is important to maintain full transparency of these relationships. In my opinion, while any relationship with industry can theoretically bias an article or research, without these collaborations there would be less innovation and fewer steps forward in improving patient outcomes. It was my mission and charge to the authors to keep the manuscripts “fair and balanced.” I hope I have succeeded.