Ryan Koonce, MD

WHICH TYPE OF HIP OR KNEE REPLACEMENT IS BEST?

Choices for brand and model.

March 26, 2023

I am often asked about available brands and models of joint replacement implants for hips and knees.  This is a reasonable question because we have choices in just about everything we purchase.  When I purchase a car or bike, or even when I plan a vacation, I spend time researching the best fit for my needs.  As a patient, I want the best for my body and my lifestyle.

In the United States, there are four major hip and knee implant manufacturers:  Stryker, Zimmer-Biomet, Depuy Synthes, and Smith+Nephew.   There are many other companies that produce implants on a smaller scale.  Surgeons generally agree that implants made by any of the top four companies perform about the same.  There are no large scientific studies that show significant advantages of one implant company over another. 

​

As a surgeon, I want the best outcomes for my patients, so my goal is to use the best technology available.  Implants for hip and knee replacement surgery are constantly evolving, albeit at a relatively slow pace.  I believe the implants I use today are slightly better than those I used 10-15 years ago, and I expect to see only minor changes in implant design over the next 10-15 years.

Surgeons choose which implants to use based on a number of factors including familiarity, experience, relationships with implant companies and implant reps, hospital contracts, and personal opinions.  Most surgeons use one implant system for all patients as there is not strong evidence that different implants should be used for different patient populations. 

My current implant company of choice is Depuy Synthes, which is a subsidiary of Johnson&Johnson.  I choose this company based on my training and practice history, familiarity of the system, and the track record of the implants.  I have found that this company does a great job of tracking clinical and economic outcomes and their implants are used extensively worldwide. I also trust the local representatives of this company to provide quality products, instruments, and advice.  I don’t get paid anything by implant companies or their affiliates to use these products.

I’m often asked if I use a special implant for more athletic patients.  The implant marketplace is different than industries like automobiles where we can rent or purchase an economy version or a premium sports car.  My response is that I put the best available, highest performing implant in every patient regardless of lifestyle.

I’m also sometimes asked, “Do you use any recalled products?”  The answer to this is easy:  no surgeon or hospital that I’m aware of uses recalled products.  It’s not only illegal to do so, it’s also bad practice to use a device that we know is faulty.  This would carry the same risk as an automobile company that knowingly sells a car that has a faulty brake system.

​

I caution patients not to look up information on the Internet regarding implants.  There are two major pitfalls to watch out for when doing your own research.  First, implant companies do a wonderful job of marketing their products, and it’s hard for consumers to differentiate marketing from science.  When you read information that identifies a specific implant as gender specific or that it’s made for sports, this is more marketing than science.  Second, medical device and drug companies generally have a high net worth, and are common targets for attorneys who seek lawsuits.  There is not an implant company in existence that has escaped legal action at some point in time, and you will see this when you look up any product on the Internet.

​

My advice is to trust your surgeon and the implant they choose.  My opinion is that the brand of the chosen device is far less important than how that device is inserted during surgery and the patients’ participation in the recovery process.  Soft tissue handling, soft tissue tension, alignment, angles, rotation, and attachment points are critical during surgery no matter what brand or model we are using.  The outcome of your surgery is determined by how the implant is placed during surgery, your overall medical health, mental health, genetics, and your compliance with postop protocols and therapy.  Surgery is a partnership between the surgeon and the patient, and we must both do our part to achieve the best outcome.