She came in having done the work. She had watched the clinic videos. Read the website. She knew the name of the proprietary technique for knee replacement that the surgeon’s practice was advertising. She used it correctly in the first sentence of our consultation. What she could not tell me was what the approach actually did differently, which structures it spared, or why it might matter for her specific anatomy and recovery. She had the label. She had not been given the explanation. This is the consultation I have more than any other.
The marketing of surgical approaches to knee replacement has accelerated considerably in the past decade. Individual orthopedic practices now create patient-facing campaigns for knee replacement with terms like “quad-sparing,” “muscle-sparing,” and others, some of which are legally protected. YouTube reels. Targeted ads. Before-and-after testimonials. Patients arrive having genuinely engaged with this material. The problem is not that they are paying attention. The problem is what they are being given to pay attention to.
A trademarked name is not a clinical explanation. It is a brand. And branding, however well-intentioned, is not informed consent.
The clinical reality of knee replacement approaches
Here is what the explanation should include. The standard approach to total knee replacement, the medial parapatellar approach, is used in the vast majority of procedures performed in the United States. It provides excellent joint visualization and the entire instrument ecosystem is designed around it. To get there, the surgeon cuts through part of the quadriceps tendon. The muscle heals. But that healing is real work, and it drives much of the pain and functional limitation patients experience in the first weeks after surgery.
The subvastus approach takes a fundamentally different path. Instead of cutting (splitting really) the quadriceps tendon, it goes below the lower border of the vastus medialis. The muscle is not cut. The entire quadriceps stays intact. In the right patient, this can mean less early postoperative pain, an earlier ability to perform a straight-leg raise, and a smoother first few weeks of rehabilitation. I use it regularly. Almost always. I do so because of what I was seeing in my own patients’ recovery. Patients typically are measurably better in those critical first days and weeks.
But it is important to mention what the evidence shows over time. Those early advantages largely disappear by six weeks. High quality side-by-side studies show equivalent outcomes in most patients by three to six months. Also, the subvastus approach is considered to be more technically demanding for the surgeon. The surgical field is more visually restricted. The patella can be harder to move safely out of the way. Patients with significant prior surgery, substantial deformity, or limited preoperative motion only amplify these technical challenges and I may convert intraoperatively to a standard approach. That is not a failure. That is the judgment the technique requires. None of that nuance is in the clinic video.
Why surgical branding undermines informed consent
And here is where the marketing creates a specific kind of harm. When a patient arrives having chosen a surgeon because of a trademarked name, they believe they have made an informed decision. They have not. They have responded to a brand. The distinction matters because consent built on a brand is not really consent. It is preference formation shaped by advertising, which is a different thing entirely.
Our specialty has been an active participant in this dynamic. I am not standing outside it throwing stones. But there is a meaningful difference between communicating that you use a specific approach and actually explaining what that approach involves, when it is appropriate, what its honest tradeoffs are, and whether this particular patient is a good candidate for it. The first is marketing. The second is medicine.
Reclaiming the conversation in joint replacement
The fix is not complicated. It is a conversation. Because of the current environment with direct-to-patient marketing, the surgical approach for knee replacement should be a standard part of the preoperative discussion: what the surgeon uses, why, what the tradeoffs are, and whether a particular technique is appropriate for that patient’s anatomy, history, and goals. That conversation takes five minutes. It converts a branded promise into something a patient can actually evaluate.
Patients who understand what is actually happening to their body during surgery recover differently than patients operating on a brand impression. Not because understanding heals tissue faster. Because understanding reduces fear, and fear is one of the most consistent predictors of slower rehabilitation and lower satisfaction after joint replacement. The literature supports this. It is not a soft observation.
She was a good candidate for the subvastus approach, as it turned out. We discussed it properly. She had questions I had not heard before, because she had actually been thinking about it rather than just absorbing a name. That conversation made her a better surgical patient than any marketing could have.
If you are preparing for knee replacement and a surgeon’s practice has used specific technique language in their marketing: Ask them to explain it in understandable but clinical terms. Ask when they would not use it. Ask what happens if they start with that approach and it does not work as planned. If the answer is clear and honest, you have your information. If it is not, that is information too.
Cory Calendine is an orthopedic surgeon specializing exclusively in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, Tennessee, and is affiliated with Williamson Health. He performs more than 700 joint replacements each year. His clinical interests include surgical technology, including robotics, minimally invasive techniques such as the anterior approach for hip replacement and the subvastus approach for knee replacement, pain management strategies, and optimizing patient outcomes.
Dr. Calendine speaks regularly, nationally and internationally, on joint replacement and has been recognized as a Castle Connolly Top Doctor from 2018 through 2025. He is the founder of Bone Doctor, a patient education YouTube channel with nearly 600,000 subscribers dedicated to helping patients understand arthritis, joint replacement surgery, and recovery. He is committed to advancing patient education, surgical innovation, and the pursuit of better outcomes in hip and knee replacement.
He shares professional updates through his website, LinkedIn, Instagram, Facebook, and X. His academic work is also listed on Google Scholar and ORCID.
