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A patient asked for her knee surgery by its brand name. She used the term perfectly. She just had no idea what it actually meant. Orthopedic surgeon Cory Calendine, who does nearly 700 to 800 hip and knee replacements a year, returns to unpack how marketing is quietly reshaping what patients ask for in the exam room. This episode is based on his article “Knee replacement marketing undermines informed consent,” published on KevinMD. You will hear why trademarked procedure names now get searched more than the implant companies that make the hardware, how many carry no published data of their own, and why false expectations can genuinely slow recovery. Cory shares how he guides patients who arrive with a name and a wish list, meeting them where they are instead of talking them out of it. You will come away knowing how to separate an honest surgical claim from a marketing one, and the exact questions to ask before you agree to anything.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Cory Calendine. He’s an orthopedic surgeon. Today’s KevinMD article is “Knee replacement marketing undermines informed consent.” Cory, welcome back to the show.

Cory Calendine: Well, thank you so much. We were just talking before, and it’s been several years. Kevin, it’s good to connect back with you.

Kevin Pho: Wonderful. And I see you, like we talked about, all over social media, clearly doing well, and I love how you blend what you do online with your orthopedic practice. Your KevinMD article talks about knee replacement marketing, something that we don’t often talk about on this podcast. Now, why did you decide to write on this particular tangent for KevinMD?

Cory Calendine: It really came to me during a patient consultation. A patient came in and asked me about a branded surgical technique, a trademark name, and she used it in a sentence correctly. She knew when to ask for it, and she asked for it early. But she didn’t really understand the term. She didn’t know what she was saying. Even though she knew the name, she didn’t really know the science behind it.

And Kevin, you’ve done great work for us in this field, bringing education to patients where they are. Patients are going to find information, and if we don’t do a good job educating them, they come in with the name but not the substance. That’s what got me interested.

Kevin Pho: Obviously I don’t do orthopedic procedures, but there are a lot of branded procedures that people see on social media and on television, and they would come to me with a particular condition and say, “Hey, what do you think about this procedure that I saw on television?” And I can only imagine that in orthopedic surgery there are so many different types of procedures that patients get exposed to, and like you said, they know the name but they don’t quite know the science behind it, which is of course where you come in. In this particular instance, where did this patient find out about this particular procedure?

Cory Calendine: Facebook community groups, of course. There are groups now, and I want to shy away from naming too many actual names here, because these names are federally trademarked and we want to be respectful of what they’re building. But she came to me and she had done her research. She had probably read your blogs, Kevin. She had been through the internet to find the way that she could recover the fastest.

If we rewind a couple of years, what’s really happening is that we used to use broad terms like minimally invasive surgery. Minimally invasive sounds good. If I was a patient, I would definitely want minimally invasive surgery. The problem is that the term doesn’t mean anything, and we’ve taken it a step further to say, well, now it’s an X approach or something that’s nondescript. So what I’ve tried to do in my patient education on YouTube and elsewhere, and hopefully through this article, is to really bring the substance behind it.

So let’s take knee replacement, because that’s really what we’re talking about in the article. The approach that many, many people are using now is called the subvastus approach. Now, subvastus isn’t very good for a billboard. It’s not a real catchy name. But subvastus means we come underneath the muscle, so we’re able to do knee replacement now without cutting the muscle. Now you’ve connected. Patients can understand that for sure. You’ve come under the muscle. You could do a knee replacement without cutting the muscle. If you don’t cut the muscle, it doesn’t have to heal. That leads to a faster recovery.

That’s what I wanted to bring attention to. We need to do a better job giving patients substance, so they don’t come in asking for, “Oh, I want the, I don’t know, what would we call it, the purple and blue knee,” or the golden orange knee, or whatever name we would give it. We want to give them the reasons behind it, and not cutting the muscle, that’s where you can connect to education.

Kevin Pho: So of course, over the last few decades, we’ve had direct-to-consumer marketing when it comes to medication, but now this has expanded to orthopedic procedures. Talk to us a little bit about the evolution of that. When did it become more prevalent for specific branded orthopedic procedures to be commonplace?

Cory Calendine: For us, particularly in knee replacement, which is the example that started this article, it’s really been in the last five years. If you look up some of these branded terms now on Google Trends, they outpace some of the big company names. There are big company names in orthopedics, Stryker, Zimmer, DePuy, but if you look at some of these branded procedural names, they’re getting searched for way more than the companies producing the implants. We’ve seen that trend over the past five years or so.

And I don’t think it’s all bad. I think the fact that patients have better access to information is great, but it comes back to where they are getting their information, and what is the quality of the information we’re giving them? On YouTube, Kevin, YouTube will certify you as a licensed provider, and I think that’s very, very helpful. Here in ortho, with what we’re talking about with approaches, these are board-certified orthopedic surgeons, but the quality of the education still isn’t there. So it’s not just certifying who it’s coming from, but also making sure it has the right depth.

Kevin Pho: So let’s talk about this particular case where this patient came to you asking about this particular procedure. Now, was it appropriate for her underlying condition?

Cory Calendine: What a great question, Kevin, because some patients do come in not appropriate for the procedure. It was completely appropriate for her. With this approach we’re talking about, the subvastus, where you come underneath the muscle to do a knee replacement, one, she needed a knee replacement, and two, she was a great candidate for the subvastus approach. So in her case she would have done well with said named procedure.

But there are people who get offered a false expectation. Not everyone, for example, can have a subvastus approach. Certain deformities, certain shapes, certain body habitus won’t allow coming underneath the muscle. So in knee replacement, sometimes I have to cut the muscle. I don’t want the patient to feel like they’re missing out or getting something less than. We’re just trying to customize the procedure to them. But for her, she was a great candidate for what she asked for.

Kevin Pho: So in terms of actual harms, patients come in having gotten just a 30-second synopsis of X surgical procedure, and then they come to you and talk about it. What are the actual harms to patients of knowing specifically what to ask for, or of asking you for what they see on social media?

Cory Calendine: Well, we know this, Kevin, that patient expectations are directly aligned with how patients do. This has been shown again and again and again. So my concern is largely that if we give patients unrealistic expectations, or maybe even worse, like we were just talking about, they get their hopes up, their expectations up, for one procedure that they don’t qualify for, that lowers their overall morale and, quite frankly, their ability to recover.

There’s a mental game to recovery, and I don’t mean that patients are crazy or somehow impairing their healing. I mean they need to be empowered, and it’s our job to empower them. So offering false hope, I think, is very dangerous. I think that’s a real harm, and I think our ability to give patients realistic expectations is critical. This has been shown again and again in the published literature.

Kevin Pho: So just so we’re clear, because not everyone listening to this may have seen some of these placements, in general, what are some of these branded orthopedic approaches or procedures? What exactly are they promising?

Cory Calendine: Well, they’re promising what every patient wants, less pain, faster recovery. But again, with the brand names, let’s say it would be called Ready Knee or something like this. They’ll come up with a clever name, or Swift Knee. These are not names that I’m familiar with, but I’m just giving an example. So they’re the Ready Knee or the Swift Knee.

The issue is they’ll say, “Faster recovery, and you’ll be back to work in a week.” Well, they may be based on the well-established techniques we were just talking about, like the subvastus approach, that some people are candidates for and some people aren’t, and there is data to say that the subvastus approach helps you recover faster. But once you stick a name on it, patients ascribe all that goodness to the name and not to the underlying cause. That’s where I think the expectations can be mismatched.

Kevin Pho: Now, are we talking specifically about knee procedures? In the orthopedic world, what are some other common branded procedures that are being advertised to patients?

Cory Calendine: Well, on the hip replacement side, and virtually all I do is hip and knee replacements, maybe you’ve even heard about this, Kevin, or your patients have asked you about it, there’s the direct anterior approach. Now, this isn’t a named brand. It’s descriptive of the procedure, so I think it’s more valuable. But when that came out, the direct anterior approach, it was, “We don’t cut muscle, faster recovery.” And even some of those marketing claims were ahead of the data. Now the research has borne that out, and it just so happens that I do the direct anterior approach, and it doesn’t cut muscle, and there is faster recovery in the published literature with lower dislocations. So that bore itself out, but marketing came before the literature, which I think is another thing that we have to be careful of.

The difference in that scenario, Kevin, though, is that the name that got signed up for was really a description of the procedure, and so I think at least it offers, OK, anterior, you’re going to come from the front, or you’re going to at least figure out what that word means. I think that was better for patients. It gave them a little bit more of a description, as opposed to maybe a name that they can’t connect to what the anatomy is.

Kevin Pho: You said earlier that sometimes the literature is not quite where the marketing is. So in general, with these procedures, and I know that in what I do in internal medicine, the literature doesn’t necessarily support the marketing. Where are we with these branded orthopedic surgery procedures? In general, is the literature supporting what they’re advertising?

Cory Calendine: Unfortunately, not so much with the names that I’m referencing in the article around knee replacement. Many of them are built on the subvastus approach, but there’s literally no published data on, again, I’ll use the names that I don’t know are real names, the Ready Knee or the Swift Knee. Now, is there published data based on the approach, the subvastus approach, that is part of that program? Yes. But unfortunately, for the branded procedural names for knee replacement, there is zero published literature.

So they’re really borrowing the claims from the approach, which is the subvastus. And again, I just think that’s confusing, and patients will think, “Oh, if I don’t get the brand-name approach I’ll have a different outcome.” But really, they’re leveraging the good-quality research based on the surgical approach, not the name.

Kevin Pho: So tell us about the spectrum of outcomes from this scenario. You have patients, I’m sure, come to you all the time perhaps asking for a specific procedure that they saw in media. Now tell us your approach to guiding patients like that through that conversation. What’s it like inside your exam room during that initial consult?

Cory Calendine: For me, I think that there’s maybe a temptation to push back and be the physician who gives them all the answers. But I’ve actually adapted. I actually welcome the fact that they have looked around and tried to understand things. Now, obviously, ultimately I want every patient, certainly all my patients, to trust me, but I think it’s good that they came prepared.

So I would tell you that in my exam room, one, I’m very receptive to what they’ve learned. I want to understand what their level of understanding is. And I’ve found that if you start from where they are, they’ll buy into whatever you say, even if it’s the opposite, even if it changes their perception, because they know you tried to meet them where they are. And that’s our responsibility. We’re never going to be good enough digitally to deliver that level of nuance, because everything that somebody hears, they’ll hear differently, if you will. So that customization is always going to happen face to face.

But how would I handle it? I’m very receptive to what they say. I start where they are, and then I try to give the reasons. And quite frankly, I think every surgeon should be receptive to that. If we as surgeons, or us as physicians, can’t explain in common terms good foundational reasons for what we do, then I think it’s an opportunity for us to challenge our own beliefs.

Kevin Pho: Now, for the patients who may be listening to us right now, sometimes they see a 30-second ad on television or they scroll past a procedure or a branded procedure on Facebook. Tell us the type of questions they need to be asking themselves to determine whether this is something that may be right for them or not. What are some questions they need to be asking whenever they see an advertisement like that?

Cory Calendine: Well, I tell my kids the same thing: If it sounds too good to be true, it probably is. So there are certainly some outlandish claims, although I don’t think that’s always true. But anything that sounds too good to be true, certainly be skeptical of. This comes up for us in orthopedics with stem cells. Everybody wants to believe that stem cells grow new cartilage and we don’t need any more surgery. I would love that, but if it sounds too good to be true, it probably is. With stem cells, there’s just no supportive evidence there.

But with regard to the approaches, I think you’re trying to look for honest messaging, and I think most of us can see it. If they say everybody gets back to work in a week, you probably know right away that that’s not right, because surgery and the recovery have to be customized. Maybe you sit at a desk. Maybe you’re an industrial worker and you stand on a factory floor for eight hours. So I think if you just listen to the claims that try to be too generic and don’t sound like they would match everybody, that’s probably a notable caution.

And then ultimately, I think it’s great that it brings people in to have the conversation with the physician, which I do want to hold sacred. Bring your questions. Why do you do it that way? How many of these have you done? What are some other ways that you can do this procedure, and why don’t you do it that way? I think these are all very fair questions. I don’t think any of us wants to be under a lawyer’s microscope, per se, but questions in good faith, asking the surgeon to give you reasons for why they do what they do, my guess is that most all surgeons have a very good reason, and that is to deliver you the best care. They’ll be able to explain it.

Kevin Pho: We’re talking to Cory Calendine. He’s an orthopedic surgeon. Today’s KevinMD article is “Knee replacement marketing undermines informed consent.” Cory, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Cory Calendine: Well, thank you so much. My message would be that you are the master of your own health. And so I encourage all your listeners to look around and educate themselves about what’s going on with their body, and to try to articulate what’s going on with their body. And then, and only then, find someone you can trust, a physician, a surgeon, who will sit down and talk to you and customize the care to you. Every patient is different. I do nearly 700-800 hip and knee replacements a year. Every one is different. So one, be the master of your own care. Find someone you can trust. Build your own custom plan. Thank you, Kevin, for having me.

Kevin Pho: Cory, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Cory Calendine: My pleasure.