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Graham Keys Case Study

Mr Keys is a well respected Consultant Orthopaedic Surgeon at Macclesfield, UK, involved in developing an efficient, patient-focused pathway for elective arthroplasty patients. Mr Keys completed his surgical education and training in Cape Town, South Africa. In 1988 he began using the AGC Primary Knee. In 1989 keen to broaden and develop his orthopaedic skill set and experiences, Mr Keys moved to the UK.


An experienced user of Biomet’s AGC Knee System


Mr Keys has been a consistent user of the AGC primary knee system throughout his surgical career. The importance and much of the surgical reasoning for using the AGC system is around the long-term survivorship of the implant and patient satisfaction, particularly around re-establishing an acceptable level of functionality and quality of life.

AGC Surgeon Benefits:

  • Long-term survivorship – with great clinical outcomes and results
  • Ease-of-use, for the surgeon & operating theatre staff
  • Minimal instrumentation that ensures a straight-forward procedure
  • Advantages of the monobloc option – lack of backside wear due to thecompression moulded poly1 
  • Reduction in expensive stock inventory

AGC Patients Benefits: 

  • Implant durability – survivorship rates of 98% at 15 yearsensures ‘comeback’ for polyethylene wear and revisions are almost eradicated
  • Flat on flat design facilitates good flexion range, functionality and quality of life
  • AGC Patients are doing very well up to 20 years – 97.8% survivorship3
  • Comparable pain 92% and function 91% scores between Oxford and AGC4,5
  • Importantly, 98% of AGC patients would have op’ again4!


Oxford Partial Knee System – Phase II & III


Mr Keys performs Oxford PKA surgery only on carefully and properly selected patients with the right indications – Mr 

Keys currently performs partial knee arthroplasty surgery on 25% of his patients. It is this level of expert clinical reasoning that ensures PKA patients do very well long-term under the care of Mr Keys with similar pain (92.5%) and function scores (91.5%) reported5.


Importantly, revisions were on average 9.3 years and largely due to lateral compartment osteoarthritis4. The Oxford PKA system demonstrates excellent long-term results, with prosthesis survival rates of 92.4% at 10 years6-12.


Surgical Challenges – ‘A younger, active patient with increased expectations’


There is no doubt, today’s patients are younger and have greater expectations of their surgery with many expecting to make a full recovery, even returning to extreme sporting activities. Not happy to put up with the pain, the younger patients are presenting new surgical challenges!  


Mr Keys has adopted the Oxford philosophy for patient choice throughout his career. Patient function is much better and as a result of a receiving an Oxford prosthesis; "They do better biomechanically and kinematically.” 


Patient expectation setting is crucial for the younger patient group. Mr Keys highlights and explains the importance of Dr Mike Berend’s eight questions as a more intrusive and meaningful way of extracting sensitive patient information regarding their levels of activity before and expectations for activity and quality of life post surgery.


In summary, there is no significant difference in the long-term outcomes of the Oxford and AGC knee systems. Patient expectation setting is essential, getting over the key messages to the younger, more challenging patient groups is essential in establishing the right level of expectations and achieving the desired clinical outcome – for the surgeon and the patient.


Click here to read an interview with Graham Keys.