The Ethical Implications of Recent Innovations in Knee Arthroplasty

Abstract

Total knee arthroplasty is currently one of the most commonly performed elective orthopaedic procedures. It has been validated as offering relief from the pain associated with degenerative arthritis when that pain is unresponsive to medical therapy1,2. Some recent innovations in arthroplasty surgery offer the potential for improved and more reproducible outcomes. Minimally invasive arthroplasty has generated great interest among patients, arthroplasty surgeons, and health-care providers and has been the subject of widespread coverage in both the medical and the lay press. Much of this interest is based on the promise of the same or better long-term results and a shorter, less painful recovery, earlier mobilization, and reduced hospital stay and cost3,4. Computer-assisted surgery is another recent innovation that is gaining popularity among arthroplasty surgeons. This type of surgery has been validated by a number of studies that have shown its ability to improve the mechanical alignment of the lower limb after total knee replacement and to improve the reproducibility of this out-come measure5-7. Medical ethics may be considered as a code of professional conduct, the foundation of which is commonly based on four principles—nonmaleficence, beneficence, autonomy, and justice—as described by Beauchamp and Childress in their text: Principles of Biomedical Ethics 8. Nonmaleficence: Surgeons have an obligation not to inflict harm on patients, either intentionally or carelessly. “Primum non nocere,” first do no harm, is one of the most fundamental aspects of biomedical ethics. Harm in terms of bioethics refers to physical harm, including pain, disability, and death. Unfortunately, all surgical interventions inevitably cause some harm and carry some form of risk, and so this principle is impossible to guarantee in any surgical procedure. It is important to point out that, for nonphysicians, nonmaleficence is acceptable behavior but, …