Dr Robert Steensen specialises in all aspects of the knee, from sports injuries to knees worn out with arthritis. He is uniquely qualified as a result of his fellowship training with one of the pioneers of knee surgery that included cartilage transplantation and work with the NFL’s Atlanta Falcons. He is recognised internationally for the development of a surgical technique to prevent recurring dislocations of the patella. Through research efforts, Dr Steensen helped define the anatomy of the Medial Patellofemoral Ligament (MPFL), and developed a procedure based on this information, with results published in several orthopaedic journals. He has an interest in kinematic alignment in total knee replacement which places the implant in the position unique for each individual. He pairs this with MicroPort’s Evolution® Medial-Pivot knee implant to match, as best possible, the motion and stability of the normal knee.
OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?
RS: I enjoy working with my hands and the technical challenge of orthopaedic surgery. I focus on planning the steps of a procedure, essentially making the game plan. Orthopaedic surgery is rewarding for patients and surgeons as it restores function and activity for patients, many times normal or close to normal.
OPN: It is clear that the healthcare industry has been greatly impacted by the global pandemic, what has been the greatest impact for you within the orthopaedic industry?
RS: There have been two major impacts. We have limited our surgeries mostly to outpatient procedures. Fortunately, we can do many of our procedures on an outpatient basis now, even total knee replacement. But we have postponed our more complicated surgeries and procedures in our patients who have medical co-morbidities or limited mobility. It has also affected our residency training program. Conferences now are mostly virtual and the interaction and discussions are not as robust as in-person conferences.
OPN: What’s the best part of your job?
RS: Satisfied patients who can resume their active lifestyle.
OPN: … and the worst?
RS: The ever-growing bureaucracy.
OPN: What has been the highlight of your career so far?
RS: I think it has been the continued interest in developing an understanding of very fundamental core concepts on knees and knee surgery, and then applying those concepts to procedures. Early in my career that focused on ACL surgery and osteochondral defects. In my mid-career, I became very interested in patellar dislocation, and developed my treatment algorithm based on very specific principles. Lately, my interest has been in total knee replacement and combining Kinematic Alignment technique with a Medial-Pivot implant. Each of those choices is based on a philosophy. And by combining them we obtain the benefits of both.
OPN: You recently spoke at the American Association of Hip and Knee Surgeons (AAHKS) event in November, talking about how kinematic alignment offers benefit in total knee replacements, can you tell us more about your discussions?
RS: The symposium focused on the synergy one can obtain by combining Kinematic Alignment technique and a Medial-Pivot implant. Kinematic Alignment places the implant to match the position of the individual patient’s joint surface before the development of arthritis. The MicroPort Evolution® Medial-Pivot knee has a record of patient preference over conventional implant designs, long survivorship, stability throughout the arc of motion, and matches the medial-pivot kinematics of the normal knee.
OPN: How would this improve patient outcomes and experience?
RS: I consider the joint surfaces and the ligaments to work as a functional unit. Kinematic Alignment matches the patient’s joint surfaces so the ligaments are under normal tension. They do not require release, so this is less surgery and is particularly helpful for outpatient procedures. Since the ligaments are at their normal tension, my patients achieve more motion overall and achieve it more quickly. Kinematic Alignment restores the normal flexion-extension axis of the knee.
The MicroPort Evolution® Medial-Pivot knee offers stability on the medial side of the knee and mimics normal medial-pivot kinematics.
Combining Kinematic Alignment with the MicroPort Evolution® Medial-Pivot knee implant matches both the normal flexion-extension axis of the knee and the normal longitudinal rotation axis of the knee, and therefore the new knee should feel the most natural to the patient.
OPN: Are you currently involved with any scientific research?
RS: I have two projects related to trochlear dysplasia. Trochlear dysplasia is a condition where the groove on the femur for the patella is not as deep as normal. Sometimes it is flat, and sometimes it is even convex. This is a significant factor in many patients with recurrent patellar dislocation.
OPN: Please can you tell us more about the research?
RS: I have noticed that the majority of my patients who need a total knee replacement for arthritis about the patellofemoral joint have trochlear dysplasia. We are evaluating the prevalence of trochlear dysplasia in patients undergoing total knee replacement for patellofemoral arthritis and will compare this with patients with medial or lateral compartment arthritis.
The second project looks at a familial pattern of trochlear dysplasia. I have a number of families with more than one family member with trochlear dysplasia, such as three siblings, two siblings, and a parent and child. We plan to report this as it suggests a familial tendency for this condition.
OPN: Are you planning to attend any orthopaedic events in 2022?
RS: I will most likely attend the AAOS this Spring.
OPN: If you weren’t an orthopaedic surgeon what would you be?
RS: Most likely a high school science teacher and basketball coach.
OPN: What would you tell your 21-year-old self?
RS: Don’t plan the future. It will work out and be more exciting if you welcome the opportunities that come your way.
OPN: If you were Health Minister for the day what changes would you implement?
RS: I would declare a National Health Care Heroes Day! They really are!
OPN: Away from the clinic and operating theatre – what do you do to relax?
RS: Mostly yardwork. It is always good to be outdoors and get some physical exercise.
OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2022 and the next decade?
RS: I believe orthopaedic surgery will continue to be one of the most innovative fields in medicine. Technology will continue to emerge but it must show true value to the patient. We will continue to gain deeper insight into orthopaedic conditions that will allow better treatment options. Progress is not always linear, often it goes in fits and spurts.
The views, opinions and product experiences discussed in this article, whether implicit or explicit, are those of the surgeon and do not necessarily reflect the views and opinions of MicroPort Orthopedics Inc.