For those of us who handle workers’ compensation claims involving knee injuries, there’s a new medical technology we need to know about – because it’s going to start showing up in our cases if it hasn’t already.

It’s called the “smart knee” implant, and the leading device right now is the Zimmer Biomet Persona IQ – the first and currently only FDA-approved knee replacement with built-in sensor technology. From the outside, it looks and functions like any standard total knee replacement. But embedded inside the tibial stem is a tiny wireless sensor that continuously tracks the patient’s recovery in real time.

The implant measures range of motion, step count, walking speed, stride length, and pressure distribution across the joint. That data is wirelessly transmitted to a small base station plugged into the patient’s home Wi-Fi, and from there it uploads to a secure, HIPAA-compliant cloud platform. The treating surgeon can log in and review the data remotely. The patient can see their own progress through a smartphone app, and even compare their recovery metrics against national benchmarks for patients of the same age and stage of recovery.

This isn’t experimental. It’s being used right now at major orthopedic centers across the country, including Mayo Clinic, the Hospital for Special Surgery in New York, UChicago Medicine, and Lee Health in Florida. And adoption is expanding rapidly into smaller community hospitals and ambulatory surgery centers. As recently as June 2025, UP Health System in Michigan’s Upper Peninsula began offering the device for the first time.

So why should workers’ comp practitioners care? Several reasons.

First, this technology replaces subjective recovery assessments with objective data. Historically, post-operative knee recovery has been tracked through periodic office visits and patient self-reports – the surgeon asks patients how they feel, watches them walk across the room, and measures their range of motion with a goniometer. One Mayo Clinic surgeon described the traditional approach as “very, very subjective.”

The smart knee changes that equation entirely. Now the surgeon has daily biomechanical data showing exactly how the knee is performing between visits. For attorneys and adjusters, this means disputes about whether a claimant has reached maximum medical improvement, whether recovery is progressing on schedule, or whether functional limitations are consistent with the objective findings could increasingly be resolved by implant data rather than dueling medical opinions.

Second, the technology enables earlier intervention when recovery stalls. Orthopedic surgeons at UChicago Medicine have emphasized that the first three months after knee replacement are critical – if patients don’t regain adequate strength and range of motion during that window, those losses can be very difficult to make up later. With the smart implant, a surgeon who sees a sudden drop in step count or a plateau in range of motion can reach out to the patient immediately and adjust the rehabilitation plan. That kind of early intervention could shorten disability durations and reduce overall claim costs.

Third, smart implants reduce the need for frequent in-person follow-up visits. The remote monitoring capability means patients who live far from their treating surgeon may not need to travel as often for routine post-operative checks – a meaningful consideration in workers’ comp, where mileage reimbursement, time off work for medical appointments, and delays in scheduling all add friction and cost to the system.

Fourth, consider the long-term implications. The sensor battery is designed to last at least 10 years, and the device can help detect early signs of implant loosening, abnormal wear patterns, or biomechanical changes that might signal a problem before the patient even notices symptoms. Since workers’ comp carriers often remain responsible for future medical treatment related to the original injury – including revision surgery – early detection of developing problems could mean smaller, less invasive, and less expensive interventions down the road.

Finally – and perhaps most significantly for litigators – think about the evidentiary implications. These implants generate a continuous, objective record of the patient’s functional capacity. Daily step counts. Walking speed. Stride length. Range of motion trends over weeks and months. That data could become powerful evidence in disputes over functional limitations, compliance with prescribed physical therapy, and readiness to return to work. It cuts both ways: it could support a claimant who is doing everything right but still struggling, or it could undermine a claim where the reported limitations don’t match the biomechanical data.

The smart knee is not yet the standard of care for every total knee replacement — cost, patient comfort with the technology, and the need for home Wi-Fi are still limiting factors. But adoption is growing quickly, and as it does, workers’ comp professionals on both sides of the aisle will need to understand what this data means, how to obtain it, and how to use it.

This is one worth watching.

Karen Majovski is a deputy city attorney (DCA) in the Los Angeles City Attorney’s Office. The office uses a classification system – DCA-I through DCA-IV – with pay steps within each classification, all governed by memoranda of understanding (MOUs) between the City and DCA labor unions. Within each classification, DCAs automatically advance one step per year. Promotions from DCA-I to DCA-II and from DCA-II to DCA-III could be automatic under certain conditions, but promotions from DCA-III upward were never automatic and were typically granted through competitive Performance Recognition Programs (PRPs) or, more rarely, by discretionary action.

Majovski obtained her law degree in 2013 and was admitted to the State Bar in December 2013. In May 2014, with only five months of legal experience and no employment litigation background, the City hired her as a DCA-I in the Workers’ Compensation Division (WCD). She advanced through automatic pay steps over the next two years.

In November 2016, Majovski transferred to the Employment Litigation Division (ELD). At the time of the transfer, she asked Chief Assistant City Attorney Thom Peters to promote her to DCA-III, pointing to another female attorney who had been hired at that level. Peters escalated the request to Chief of Staff Leela Kapur, who declined, explaining that Majovski had come in with no experience and that her workers’ compensation background was not comparable to employment litigation. Kapur noted that both Majovski and male DCA-I George Sami were in similar positions and should be treated similarly. Majovski did not allege gender discrimination at that time.

Majovski was not provided parking at City Hall East (CHE), the ELD workplace. Under a Special Parking MOU, parking priority was given to “Upper Management” (DCA-IIIs and above), electric vehicle owners, and employees with seniority. As a DCA-I without an electric vehicle and without sufficient seniority, Majovski did not qualify. All female attorneys in ELD at that time had parking because they were DCA-IIIs. Male DCA-I George Sami was seen parking at CHE, but undisputed evidence showed he had an electric vehicle, which gave him priority. Female DCA-II Susan Rim, hired in July 2017, was also not provided parking.

In spring 2018, Majovski first complained that she and Rim were underpaid compared to others in ELD – both male and female – and requested promotions to DCA-III for both of them. In July 2018, the City promoted Rim from DCA-II to DCA-III but promoted Majovski only from DCA-I to DCA-II. Kapur explained that promoting an attorney with only about four years of practice and a year and a half of civil litigation experience from DCA-I directly to DCA-III would have been “highly irregular.” No evidence in the record identified any employee who had ever received a DCA-I to DCA-III promotion. Majovski then asked to keep her original salary anniversary date rather than resetting it to the promotion date, but Kapur denied that request as contrary to standard practice. Peters forwarded Majovski’s request to Kapur with the comment “Chutzpah,” to which Kapur responded, “Yup there is a word for it.”

In September 2018, before Majovski’s voluntary transfer from ELD to the Los Angeles World Airports Division (LAWA), Peters initially told her she would be promoted to DCA-III regardless of whether she transferred. After discussing with Kapur, Peters reversed himself and said she would be promoted only if she stayed in ELD. Chief Assistant City Attorney Jim Clark then told Majovski she would be promoted regardless of her decision. Majovski chose to transfer to LAWA in November 2018. She was not promoted at that time.

In October 2019, Majovski applied for a promotion through an office-wide PRP. Of 364 applicants (190 female, 174 male), 93 received promotions or step advancements. Female applicants were selected at a slightly higher rate (26.3%) than male applicants (24.7%). Majovski was among 271 applicants who were not selected. Kapur, whose recommendations the City Attorney always followed, testified that she did not recommend Majovski for several reasons: Majovski had received recent promotion, had relatively short tenure, her division had received a fair number of promotions, and her promotion would not necessarily have advanced the office’s goals for racial and ethnic diversity.

In January 2020, a DCA-III in LAWA resigned, and Majovski took over most of her duties. In March 2020, the COVID-19 pandemic triggered a hiring and promotion freeze. LAWA’s CFO, Tatiana Starostina, determined that LAWA would not fund the vacant DCA-III position because of the freeze. In September 2020, Majovski again requested the promotion, but Kapur declined to seek an exception to the freeze, explaining that the office’s limited exceptions were prioritized for new hires rather than promotions. Majovski then emailed her supervisors stating she believed the front office was intentionally declining to adjust her pay for “personal, retaliatory, and gender related reasons.” An HR investigation found no evidence supporting her complaint.

In March 2021, Majovski filed suit against the City, alleging gender discrimination, associational discrimination, retaliation, and failure to prevent discrimination under FEHA, as well as claims under the Equal Pay Act (Lab. Code, § 1197.5) and the whistleblower protection statute (Lab. Code, § 1102.5). In August 2021, after the hiring freeze was lifted, the City granted Majovski a discretionary step advancement to bring her into pay parity with a similarly experienced individual being brought into the office (whose gender was not identified in the record). In June 2022, through a second PRP, Majovski was promoted to DCA-III.

Between 2016 and 2022, the City’s statistical evidence showed that of 240 discretionary promotions, 52.5% went to women and 47.5% to men. For promotions specifically from DCA-II to DCA-III, 55.5% went to women. The City moved for summary judgment. The trial court sustained 31 of the City’s 55 evidentiary objections, including an objection to an undated draft gender equity report by the former City Controller. After a hearing, the court granted summary judgment in favor of the City on all claims.

The Court of Appeal affirmed the summary judgment in its entirety in the  unpublished case Majovski v. City of Los Angeles, No. B335739 (February 2026).

The court held that Majovski forfeited her challenge to the trial court’s evidentiary rulings by raising it for the first time in her reply brief without adequate citations or argument, relying on High Sierra Rural Alliance v. County of Plumas (2018) 29 Cal.App.5th 102, 111, fn. 2, and Lee v. Kim (2019) 41 Cal.App.5th 705, 721. This meant that key evidence, including the former City Controller’s draft gender equity report, was properly excluded from consideration.

The court applied the framework from Hall v. County of Los Angeles (2007) 148 Cal.App.4th 318, 324–325, which requires a plaintiff to show she was paid less than a male comparator for substantially similar work. Majovski failed to identify any proper male comparator with less experience who was promoted or classified higher. The court found that George Sami’s parking at CHE was explained by his electric vehicle priority under the Special Parking MOU, not gender. The court also found that the City’s 2021 discretionary step advancement did not constitute an admission of gender-based pay disparity, as there was no evidence the individual with whom Majovski was brought into parity was male. Three comparators raised for the first time in the reply brief were rejected as forfeited and, in any event, insufficient – one was female, and the other two had demonstrably more experience.

With regard to her FEHA discrimination claims the court applied the three-stage burden-shifting framework from McDonnell Douglas Corp. v. Green (1973) 411 U.S. 792, as applied in California under Guz v.  Bechtel National, Inc.(2000) 24 Cal.4th 317, 334, and Arnold v. Dignity Health (2020) 53 Cal.App.5th 412, 424–425. The City met its second-stage burden by producing evidence that Majovski’s level of experience explained the promotion decisions, and that women received discretionary promotions at equal or higher rates than men. Majovski failed to meet her third-stage burden to show pretext.

Because all underlying discrimination and retaliation claims failed, the derivative failure-to-prevent claim under Government Code section 12940, subdivision (k) necessarily failed as well, consistent with Department of Fair Employment & Housing v. M&N Financing Corp. (2021) 69 Cal.App.5th 434, 444.