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HELP FOR BAD KNEES
StarTwo, September 25, 2006
MADAM Low Gek Luan, 73, had suffered pain in her knees for more than 10 years. Every year, the pain got worse. At first she thought it was normal for someone her age. After all, nobody gets to their 60s without aches and pains.
But when she hit 73, the pain in her knees was accompanied by swelling and deformity; both knees were bent. Low, who hails from Malacca, could no longer stand for long periods of time. She needed a walking stick to move around.
She was not even spared the pain when she was resting.
At night the pain kept her awake. Low took painkillers. She saw a sinseh and even went for massage therapy. Nothing seemed to work.
Finally, when the pain became unbearable and she feared not being able to walk again, Low went to an orthopaedic surgeon.
Elderly affliction
Dr Mohd Kamal Mohd Hisa says that degenerative osteoarthritis is a common disease that affects the elderly.
The remedies can range from drugs and injections to joint replacement surgery, depending on the severity and how soon patients go for treatment. The most common surgeries are for the knees and hip. There are more knee surgeries conducted than hip replacement surgeries; the ratio is typically 70-30.
“In February this year, Low came to my clinic to get some advice on her condition. After examining her and doing an X-ray, I found that she had osteoarthritis.
“Her joints had been damaged, the articular surface of the knees had eroded and there was bowing of the knee because of the deformity,” said Dr Kamal.
He then advised her to go for total knee replacement surgery with the option of using a fairly new navigation system with computer-aided technology.
The surgery was performed in May on both knees on the same day. It took about three hours under general anaesthesia.
After the operation, Low was encouraged to walk as soon as possible to prevent complications. She was out of bed the very next day, although she was hospitalised for seven days.
She then underwent physiotherapy for the next three to four months – initially at the hospital and then at home supervised by her own children.
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Dr Kamal showing how well Madam Low has rehabilitated. |
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Now she can get back to her normal activities. She can walk without any walking aids or help from family members.
There is no more pain so she’s no longer on painkillers.
Navigation for surgeons
The new computer-aided navigation system uses infrared lights, cameras, an active wireless system and tracking software to produce an image of the patient’s anatomy onto the computer screen.
The trackers that are attached to the patient’s leg during surgery sends the infrared signals directly to the computer. This helps the surgeon obtain proper alignment so that the bone can be cut accurately and the alloy implant can be positioned accurately.
Previously, surgeons used internal and external jigs – an instrument that is inserted inside the bone to help surgeons judge the alignment of the patient’s bones. The use of jigs caused unnecessary bleeding.
According to Dr Kamal, the new navigation system does not use jigs so there is less blood loss during the operation. As a result, there is a shorter rehabilitation period and early mobilisation.
Accuracy of the knee replacement surgery is another advantage of the navigation system. According to Dr Kamal, studies have shown that there is better outcome if the variation of the alignment compared with the normal anatomy is less than 3 degrees. With conventional methods, studies have shown that this 3-degree variation can be achieved by about 75%. With computer-aided surgery, it can be achieved more than 90% of the time.
Currently, the navigation system is available in government and private hospitals. It was first introduced in December last year.
So far, it has only been used for knee replacement surgery. Hopefully, it will also be used for the more complex hip replacement surgery as early as next year.
Dr Kamal says he has performed about 20 total knee replacement surgeries with this navigation system.
According to him, if Low had not gone for surgery, eventually she would be in extreme pain, on more painkillers, have problems walking and perhaps even end up in a wheelchair.
Too much painkillers, he warns, would also lead to other complications such as hypertension and renal failure. Unfortunately, he informed, many Malaysians wait until the pain is unbearable before going to the hospital for treatment.
Low has a scar on each of her knees. That is the only evidence that she has gone for knee replacement surgery.
Looking at her walk today without any walking aids, you would never suspect this is the same woman who struggled to walk into Dr Kamal’s office seven months ago.
Copyright Star Publications (M) Bhd
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