Global Health Asia-Pacific Issue 5 | 2022 Issue 5 | 2022 | Page 170

Column

Advances in hip and knee surgeries

By Datuk Dr Siva Kumar Ariaretnam , Consultant Orthopaedic Surgeon at SJMC
X-ray and MRI images showing severe isolated patellofemoral osteoarthritis . The remaining compartments of the knee are otherwise unaffected .
A THR patient is able to achieve full strength in his hip abductor muscles shortly after robotic-assisted DA .
Dr Siva Kumar Ariaretnam

OVER the last decade , hip and knee replacement surgeries have undergone significant advancements , resulting in superior outcomes in terms of reduced pain , faster and better functional recovery , longer estimated lifespan of implants and significantly safer surgeries .

One such improvement lies in the early mobilisation of patients , especially after a total knee replacement ( TKR ) surgery . Historically , patients are only able to walk one to two days after surgery due to the pain and weakness . With muscle-sparing approaches , some patients may walk within a day or even within hours after surgery while a few may be able to climb the stairs the next day .
The Rise of Robot-Assisted Surgeries and Improved Precision In the past year , improved and more precise versions of robots assisting in surgery have arrived on our shores , promising improved function after surgery and projected longevity of implants .
While robots are being used to improve outcomes of routine total hip and knee replacement surgery , this versatile tool can be harnessed to do so much more .
One such example is the surgical management of severe isolated patellofemoral osteoarthritis ( PFOA ). This particular pattern of arthritis is rare and conventional TKR may lead to poor functional outcomes as the normal parts of the joint and ligaments are unnecessarily replaced . Robots now empower more surgeons to perform a limited patellofemoral replacement , previously not widely done due to the technically demanding nature of this surgery done conventionally .
In the past 7 decades , total hip replacements ( THR ) are routinely done via posterior or lateral surgical approaches to the hip . Both these approaches involve cutting major muscles to access the joint and often lead to prolonged or permanent weakness of the muscles . Over the past 15 years , a direct-anterior approach ( DAA ) to the hip was progressively modified to allow total hip replacements to be done via this approach .
The advantage is that muscles are separated instead of cutting to access the joint , hence there is no or little loss of muscle power of the hip . This approach has not been routinely performed in Malaysia due to its technical complexity , compounded by the relatively smaller size of Asian hips , increasing the margin of error .
However , with robotic-assisted THR , not only is the positioning of the implants , the accurate restoration of the limb length and superior functional outcomes assured ; the robot allows surgeons to adapt DAA for THR surgery .
This offers patients early recovery from surgery with little or no muscle weakness in addition to a better range of movement of the hip with reduced fear of dislocation .
A muscle-sparing approach to the knee , which allows for early mobilisation and rapid recovery after surgery lead to the first daycare TKR surgery to be done in SJMC in 2021 . Currently , with the muscle-sparing directanterior approach to the hip , similar superior outcomes are to be expected with hip replacements .
The combination of these superior surgical techniques with state-of-the-art robotic technology provides safe and reliable options for patients suffering from end-stage hip and knee arthritis today .
168 ISSUE 5 | 2022 GlobalHealthAsiaPacific . com