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Less is more
Minimally invasive surgical techniques mean that patients can benefit from safer , better and faster recovery .
“ We ’ re now looking at over 80 percent of partial knee replacements lasting up to 15- 20 years , which is really quite good .”
Like many orthopaedic surgeons in their thirties and forties , Dr James Wee grew up juggling his time between computer games and sports . This brought with it the dexterity and hand-eye coordination that would serve him well in his chosen profession .
“ These childhood experiences helped to mould me into the “ keyhole ” and minimally-invasive surgeon of today ,” said Dr Wee , who is the Medical Director of Oxford Orthopaedics in Singapore .
Minimally invasive surgery is an alternative to open surgery that involves much smaller incisions for faster recovery and fewer complications . Given the limited working space involved in such procedures , skilled practitioners require remarkable nimbleness and a deft touch .
In this article , Dr Wee discusses minimally invasive surgery and its applications to common lower limb conditions .
Minimally invasive partial knee replacement surgery The knee comprises three compartments , the inner ( medial ) and outer ( lateral ) sides , and the knee cap .
About 9 in 10 patients with knee arthritis first develop pain and degeneration on the inner side . When this deteriorates into more advanced arthritis , patients are then offered knee replacements to deal with the pain .
Conventionally , total knee replacement surgery is the option that most surgeons offer for the treatment of severe knee arthritis . In total knee replacement surgery , the entire knee joint is resurfaced with a prosthesis , which comprises metal implants that are separated by a polyethylene spacer , allowing the knee to move smoothly and with little or no pain .
In contrast , partial knee replacement surgery is targeted at replacing only the damaged compartment of the knee , preserving the healthy compartments . The surgery can be done through an incision that is approximately half the length of that needed for total knee replacement . This leads to less soft tissue injury during surgery , and patients experience much less pain and benefit from faster recovery times .
“ We see most patients going home within a day of surgery , and they ’ re back on their feet very quickly , often only hours after the operation ” said Dr Wee .
The latest data shows that in terms of long-term durability , partial knee replacements have reached a level similar to total knee replacements , provided the surgeon is well-trained and experienced in partial knee replacement surgery . “ We ’ re now looking at over 80 percent of partial knee replacements lasting up to 15-20 years , which is really quite good ,” Dr Wee added . This is good news for young patients with knee arthritis .
“ We ’ ve seen a trend towards younger patients coming in with painful knee arthritis . These patients tend to have been active in sports and sustained injuries to their knees in their twenties and thirties . They come to me with worsening knee pain in their late forties and fifties , and want to have their knee sorted out so they can continue with their heavy work schedules and active lifestyles ,” said Dr Wee .
The priority of younger patients is to get back to work , leisure and sporting activities as soon as possible . Partial knee replacement offers a significant advantage by allowing them to return to their productive lives within a matter of weeks , as opposed to the months away from work that total knee replacement often entails .
Furthermore , older patients with medical problems such as heart disease are often steered away from total knee replacement surgery , with their doctors advising of the operative risks . These patients can instead benefit from partial knee replacement surgery , which has been consistently demonstrated in many large studies to have significantly lower complication rates and adverse events .
Another advantage of minimally invasive partial knee replacement surgery arises from the fact that only 25-30 percent of the knee joint is replaced and all
4 JUNE 2021 GlobalHealthAsiaPacific . com