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WHEN I get older, losing my hair, many years from now? Will you still need me? When I’m sixty-four?… Yours sincerely, wasting away” – When I’m 64 by The Beatles

Poignant lyrics by The Beatles from way back in 1967. Fast forward to 2005 and we are looking at 73 years or even 100 years by 2030! I am sure it comes as no surprise that we are living longer today – at last count in Malaysia we were averaging 73 years.

Older people today are challenging the stereotype that old age means vulnerability and incapacity to make decisions. We are stronger, bolder and demanding more of ourselves in every way. This is helping to develop a new account of ageing, that of the “heroic third ager” who is more and more living the life of the younger generation than that of the “old and vulnerable elder”.

Improving joint alignment has been a focus of surgical technique research and development and computers have been roped into the surgery room to help surgeons better ‘see’, ‘find’ and ‘place’ throughout.

However, there’s no denying the physiological decline of the body as we age. As a doctor, I face every day what is emerging as the most feared threat to living large in our golden years – joint degeneration.

Although very much a disability of the body, the impact that joint diseases have on the ability to walk and function without help over time amplifies its effects to the mind, heart and soul.

Any joint disease, whether inflammatory, degenerative or post-traumatic, will ultimately lead to erosion of cartilage and joint damage if the condition is left to progress untreated. This will culminate in swelling, pain, deformity and instability of the joint.

A majority of minor joint problems respond well to first line treatment – physical therapy, medication, and injections. However, more serious conditions may require a higher level of treatment. In these severe situations, surgical reconstruction can be a real treatment option, dramatically improving independence and quality of life by relieving pain and improving mobility.

One of the most effective treatment is total joint replacement or total joint arthroplasty (TJA). TJA can improve joint problems associated with severe injury to the joint, osteoarthritis, rheumatoid arthritis, and other degenerative conditions such as osteonecrosis – a condition in which obstructed blood flow causes bone tissue to die.

You’ve come a long way, baby

Since “invented” by Sir John Charnley, an orthopaedic surgeon at Wrightington Hospital for Joint Diseases in Wigan, England in 1961, TJA has come a long way. It has become fairly routine and is successful around 95% of the time. Minimally invasive surgery (MIS) techniques, instrumentation for better alignment and advancement in prostheses design and materials have all contributed to making the total surgical experience and results of TJA, notably for the hip and knee, the best it has ever been with survival rates of over 90%.

The main goal of TJA is the return of mobility and function. All you DYI enthusiasts will know that precise alignment of hinges is the key to optimising the function of moving parts. In the case of TJA, the hinge is your joint! Improving joint alignment has been a focus of surgical technique research and development, and computers have been roped into the surgery room to help surgeons better “see”, “find” and “place” throughout.

The precise alignment of hinges is the key to optimising the function of moving parts.

This technology, also called computer-assisted surgery (CAS), uses the same positioning technology as that fitted in cars to help you navigate streets – global positioning system or GPS. It helps the surgeon make the right cut and align the artificial joint to the bone more precisely for each individual patient.

CAS has been shown to increase the effectiveness of joint replacements and offers substantial benefits to the patient including a more rapid return to previous activity levels as well as durability of the prostheses thereby preventing the need for repeat surgery.

In most instances a joint replacement should last at least 15 years or longer. This revolutionary surgical technique is an option readily available in Malaysia today and with an estimated 20,000 patients considering TJA annually, CAS can offer a real treatment option that is simpler, safer and with better results.

The right treatment for the right patient

Are you a right candidate for joint replacement surgery? This is a conclusion you need to reach with the counsel of your surgeon who will take into consideration:

• The severity of your condition and how much it limits your mobility and function
• The risk of further injury if you don’t have the surgery
• Overall good health
• Failure to respond to conservative treatment  Equally important, as a patient you need to consider:
• Your lifestyle including how much exercise you get
• Your willingness to modify and adapt your lifestyle to either option
• Your motivation to work through rehabilitation to strengthen your joint after surgery.

Complications of total joint arthroplasty

No surgery is without risk, similarly TJA. Complications may include infection, joint instability, joint stiffness, deep vein thrombosis and anaesthetic problems. Your surgeon will assess you pre-surgery to make sure you are able to withstand the surgical procedure. He or she will also ensure that you fully understand the limitations and risks of the procedure before consenting to the operation.

Walking down the road of life

As we see ageing as a destination rather then an end, we are shaping our approach to preventative medicine and forging new breakthroughs in medical treatment to give older persons the ability to live life longer and better.

TJA remains one of the most successful and effective procedures in surgery with a success rate of over 95% in leading medical centres. Patients are most impressed with the immediate relief of pain and discomfort. They can look forward to walking within two to three days and are discharged from the hospital after four to five days. With improving surgical techniques and instrumentation including CAS and minimally invasive approaches, the day will come when joint replacement is done on a day care basis.

Note: Dr Lee Chong Meng is a consultant orthopaedic and arthroplasty surgeon.

About OSC:

Orthopaedic Specialist Centre (OSC) is the brainchild of four highly-experienced Malaysian orthopaedic specialists, who have come together to create an innovative centre of excellence purely focused on bone and joint care. Using their decades of experience in practice, they have embarked on a new mission for Malaysian orthopaedics. At OSC, the patient’s journey from treatment to recovery is accompanied by elevated levels of personalised expertise and empathy, in order to make a real difference to our patients’ lives. In contrast to large, faceless hospitals, OSC is a uniquely intimate medical boutique, one that puts meticulous, tailored care at the heart of the patient experience. OSC aims to redefine orthopaedic care in Malaysia, by making world-class treatment comfortable, cost-effective and attainable for the whole community. For more information, please visit www.oscortho.my