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”.
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.
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.
THE foot is a complex anatomical structure tailored to withstand the demands of being the organ of locomotion of the human being. It consists of 26 bones, various interlocking ligaments and multiple tendon slings all cushioned by specialised tissues of the sole.
This complex combination allows the foot to adapt to the infinite demands placed on it during the various activities of daily living. But it is also this complexity that makes it vulnerable to injuries and ailments. Conditions of the foot that may need medical attention include traumatic, degenerative, inflammatory and infective problems.
Traumatic injuries to the foot are a common presentation to the orthopaedic specialist. Acute ankle and foot sprains are normally treated with cold compresses, rest, elevation and compression bandaging. Medication is needed for pain relief.
Fractures of the ankle and foot are not uncommon. Ankle fractures can be complex and may need surgical intervention, especially for those involving the ankle articulation. Neglected fractures can lead to rapid ankle joint degeneration, as the ankle mortise does not tolerate even minor incongruity.
Fracture of the 5th metatarsal base is very common and is normally treated conservatively.
Chronic trauma can lead to corns and calluses of the sole. This can be treated by paring of the skin or local applications. Large calluses may need to be excised.
Inflammatory degenerative conditions that affect the foot include osteoarthritis, rheumatoid arthritis and gout. Osteoarthritis is normally secondary to trauma. Gout normally affects the big toe. Acute gouty attacks are treated with anti-inflammatory medications and rest. Long-term treatments include diet manipulation and allopurinol.
Heel pain is a frequent complaint. It is frequently due to plantar fasciitis, an inflammatory ailment involving the soft tissue around the heel. Treatment with anti-inflammatory medications, heel cushion or corticosteroid injections normally work. Surgery for plantar fasciitis has unpredictable results.
Achilles tendinitis is an inflammatory condition of the Achilles tendon. Anti-inflammatory medications and physiotherapy is the mainstay of treatment. Corticosteroid injection for achilles tendinitis is risky as it may predispose to rupture of the tendon.
Ingrown toenail infection is a common infective condition. It can normally be prevented by proper nail care. If antibiotics fail to control the infection, surgical resection of the nail may be needed.
Diabetic patients are particularly prone to infection of the foot due to reduced resistance and insensitivity of the foot due to involvement of the nerves. Amputation is always a possibility in diabetic patients.
Proper foot care involves understanding and prevention of the above ailments. Proper footwear is of utmost importance. The shoe should be comfortable to wear and support the foot at the correct places. Tight shoes and heels (although fashionable) should be avoided.
Maintaining an ideal body weight and prompt and proper treatment for injuries will prevent osteoarthritis.
Dietary manipulation to reduce purine intake is important in patients with gout to prevent the complications of hyperuricaemia.
The foot is the bane of the diabetic patient. Because of nerve involvement, their feet become insensitive and they are often unaware of something amiss until the infection is advanced. Diabetic patients should be extra vigilant of their feet. A podiatric service is invaluable.
- This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician. For more information, e-mail [email protected]The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.