Robotic surgery gives hope for painful knees

Robotic surgery gives hope for painful knees

Q. I am a 64-year-old man. I have been experiencing intermittent pain on the inner side of both knees.

However, it is still bearable.

The pain arises only when I move suddenly or when I get up from a sitting position. After sitting for a long time, say, when I watch a movie, I find getting up painful.

I walk 4.3km every day, in the mornings and evenings.

I do not feel any pain or discomfort when I walk. The problem occurs only when I get up from a sitting position or when climbing out of a car.

A. What you described is a very common problem among elderly people.

You are most likely afflicted with early cartilage wear at the back of the kneecap.

This is known as the patello femoral cartilage wear.

It starts off with pain when getting up from a sitting position and when walking up and down the stairs.

Over time, the knees will usually begin to swell, also known as an effusion.

For some people, the cause of such patello femoral wear could be linked to having flat feet.

The diagnosis is normally made after the doctor gathers a thorough medical history and performs a physical examination. A magnetic resonance imaging scan will usually be required too.

Most cases can be treated conservatively with medication, physiotherapy and, at times, injections of hyaluronic acid into the knee.

These three options are usually enough to treat such conditions.

However, surgery may be required in recalcitrant cases.

Natural wear and tear

Surgery usually entails removing the loose pieces of cartilage at the back of the kneecap via a keyhole method called arthroscopic surgery.

This in itself, however, does not solve the problem at all. The natural progression of wear and tear will still continue. So it is usually a matter of time before the pain returns.

If the person has extensive wear of the cartilage, such arthroscopic surgery would not benefit him at all.

In the past, a total knee replacement would be advocated for such cases.

While a knee replacement is very good in relieving pain, there is a shelf life to such implants - they do not last forever. More often than not, patients are also not entirely satisfied with their implants as they do not function like normal knees.

However, the advancement of robotic surgery is revolutionising the treatment of such conditions.

Robotic surgery now allows doctors to retain the healthy parts of a worn-out joint while removing the damaged segments, in a process called resurfacing.

It allows all the intrinsic tendons and ligaments of a patient's knee to be preserved.

This, when combined with effective pain relief, translates to a more normal function of the knee.

Robotic surgery also enables the surgeon to precisely pre-select the implant that is the closest fit for a patient.

At the same time, it allows the surgeon to place the implant in a very precise and accurate position. This is determined using robotic tools before the operation.

Once the operation is under way, the doctor rarely has to make any further adjustments because the robotic technology is very precise.

Consultant orthopaedic surgeon, joint replacement specialist and sports surgeon at Mount Elizabeth Medical Centre

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