Both knees and hips are the largest joints that support a person’s bodyweight so that one can move freely. If either are in pain, daily activities can be affected. The field of joint replacement is rapidly advancing. At some point, people with higher activity demands will likely require joint replacements to treat arthritis and other related bone issues.
We find out more from Dr. Gurpal Singh, an orthopedic surgeon at Farrer Park Hospital with a subspecialty interest in joint replacements and orthopedic oncology, about such conditions and how to manage and take better care of joints.
In general, joint pain is widespread and various conditions such as arthritis, sports injuries and infections can lead to painful joints.
"Some are episodic. Most of the time, when we are looking at very young patients in their 20s and 30s, most of the causes are some form of sports injury," Dr. Singh explained. "For those who are 45 to 50 years of age, the joint pains are usually due to wear and tear, which could affect their daily activities and mobility," he added.
Uncommon joint pain can be due to more severe conditions such as infection and tumor. They make up about five to 10 percent of patients who present with bone and joint pains today.
"Medically speaking, the statistic is quite a significant percentage because patients with tumors and cancers are living longer due to more advanced treatments," he said.
Dr. Singh advised checking the pain early if you experience pain at night or during rest; especially if the pain wakes you up from sleep, if it does not correlate very well with regular daily activities, or if you have a recent history of cancer.
Arthritis happens because of wear and tear to the cartilage or the lining of the joint. More often, there is no need for surgery.
"About 80% of patients who visit my clinic for arthritis do not require surgery. Physiotherapy is the first line of treatment for most people with arthritis. It helps keep your joints and muscles moving and gives you the confidence to continue exercising independently. If done in a targeted fashion, the results are usually amazing."
"I often tell my patients that they are their best physiotherapist. They need to do the exercises daily and as often as possible. It’s important to focus on strengthening one particular group of muscles," he added.
Another form of treatment for arthritis is medication; some of which are painkillers or anti-inflammatory medication. There is also a wide variety of walking aids to consider. Special orthopedic shoes and shoe inserts are widely used walking aids for arthritis. They displace the joint's pressure by appropriately adjusting the position of the foot in the shoe. Walking frames and walking canes are also helpful with mobility.
Modifying an exercise regime such as switching from jogging to swimming is another consideration. There is also the option of injections. According to Dr. Singh, there are two types that are commonly administered - steroid-based injections or gel-based injection.
"There is no one universal treatment plan for all. Every patient is different and modern medicine is all about customizing treatment," he added.
Dr. Singh said about 20% of patients in his practice have advanced arthritis.
"In advanced arthritis, joint replacement surgery is needed because the patient would have lost all the cartilage with a deformity in the joint."
People with advanced arthritis face increasing pain related to activity, higher dependance on painkillers, stiffness of the joint, reduced movement, muscle stiffness and deformity around the joints.
"One of the challenges with joint replacement is getting the position of the implants right with precision. Once we achieve the precision in placement, the longevity or lifespan of the implant logically would increase and the new joint would be as good as the original," Dr. Singh shared.
"As we are also seeing a lot of patients who are younger and more active, the treatment that they receive should last their lifetime," he added. The service life of an implant is between 15 to 20 years.
Orthopedic surgery uses many mechanical and technical factors to place implants correctly.
"In the past, surgeries had to deal with in-between sizes of implants for patients and a lot of the final placement is dependent on the surgeon's experience and visual landmarks to ensure accuracy," Dr. Singh explained.
Nowadays, technology is able to help significantly. For instance, Makoplasty, a CT-based joint replacement robot that is used to assist a surgeon perform total hip and partial knee replacement surgery.
Before the surgery, a CT scan is first taken to build a virtual model of the patient's knee or hip joint. Using the model as a guide, the surgeon then uses the robotic arm to place the implant precisely during surgery.
Another notable benefit is that the robotic technique makes the surgical cut smaller. This translates to less pain, shorter hospital stays, faster recovery and improved mobility.
Infection control is essential during a joint replacement surgery.
"Whenever we do a joint replacement surgery, the biggest fear is infection. If we get an infection with a piece of metal inside, surgery would be required to remove the metal. The bacteria tend to stick to these metallic surfaces and form a resistant film called biofilm. Hence, antibiotics do not penetrate the infected area so well," Dr. Singh explained.
During a joint replacement surgery, the surgeons wear special protective suits with an internal ventilation system. It prevents any secretion or bacteria from the surgeon from falling on to the surgical field. While the surgery is on, people's movements in and out of the operating suite are strictly limited. There are usually about 4-5 people in the room. Airflow control and cleaning solutions are other measures taken to make sure that infection risk is at the lowest.
"Maintaining a healthy body weight, having a good diet with adequate calcium and vitamin D, and a reasonable balance of exercise are simple measures to start. Swimming or even walking around in a pool of water – those are good for your joints," Dr. Singh said.
"If there is already some degree of arthritis, slow down and adjust your daily activities to avoid causing more damage to the joint," he added.
Before the COVID-19 pandemic, Dr. Singh had been collaborating with a team of material scientists, doctors and engineers to develop new material for implants that can potentially last the patient's lifetime.
"We are pushing the boundaries every day. Now with robotic-assisted surgery, I hope we can advance joint replacements and implants further," he said.
What about regrowing cartilage in the joint?
"There has been much research in this area. However, where advanced arthritis is concerned, it is not the right solution. The best treatment is to seek help when the condition is still in its early stage," Dr. Singh concluded.