Latest in knee replacement: partial replacements and cartilage transplants

By Cheranka Mendis

With the rising frequency of knee pains in almost all populations, partial and full knee replacement surgery is becoming increasingly popular in the region.

This is how the surgery is done, shows Gleneagles Medical Centre Medical Director and Consultant Orthopaedic Surgeon Dr. Lim Lian Arn  – Pic by Upul Abayasekara

Gleneagles Medical Centre Medical Director and Consultant Orthopaedic Surgeon Dr. Lim Lian Arn in Sri Lanka to attend a lifestyle seminar on ‘The painful knee: causes, prevention and an update on current treatment” organised by ParkwayHealth Sri Lanka told the Daily FT that even though total knee replacement surgery is completed successfully in Sri Lanka, the latest advances in technology has introduced a partial knee replacement surgery and cartilage transplants which looks at less invasive surgeries, faster recovery period and the long term ability to partake in sport activities.

“If you look at knee pain as a whole the treatment is medication, injections and sometimes surgery. As far as medication and injections are concerned there are very few recent advances that have made big differences. But in terms of surgery there have been some big advances,” Arn said.

Depending on the severity of the knee there are various modalities of surgeries, ranging from very small minimally invasive surgery to knee replacement surgeries, he said.

 “These are being done here in Sri Lanka but there are some advances that might not be so wide spread here.”

The usual practice has been the full knee replacement surgery even though partial replacements which instead of replacing the entire knee joint, looks at replacing only parts of the knee joints that are worn off is becoming increasingly popular.

“We have been doing this more and more. Advantage of this is that the surgery is less invasive, recover is faster and most of the patients end up with knees that feel more natural than one that is totally replaced.”

However even before doing knee replacements there are advances like cartilage transplantation.

“This is where we taken the patient’s own cartilage and we send it to a lab to grow the cartilage into a bigger chunk. And instead of replacing the knee with an artificial knee joint, we replace it with the patient’s own cartilage,” Arn explained. However this is not done for older patients. Instead the surgery looks at younger patients and patients who have more demand to partake in activities such as sports.

“I do not know whether this is done in Sri Lanka; but it is certainly an option for people to think about. There is high chance for patients undergoing this treatment to return to sports. We have seen many positive results.”

Arn stated that even though he is confident about the total knee replacement surgery done in the country, when it comes to adopting latest advancements, he does not know Sri Lanka’s status.

“I cannot comment on the country’s progress in the field. But I do not know how advanced they are regarding partial knee replacement, computer guides to knee replacement and customise instrumentation for knee replacement.” 

He noted that the need for customised instrumentation came about after discovering that the knees of the sexes are different to each other. “Two, three years ago there was only one type of implant for male and female but with this increasing recognition that it is different, we have started putting in different knees for different sexes.”

When questioned on how long it would take Sri Lanka to embrace cartilage transplants, Arn stated that the basic surgical skills needed for cartilage transplant is there in almost any orthopaedic surgeon.

What is lacking is the technology to grow the cartilage, the expertise to know how to paste it in and the expertise to choose the right patients.

The technology to grow the cartilage does not have to be imported either. “What we do is send the pieces of cartilage to people who have been doing it regularly. We send them to America, Germany and Australia.”

The problem however is in that in the cost factor. Arn noted that to send the cartilage abroad and bring it back alone would cost some US$ 20,000. This is not counting the other surgical fees.

“But other than that it doesn’t take much to get it started here,” he said.

What he brings to Sri Lanka is information on knee problems and solutions to knee problems.

“I have no doubt that the doctors here manage patients very well. From whom I have spoken to I understand that standard of healthcare is very good in Sri Lanka. The frequency of knee pains in almost all populations is pretty high so it is a common problem.”

Patients can opt for treatments such as partial knee replacements and cartilage trabsplants in Singapore under the ParkwayHealth branch in Sri Lanka.