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A Knee-d for Surgery? How Knee Osteoarthritis Can Be Managed and Treated

As knee osteoarthritis is prevalent among Asians, staying informed on the signs and symptoms, available prevention and treatment methods is vital in maintaining a healthy and active lifestyle.

Article contribution by Dr Yuen Jin Chuan, Sunway Medical Centre Velocity (SMCV) Consultant Orthopaedic, Trauma and Arthroplasty Surgeon

Picture: The most prevalent form of osteoarthritis is knee osteoarthritis (OA), which affects over 10 to 20 percent of the Malaysian adult population. (credit: Shutterstock)


Osteoarthritis (OA) is a degenerative joint disease that affects millions worldwide and significantly impacts mobility and quality of life. Known as the most common form of arthritis, it is characterised by the breakdown and eventual loss of cartilage in the joints, leading to pain, stiffness, reduced mobility, or even disability.

The disease is usually seen in older individuals and commonly affects joints including the knees, hips, and hands. The most prevalent form of OA happens to be knee osteoarthritis, affecting over 10-20% of Malaysia’s adult population.[1]

Understanding Knee Osteoarthritis

In an analysis conducted by Beijing Osteoarthritis Study, it was found that Asians are more prone to knee OA compared to hip OA, which is more common in Western populations.[2] This can be caused by various factors, such as differences in the way our bodies are structured, lifestyle choices, and environmental influences. For example, cultural practices like squatting in Asian communities may lead to more stress on the knee joints which contributes to the development of knee OA. Additionally, eating habits, obesity, and work-related activities that involve repetitive movements may also influence the prevalence of knee OA among Asians.

Younger individuals can be at risk of knee OA if they have a history of joint injuries, or participate in high-impact sports such as running.

While ageing remains as a primary risk factor, younger individuals could also be at a risk if they have had previous joint injuries, such as fractures or strains, as this may accelerate cartilage degeneration. Participating in high-impact sports like running, basketball and tennis can also increase the risk of knee OA among younger people as these activities can subject the joints to excessive mechanical loading and repeated strain, causing damage to the cartilage and joint over time. Additionally, individuals with pre-existing joint conditions like rheumatoid arthritis, gout or metabolic diseases such as diabetes are at a heightened risk of developing knee OA.

Gender and genetics can also be contributing factors to knee OA development. A family history of heredity in minor joint abnormalities or hypermobility (double-jointedness) could increase one’s susceptibility to knee osteoarthritis. Women face a higher risk compared to men, due to hormonal factors and differences in joint biomechanics. The symptoms of knee OA to lookout for include stiffness in the knees, pain while standing or walking short distances as well as swelling in the knee joint.


Preventive Measures & Treatment Measures for Knee Osteoarthritis

There are several preventive measures that one can take to lower the risk of knee OA. This includes maintaining a healthy weight to alleviate joint strain and incorporating joint-friendly foods such as fish, leafy greens nuts and berries into your diet. Aside from weight management and a balanced diet, taking supplements such as omega 3 fatty acids and glucosamine can also help reduce the risk of knee osteoarthritis.

It is also important to make exercise a part of your daily routine to combat the onset of knee OA. There is a common misconception that movement worsens osteoarthritis and that lesser movement is better. However, engaging in low-impact activities like swimming, cycling and yoga can actually help maintain joint flexibility and stability while strengthening the muscles without putting too much strain on them. Additionally, the significance of small lifestyle changes in day-to-day activities, such as practicing good posture, being mindful when lifting heavy objects, and ensuring adequate rest cannot be overstated.

In terms of treatment, various options exist for knee osteoarthritis. Localised treatment options include medications such as chondroitin, steroid and hyaluronic acid injections as well as a minimally invasive procedure known as radiofrequency ablation that targets the nerves around the joint. However, it is important to recognise that while these treatments may provide symptomatic relief, knee OA is a progressive disease. To manage it effectively in the long term, total knee replacement (TKR) surgery is an available solution when localised treatment is no longer effective. TKR can provide patients suffering from severe knee OA with long-term relief as well as improved joint function.

MAKO Robotics Assisted Surgery

One such option is the MAKO robotic-assisted surgery, executed using the MAKO Robotic machine. Compared to traditional surgery, MAKO Technology allows for a more precise and customised operation thanks to its 3D imaging system that creates a patient-specific plan.

The robotic arm assists the surgeon in making customized bone resections, allowing for better alignment which leads to improved joint function and longevity for the patient. Comparing to the MAKO robotic-assisted surgery, the conventional total knee replacements (TKR) surgery often will alter the kinematics of normal knee alignment, potentially resulting in compromised joint function. However, MAKO robotic-assisted surgeries have the capability to accurately reproduce the natural kinematics of the knee, restoring alignment and enhancing overall joint performance.

MAKO Technology ensures a less invasive surgery which results in reduced pain levels and recovery time for patients. There is also a lower risk of implant failure as the robotic arm ensures precise placement of the component, thus lowering the risk of complications and the need for future surgeries. Patients who have undergone MAKO robotic-assisted surgery have reported higher satisfaction scores and improved joint function post-surgery.

Due to the novelty of MAKO Technology, there are many misconceptions surrounding the technology.  The most common misconception surrounding MAKO robotic-assisted surgery is that the procedure is done fully by a robot thus making it riskier and lacking a surgeon’s expertise.

The reality is that doctors are the ones conducting the surgery as the MAKO technology merely serves as a machine that is controlled by the surgeon and combining technology with surgical skill thus ensuring that the doctor remains in control. As the MAKO Technology can map variations in a patient’s unique anatomy and create a personalised approach, there have been fewer complications associated with this surgery and therefore a lower rate of risk. Operating the MAKO robotic machine also requires expertise as formal training and skill are both needed to operate the machine effectively. Surgeons would need certification to be able to conduct MAKO robotic-assisted surgery, thus ensuring that only highly trained surgeons can perform it.

With the prevalence of knee OA in Malaysian adults, innovative solutions like the MAKO robotic-assisted surgical machine marks the beginning of a new era in the field of orthopaedic care. By offering patients with personalised surgical solutions, minimally invasive procedures, improved surgical outcomes and faster recovery, SMCV is empowering individuals to regain mobility and reclaim their quality of life. With MAKO Technology, the future of knee osteoarthritis treatment promises patients revolutionary surgical procedures and enhanced patient care.  

[1] https://medic.upm.edu.my/upload/dokumen/2017090710491402_MJMHS_Vol13_No2_2017_-_0016_-_p7-15_4th_proof.pdf

[2] Zhang Y, Xu L, Nevitt MC, et al. "Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study." Arthritis Rheum. 2010;62(4):1102-1107. doi:10.1002/art.27321.


Sunway Medical Centre Velocity (SMCV) Consultant Orthopaedic, Trauma and Arthroplasty Surgeon, Dr Yuen Jin Chuan

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