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Study of 1,100 patients finds big improvements in their physical activities and ‘social functioning’
 MADAM Mary Ho can now go dancing with friends without having to pay the penalty of an aching left knee. The 75-year-old grandmother had that knee replaced with an implant at Singapore General Hospital (SGH) two years ago. She is not alone in getting a new spring in her step. A study by a team of doctors, which tracked more than 1,100 patients at SGH for two years after surgery, found significant improvements in many aspects of their lives, beyond the relief from pain. The doctors used a detailed and technical measurement of patients’ subjective ratings of various factors, from pain and physical movements to social and emotional well-being.
A big change came in the activities they could do after the surgery. The average improvement, according to the patients, was more than 40 points. The patients said their “social functioning”, such as interactions with family, friends and neighbours, improved by a whopping 30 points. One of the authors of the paper – Professor Julian Thumboo from SGH’s rheumatology and immunology department – said a 10-point increase is considered a significant improvement. Other major changes were better physical movements and no or less pain in their knees. Orthopaedic surgeon Lo Ngai Nung, another author of the paper, said: “There is a substantial change. It’s almost back to normal for people of their age.”
What changed the least was general health, which remained fairly stable. The results of the study were published this year in Value In Health, a journal of the International Society for Pharmacoeconomics and Outcomes Research. Patients who went for implants said the biggest improvements occurred in the first six months. But some noted that things continued to get better, and life two years after surgery was vastly different. Prof Thumboo, who recommends the surgery, said the majority of patients noted a big improvement within days.
SGH does about 130 knee transplants a month. It tracks its patients and had feedback from 1,715 of them after six months post-surgery, and from 1,113 after six and 24 months. Dr Lo expects the demand for knee replacements to go up. “Expectations have changed. People want to be independent, they live on their own, they want to travel and enjoy their retirement,” he said. Madam Ho said that when she first asked around for advice, some people said an implant was very good but others said it did not make much difference. But since she loved to dance, she decided to go ahead – and is glad she did. The leg that was operated on “is now better than the other one”, she said.
KNEE REPLACEMENT SURGERY
In total knee replacement surgery, the damaged surfaces of the joint are removed and the surrounding bone is reshaped to fit in metal alloy implants. The two implants are capped over the damaged ends of the thigh and shin bone. A polyethylene plastic spacer is also inserted between the metal implants, which are fixed onto the bone using a polymer bone cement, a viscous liquid that hardens over time.
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