Age is just a number, if your mom has been taking care of herself well. The average life span for a Singaporean woman is now 86 years old, according to the Singapore Census 2010.
I’ve known patients who are not even 40 years old, and have lost 3 limbs (both legs and right hand) due to poorly controlled diabetes.
There are also many patients who are barely 40+ years old, but failed to take care of themselves. Consequently, they suffered from kidney failures, strokes and heart attacks.
This is the concept of physiological age, when your body is being kept at a optimal condition.
Your mom’s 70 year old body might be stronger than a poorly taken care 40 years old body.
And if she has been taking care of herself well, it is very likely that she will live longer than average. It also means that she MAY need to suffer from knee pain for another 10 – 20 years. It is certainly not fun having to deal with pain for the rest of your life.
Knee replacement surgery is the most reliable treatment option for end stage knee arthritis in the elderly population, with the success rate exceeding 95% in experienced hands.
It effectively removes the pain, and restores the quality of life.
I’ve always used this analogy when I’m counselling my patients – “humans are just like cars, the knee joints are like the tyres. If your car engine and everything else are still fine, what would you do when the car tyres are worn out?”
I’m sure everyone would choose to replace the tyres, rather than writing off the car.
Hence, if your mom has been taking care of herself well (the car engine is still strong), I hope she won’t write off her car (or your “Kah” in Hokkien) when her tyres (knee joints) get worn out.
A new set of tyres (knee replacements) will definitely bring a new leash of life.
Of course, doctors will also check on your pre op fitness with a full thorough check up before proceeding with surgery.
Thank you for your question. Persistent severe pain after a right knee replacement is abnormal especially when her other knee replacement was doing fine.
I'd strongly advise you bring your grandmom for a checkup and we'll need to do a thorough investigations including X rays, blood tests and advanced imaging (MRI/ CT) to find out what is the cause of this persistent pain. The cause of persistent pain would include infection, implant malposition, cement fracture or referred pain.
Only after the cause of the persistent pain is identified then we can talk about the treatment. If it's due to infection/ implant malpositioning/ cement fracture, revision knee replacement might be the only option to solve the persistent pain.
A "blind" revision knee replaccement surgery is not recommended if the cause of the persistent pain cannot be identified.
Please check with her original orthopaedic surgeon about the cause of the persistent pain and I will be most glad to provide a second opinion for your grandma.
Dr. Henry Chan
Effusion means that there was "water" accumulation in the joint, and it usually signify that there was some damage in the internal structures of the knee - and that's why the knee was "swollen". I suspect you may have damanged your meniscus as squash is a sport that involes a lot of changing direction under high speed and high force, the meniscus would usually be under a lot of pressure and can be damaged during an intense squash game.
I'd highly recommend you to seek treatment with an Orthopaedic Surgeon and we would do a MRI scan for you to thoroughly investigate the cause of the effusion and the pain and then we can advise you further.
Hope that it clear some doubts for you.
Dr. Henry Chan
Our knee ligaments are bands of tough, elastic, connective tissues that help stablise our joints. They prevent our knees from buckling when we play sports, or during our daily activities.
Typically, there are a few causes of “knees buckling”:
1. Previous ligament injuries that weren’t diagnosed
Many of my male patients have actually damaged their knee ligaments during their army days (or the "weekend warrior days"). Those of them who experienced painful and swollen knees either ignored it or visited traditional chinese “sinseh” to “set the bone” right. The pain and swelling usually subsides eventually but the knee ligaments remain damaged, and hence the frequent buckling.
2. Weak knee muscles
Your knees might be very strong structurally, but the muscle controlling your knees are weak. The most common cause of such profound muscle weakness is due to nerve compression in the spine, usually due to a slip disc or bone spurs.
Some medications like steriods or cholesterol-lowering drugs can also cause severe muscle weakness. Also, if you've led a very sedentary lifestyle for a long while, there's a possiblity that you lost a lot of muscle strength over the years.
In any case, having knees that buckle randomly is deinfitely not normal. I would advise you to seek advice from an Orthopaedic surgeon. He/she will take your detailed history and perform a thorough physical examination to determine the cause of your knee buckling.
A MRI scan of your knee or your spine would be required if your doctor suspects knee ligamentous injuries or a nerve compression in your spine.
I hope you will be able to find out the cause of your buckling knees soon!
Osteoarthritis means the “normal” wear and tear of the joints, and the accompanied inflammation (“itis” means inflammation in Latin, typically presented as pain and swelling).
It comes with aging, but of course, to varying degrees and different severity.
Osteoarthritis itself is not a dangerous disease that will threaten your life or safety per se, so not everybody suffering from osteoarthritis needs to go under the knife to have surgeries.
However, when the arthritis is so severe that it causes significant functional limitation in your daily activities and your quality of life, you should consider treatment.
Mild arthritis can be well controlled with medication/ lubricant injections.
Severe arthritis, defined as complete loss of cartilage and significant mal-alignment of the limb, usually can only be cured by surgery.
I always tell my patients that “humans are like cars, and our knees are like the car tyres”. Your description of “bone on bone” appearance actually refers to the complete loss of cartilage in your knees.
If you imagine yourself like a car, the rubber tyres have been completely worn out and the metal rims are directly grinding on the ground!
I think few people would wait for another 3 years to change the tyres, so why would you wait another 3 years to replace your knees?
Gone are the days when the success rate was 50/50 or the implants can only last 5-10 years.
With modern technology, we are pushing the success rate of knee replacement surgeries to >95% and the implant longevity to 15-20 years (with the advanced ceramic OXINIUM™ implants).
So coming back to your question about “How do I know if I need to get a total knee replacement”, I would actually say that the patient would know the best.
If your knees pain are persistent and prevent you from doing your daily activities and affecting your quality of life, then you should at least see an orthopaedic surgeon and do an X rays/ MRI scan to determine the severity of your knee arthritis.
As I have mentioned earlier, mild to moderate arthritis can usually be well controlled with medication/ lubricant injections), while severe arthritis with complete loss of cartilage (“bone on bone” apperance as described) can only be cured with knee replacement surgeries.
The other benefits of treating the knee osteoarthritis early is to protect the other joints. As I have said, human are like cars.
If one tyre is down, the remaining 3 tyres will have to take on the extra load, so the next thing you know is that your other knee will start to ache because of the extra load to bear, and your spine will start to have pain because of the poor walking posture due to the significantly bowed knee.
And not forgetting that all the strong pain killers have significant side effects to the stomach, kidneys, heart if consumed for prolonged perior of time. Personally I have seen patients suffering from gastric ulcers/ kidney failure simply by taking these strong pain killers everyday!
Your knees can be replaced easily, with the success rate well > 97%, but your stomach/ kidneys cannot be replaced!
First of all, we need to find out why you are having persistent knee pain in the first place.
Without finding out the cause, your knee pain will never be resolved and you will have to keep taking strong painkillers like NSAIDs continuously for a prolonged period of time. That's when you might suffer from serious side effects such as kidneys damage, stomach ulcers or heart problem.
Knee pain is so common that it happens to almost everyone at some point of time. However, if the knee pain don't go away within 1-2 weeks, these pains may not be the usual “strain” or “muscle pull”. I have listed down some signs and symptoms that you should look out for. These are the "red flags" that might indicate potential serious knee issues:
1. Associated swelling in the knee - All joint swelling are abnormal, if you noticed that your knees swells up after an injury, or you noticed intermittent swelling of your knee, something is definitely wrong with your knee - the ligament or the meniscus could be torn.
2. Sense of instability - You feel that your knee is “loose” or giving way when you trying to change direction rapidly or when you trying to go around a corner/staircase. This means that the ligament could have been torn.
3. Locking - You cannot straighten your knee fully. This means that the meniscus could be torn and trapped inside the joint, preventing it from straightening fully.
4. Persistent pain beyond 1-2 weeks - This might indicate that there may have been a concomitant damage to the cartilage or even the underlying bone
There are also some less serious causes of knee pain such as tendon inflammation. Simple muscle pull/ strain or tendon inflammation responds very well with rest, anti-inflammation medication and physiotherapy (with adjuvant therapy such as Ultrasound treatment, Transcutaneous electrical nerve stimuation (TENS).
However, the more serious knee issues such as meniscus tear/ ligament rupture/ cartilage ulcer might require surgical intervention. So you can see that there are many possible causes of the knee pain, it will be best to see an Orthopaedic Surgeon for a consultation to find out what is the exact cause of your persistent knee pain rather than just popping strong painkillers non stop.
We will take a detailed history of your knee pain and perform a thorough clinical examination of your knee, together with advanced imaging technology such as MRI scan, we will be able to pin point
what is the cause of your persistent knee pain and provide you with a long term solution to your knee pain.
PRP stands for platelet rich plasma injection. This technique is developed based on the fact that platelets cells in our own blood contains a vast amount of our bodies’ natural growth factors and healing power.
The process of PRP injection is incredibly simple. First, we take some blood from the patient and process the blood in a strict sterile and clean environment. This process takes approximately 15 mins.
The processed plasma (the “liquid” portion of the blood, comprised of around 10-15% of the volume) now contains a high concentration of the platelets cells (hence the word platelet rich plasma), which carries with them all the “goodies” required to heal the injured body parts.
We will then inject this portion (approximately 3 to 4 mls in volume) directly into the injured parts of your body. It is just a small injection and it can be done at outpatient setting.
You'll have virtually 0% risk of developing any allergic reaction to the injection because it comes from your own body. I’d say it’s probably 100% safe, if done properly by a trained Orthopaedic Surgeon in a strictly sterile manner.
PRP injection works differently from all the other injections given by Orthopaedic Surgeons.
H&L injection contains steroids and its main mode of action is to reduce the swelling and inflammation of the affected area. On it's own, it does not possess any healing potential or growth properties.
Hyaluronic Acid Injection is simply a lubricant for the joint. Again it does not possess any healing potential or growth properties. In this aspect, PRP injection is unique as it harvests the healing potential of the body and kick starts the healing process of the injured body parts.
PRP injections are readily available in most established orthopaedic clinics. It has been proven to work well (and approved by Singapore Ministry of Health) for soft tissue conditions such as:
So if your knee pain is due to soft tissue injuries such as ligament partial tear, tendinitis or muscle tears, you can safely give PRP injections a try.
However, it your knee pain is due to osteoarthritis, the efficacy of PRP injection is still being investigated by various research trials. The hypothesis is that it will probably work, although we need more large scale and rigorous research trials to prove the efficacy. The bottom line is that it will not cause more harm to the knees.
At this moment, PRP injections are still considered experimental as a treatment of knee osteoarthritis in Singapore, although it’s been a very established treatment option for other soft tissue conditions.
Please seek the opinion of an Orthopaedic Surgeon, we need to find out what is the exact cause of your pain from a detailed clinical history, thorough physical examination and advanced imaging. Then we can advice you further whether PRP injection is a suitable treatment option for you.