The most common complaint that my patients have is joint pains, and the most common complaint joint that they complain about is the knee. Other joints that are often painful include the shoulder, ankle and hip, and stiffness is often present in the hands. The most common, but not the only, cause of stiff and painful joints is osteoarthritis.

Osteoarthritis (or OA) is commonly felt to be a “wear-and-tear” or degenerative disease, but the real cause is much more complex. It starts as a disease of the cartilage lining of joints, with cartilage being lost through trauma or disease. Eventually, the cartilage loss causes inflammation and deformity, and this can get to stage of being irreversible. The patient then becomes unable to live normally, and may become dependent on walking aids, or even lose the ability to walk altogether.

The prevalence of OA is estimated at 7 – 10% of the whole population, meaning that Malaysia may have 2 million sufferers. In the knee, for example, when the joint is very badly affected by OA, a total knee replacement is often indicated.

While this is major surgery, it is common and highly successful when done by properly qualified and trained Orthopaedic Surgeons. About 500,000 total knee replacements will be done this year in the USA alone! Patients are however becoming more demanding, and as injury and OA start to affect ligaments and cartilage in the young, and the older but still keen athlete, other solutions are needed. We are now looking at ways to repair and reconstruct ligaments and to “re-grow” cartilage using novel techniques. Some of these techniques include the use of biological agents to enhance repair when assisted by arthroscopic techniques. The agents include various growth factors, platelet-rich plasma, and stem cells.

For example, a patient may have a sports injury to partially tear the ligaments on the side of his or her knee. Traditional methods would include immobilization of the knee, but newer techniques may include encouraging movement in a controlled fashion in a knee brace, plus enhancing the body’s own repair capability by using the patient’s own platelet-rich plasma.

Cartilage repair in cases of full-thickness loss can often be achieved by arthroscopically ( using a minimally invasive scope) preparing the site of cartilage loss, the later injecting the affected joint with stem cells, which can either be the patient’s own, or allogenic, ie, cells already growing in a laboratory. Allogenic stem cells, or cells grown in a lab that originate from donated cells, are not immunogenic, and do not need to be tissue matched. Other techniques include obtaining a tiny sample of cartilage from the patient at an initial arthroscopy, growing the cells in a lab, and then re-inserting the cartilage grown into the joint at a second surgery.

It is important to emphasise that some of these are cutting-edge techniques, and may therefore be deemed experimental therapy, but they have shown excellent experimental, and clinical results.

Often, a combination of techniques is used, for example, reconstructing a ruptured knee ligament using the patient’s own tissue as a biological graft (for example, an arthroscopic Anterior Cruciate Ligament reconstruction as recently done for the world’s premier golfer), followed by stem cell therapy to repair associated cartilage loss, plus specific physiotherapy prescribed for the problem. The goal of our therapy is to get the person injured back to their previous level of activity, including sporting activity!

Pantai Hospital Kuala Lumpur has recently set up a new centre of excellence, the Spine and Joint Centre. Here, surgeons with an interest in either spine injury and disease, or joint injury and disease are based, in a multi-disciplinary environment with a dedicated physiotherapy service attached, meaning that we can monitor our patients closely after our intervention, and adjust treatment on an individualised basis. This leads to optimal results, and satisfaction.

Source: The Expat January 2011
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