[Sportschosun reporter Jang Jong-ho] The Chuseok holiday is a good opportunity to take a close look at the joint health of parents after being apart for a long time. If parents hold onto their knees when sitting down or standing up, spend noticeably less time walking, or avoid stairs and going out, their knee condition should be evaluated rather than dismissed as simple aging. In particular, many people continue to endure the pain despite having end-stage degenerative knee osteoarthritis because they believe surgery is difficult at an advanced age. Their children also often hesitate over whether to recommend knee replacement surgery for their elderly parents.
What would orthopedic specialists who have treated arthritis patients recommend for their own parents? Himchan Hospital recently surveyed 91 orthopedic specialists nationwide about knee replacement surgery. The survey examined what treatments specialists working in clinical settings would recommend to their own parents and what criteria they would use in making that decision. The respondents were asked about whether surgery should be performed, its timing and the surgical method, assuming that their parents had end-stage degenerative knee osteoarthritis (KL grade 4).
◇ 94.5% of Specialists Would Recommend Knee Replacement Surgery for Parents Aged 80 and Older
The survey found that most orthopedic specialists would actively recommend knee replacement surgery even if their parents were elderly. Among the respondents, 94.5% (86 people) said they would recommend the surgery to parents aged 80 or older. The reasons cited by the 86 specialists who recommended surgery were increased life expectancy at 72.1% (62 people), advances in surgical techniques at 68.6% (59 people), and improvements in anesthesia and medical management at 39.5% (34 people), with multiple responses allowed.
When degenerative knee osteoarthritis reaches its end stage, severe cartilage wear can lead to pain, joint deformity and difficulty walking. Knee replacement surgery treats the condition by replacing damaged joint surfaces with artificial components to reduce pain and restore function. It is considered when pain persists despite conservative treatments such as medication, injections and physical therapy, and walking and daily activities become severely restricted.
Kim Jeong-ho, director of Busan Himchan Hospital, explained, "When deciding whether elderly patients should undergo surgery, doctors must assess not only cardiopulmonary function and control of chronic conditions, but also muscle strength, nutritional status and the ability to perform daily activities to determine whether patients can tolerate surgery and have the capacity to recover. We compare the surgical risks with the expected relief from pain and improvement in walking function. We also consider the patient's wishes and whether there is an environment to support rehabilitation after surgery before deciding on treatment."
◇ Persistent Pain Despite Conservative Treatment Is a Signal That Surgery Should No Longer Be Delayed
What, then, is the decisive sign that parents should no longer postpone knee replacement surgery? The most common response among specialists was pain that did not improve despite conservative treatment, cited by 70.3% (64 people). This was followed by an O-shaped leg deformity that had impaired the patient's gait at 63.7% (58 people), and an inability to fully straighten the knee or a significant reduction in its bending range at 60.4% (55 people).
The concerns associated with delaying a hospital visit for patients considering knee replacement surgery included delayed postoperative rehabilitation due to reduced muscle strength at 54.9% (50 people), reduced activity and worsening chronic diseases caused by pain at 53.8% (49 people), and spinal or opposite-joint problems caused by an imbalance in walking at 38.5% (35 people).
When their knees hurt, patients tend to move less to avoid pain and put less weight on the affected leg. If this continues for a long time, thigh muscle strength can decline and gait balance can deteriorate, placing greater strain on the opposite knee or hip and the spine. Reduced muscle strength can also make walking and rehabilitation more difficult after surgery.
◇ 80.2% of Specialists Would Recommend Robotic Surgery to Their Parents... Medical Staff Expertise Is Also Essential
The specialists were also asked which surgical method they would recommend if their parents needed knee replacement surgery. Of all respondents, 80.2% (73 people) said they would recommend robotic surgery. The most frequently cited reason was accurate alignment, which is expected to extend the lifespan of the artificial joint, at 79.5% (58 people). This was followed by minimizing complications and side effects by reducing soft-tissue damage at 46.6% (34 people), consistency of surgical outcomes at 41.1% (30 people), and earlier walking and faster rehabilitation at 21.9% (16 people).
Robotic knee replacement surgery uses robotic systems such as MAKO and ROSA. These systems help surgeons plan the placement of the artificial joint and the alignment of the leg by reflecting the patient's bone structure and joint deformity. They assist with bone cuts and the assessment of the joint during surgery based on the operating surgeon's plan and judgment.
Lee Jeong-hoon, medical director of Mokdong Himchan Hospital, said, "Robotic knee replacement surgery can improve the accuracy of bone cuts and artificial joint placement compared with conventional surgery by using a surgical plan that reflects the patient's joint condition and measurements taken during the procedure. However, the operating surgeon must develop the plan while considering each patient's different joint deformity and ligament balance, and adjust it according to the situation during surgery. Therefore, the medical team's proficiency and clinical experience are important to make full use of the robot's precision."
When asked about the minimum number of procedures orthopedic specialists need to perform to achieve full proficiency and manage complications, 30.8% (28 people) chose 100 to fewer than 300 cases, 22% (20 people) chose 300 to fewer than 500 cases, and 23.1% (21 people) chose 500 or more cases. Overall, about 76% of respondents said at least 100 cases of clinical experience were essential.
The orthopedic specialists who participated in the survey were in their 40s (48 people), 50s (28 people), 30s (10 people), and 60 or older (5 people), in that order. Their years of experience after obtaining specialist certification were 10 to fewer than 20 years (40 people), 5 to fewer than 10 years (28 people), 20 years or more (20 people), and fewer than 5 years (3 people), respectively.
Jang Jong-ho, Reporter bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
