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Medical Digest Jan-Mar 2012

Medical Digest Jan-Mar 2012

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Medical Digest Jan-Mar 2012
Medical Digest Jan-Mar 2012

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Categories:Types, Brochures
Published by: Tan Tock Seng Hospital on Jun 18, 2012
Copyright:Attribution Non-commercial


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MICA (P) 031/04/2010
Jan.Feb.Mar 2012
Jan.Feb.Mar 2012
From The Editor
Dr Leong Khai Pang
Medical Digest
I need not remind to the reader that the world is changing. Changes to thepractice o medicine have been proound and are ever gathering speed.I can quote some personal examples. In 1987, I had to accompanybrain-injured patients in siren-blaring ambulances to TTSH in the middleo the night because that is where the only CT scanner in the countrywas. Now, even junior doctors can order CT or MRI scans in their owninstitutions. When I returned to the hospitals in 1990 ater two years inmilitary service, I was lost or a while because the conventional units(or instance, venous glucose was reported in mg/dl) gave way to theSI system (mmol/l). I never developed intuitive grasp o what a glucoselevel in mmol/l means. There has been a prolieration o gadgets ormonitoring, moving, probing and treating patients. Index Medicus hasyielded to PubMed. In the early years o my career, metal needles had tobe sharpened ater use and glass syringes re-packaged or sterilization. As bet our modern throw-away culture, all these and more are nowsingle-use and disposable. Henning Mankell had his character Wallanderlament that the Swedes do not value things and people anymore, sincepeople stopped darning their socks and simply replaced them.The most proound changes are in the people who constitute the heathcare system. Most people in charge do not exert regimental control overtheir charges anymore (some miss this). Most doctors now do not comerom low-income amilies, so we cannot expect them to have built-inempathy or the poor. Younger people do not accord respect to olderpeople merely because o their age or their titles, which is actually nota bad thing except to the older people. There is only one way to getrespect: earn it! A large group o younger doctors are unable to obtainhistory rom older Chinese patients. We perceive that more and morecolleagues have a let’s-see-what-I-can-get-away-with attitude ratherthan an ethical code. Bedside clinical skills are declining because oheavier reliance on tests and equipment in succeeding batches odoctors. Bob Dylan wrote: “There’s a battle outside and it is ragin’; It’llsoon shake your windows and rattle your walls; For the times they area-changin’.”I belong to the baby-boomer generation (people born between 1946and 1964) that experienced these changes. I think we have to knowwhich changes are good and which aren’t. We cannot hold it againstour juniors that they do not know the past, because they were not there.We have to gure out new ways to interact with them. Putting aside ourrose-tinted glasses, the past was not what we remember it to be. Therewas avouritism, maverick management and bullying, all o which areharder to perpetuate now. I doubt that people were more morally uprightin the past.Those o us who are older should learn rom the young and see whatmakes them click. They can help us dispense with our rigid ways othinking. Those o us who are younger should see what values we havelost. And remember that in twenty years’ time, we will be saying thesame things to the even younger olks.
Medical Progress
Classically, a surgeon depends onspecially designed jigs to aid inthe osteotomy and the placemento the implants. Combining X-raytemplating and the surgeon’sexperience, airly consistent resultshave been achieved. However, thereare still a signicant number opatients who are outliers to the norm,in which the knee implant is notaccurately implanted, oten becausethe mechanical axis has not beenaccurately restored.
Despite excellent results in kneereplacement, we know romexperience that i a prosthesis is notaccurately implanted, early revisionis oten the consequence. Total kneearthroplasty in varus alignment ailbecause o medial tibial collapsewhile those in valgus alignment doso rom ligamentous instability.
Theintramedullary design o jigs may alsoresult in at embolism and bleedingrom the bone canal.Computer navigation was introducedabout a decade ago to addresssome o these issues. The aim wasto extend longevity and prolongunction o a replaced knee, intandem with improved implantdesign. Computer navigation alsominimised the variability to producea more consistent knee surgeryoutcome every time. However,computer-navigated surgery neverbecame very popular as there isa airly steep learning curve andthey take longer time to perorm.Economically there is also a capitaloutlay or the purchase o expensivecomputer navigation system. Advances in medical imaging,computer modelling, and materialscience have advanced to allowsurgeons to more accurately implanta replaced knee. Patient-specicinstrumentation (PSI) is such arecent development. An MRI image
Customised knee replacement?
Improved prosthesis design and better material science over the last three decades have improved not only theunction but also the longevity o contemporary knee replacement. However, even the most advanced and welldesigned knee implant needs to be implanted accurately so that it will unction the way it is designed to. Moreimportantly, the limb’s mechanical axis must be restored accurately.

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