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“Lifestyles and mobility of patients from the East are very different from those from the West. While people from the West may not need to squat, bend, or sit with their feet crossed on the floor, people from the East will require very much to do so since it is part of their culture and most importantly part of their every day work. Should Eastern patients require joint replacement, their requirement and expectation for mobility after surgery is much higher than those from the West and it is a challenge for us to cater to this,” Professor Nathan told the Daily FT during a visit to Sri Lanka for a seminar facilitated by the Parkway Pantai Sri Lanka office.
Stating that the demands of South Asian patients require novel approaches that push the very boundaries of joint replacement technology and technique, he added: “The joints of the greatest relevance in this regard are the hip and knee.”
Focusing on the ‘ball and socket joint,’ located in the hip, shoulder, knee, and pelvis region, he pointed that the expectation of Asian patients to do extreme movements necessitates a different approach.
“A bigger head confers more stability but unfortunately these results in increased wear rates. For better results, special materials such as ceramic liners are used to reduce the wear on the cups. I prefer this material over metal liners since its better and long lasting for the patient,” Professor Nathan explained, adding that metal liners are the least safe alternative due to prevailing concerns in metal hypersensitivity.
He elaborated that the knee is a far more complex joint and though it is greatly thought of as a hinge joint, in reality the knee undergoes internal and external rotation at the extremes of motion.
Professor Nathan stressed that knee replacement designs have been unsuccessful in replicating all aspects of physiological knee movement.
“The general ranges of motion of 120 degrees could be achieved by most designs but flexion beyond this range can be achieved only by modifying the knee design. This can be in the form of rotating platform or refinements to the knee design effectively creating a ball and knee replacement mechanism. This is what I prefer and use over others,” he professed.
While these new and original designs and techniques of joint replacement surgery have only become available in the last decade, Professor Nathan has been trained in traditional methods of joint replacement surgery and was an early adopter of these techniques and has been in the forefront of the developments of these methods in the South Asia region.
In 2012, he received the award for best paper for his pioneering work using collagen based biomaterials in effective host implant integration in joint replacement surgery.
