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Instead we allow the bone to grow into the implant, thus stabilizing it. This cementless implant is specifically used for young patients because it preserves bone. The implant choices have widened greatly in recent years. We now have multiple options on sizes and on the knee constrain. With such a wide


spectrum of implants avaliable, I do not think there is a superior implant over the other; however, it is the job of the surgeon to select the


best implant for that particular patient and the


results are always better for total knee replacement in bigger centers because they have more options to best fit the patients. For example, if


I have a patient with a deficient


28 www.lifesciencesmagazines.com


ligament, the best implant for him would be the constrained implant. This kind of implant has linkage between the two pieces to where it can constrain the joint and keep it together in particular situations where patients have lost their ligaments secondary to a trauma. Usually cementless implants are much better for younger patients because it preserves bone and they are supposed to last longer.


Q: In your opinion, is there a gap in orthopaedic care and joint replacement in the Middle East compared to Europe and North America? A: I had the opportunity to practice in the States for over 20 years and also to work here for over 14 years now. When I started, knee surgery was a rarity; however, since it is a very successful operation, patients now are expecting this option and consenting to knee operations. The challenges in the Middle East are that patients often have very different needs. For example, people here kneel on the ground during prayers whereas it is not as common for Europeans to kneel, so we have had to do some modification of how their


knee was performing and also which implant to use. There has been also confirmation that the size of the Asian patient knee is different than that of the European patient, and that would also create a challenge in doing the operation in order to get the best fit for the patients. I think at this point the surgery has improved significantly in the Middle East and there are more and more knee implants being done annually. In spite of the fact that knee


surgeries were started later here, there is an excellent level of total knee replacement in the Middle East. I am comfortable with Middle Eastern patients doing their knee replacements in their country rather than in Europe due to the fact that their local surgeon would be able to address the specific needs of the Middle Eastern patient. There has been an explosion of education about total knee replacement and the information I have available about joint replacement is much more complicated than the time I was in the US. This also puts a great burden on us to educate the Middle Eastern patients and to learn from each other’s experience. This is why we are keen on holding on regular courses on total knee replacement. ■


AH


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