Repair or Replace

Six year old Putra pedalled hard, his tiny fingers gripping the handlebars. The rusty old bicycle chain clanked and rattled. Papa peeped out the window at the noise.

“Putra, what are you doing?” Papa asked.

It was precisely this question little Putra had been waiting for. Surely his Papa had noticed him loudly pretending to ride this junk of a bicycle every day now – this was the moment!

His Papa would now ask him if he wanted a new bicycle. Putra looked up, eyes wide in childish anticipation.

“Do you want me to repair this old bicycle for you?” Papa asked.

The pedalling stopped.

No! This is all going wrong. I want a new bicycle, Papa. Not this rusty old relic! Close to tears, the small boy ran down the garden and dissolved in the arms of his grandmother.


To repair the old vs to get something new- it’s a decision I still make every day.

When joints are badly worn out, the decision is often easy – like that of the worn out bicycle with the broken pedals – it makes sense to replace it with a shiny new one.

Sometimes however, things are not so clear.

Beaten up knees sometimes still have a little life left in them. Sometimes patients are not yet ready to have their diseased knees taken out and replaced with knees of steel.

Thankfully, from a surgical point of view, there are other options. When a meniscus is torn, and cartilage is damaged; when joint linings are swollen and inflamed – arthroscopic (scope) or ‘keyhole’ surgery can help us look into a joint and repair some of the damage.

In young people with a single damaged meniscus or ligament, this often works wonders – putting them back on the football field or running track in a matter of months ( read: after vigorous rehab).

But as our Malaysian population ages, the number of people living active, fruitful lives at age 70, 80 and beyond keeps growing.

And that’s a good thing. My personal and professional motto, ‘To Live is to Keep Moving’ aims to help my patients (and myself) stay active and healthy deep into their silver crowned years.

Question: Will repairing a badly torn meniscus in an 85 year old with bad knee arthritis heal her painful knee? …. No, probably not.

But if she’s not physically and mentally ready to have a knee replacement, a knee scope aimed at removing some of the torn meniscus and inflamed tissues may give her a window of time in which she can work on strengthening her knees, perhaps to the point where the knee replacement becomes unnecessary.

There is no one cure-all operation (or medicine) for every painful knee or joint. The most important factor in making the right treatment choice is an open and honest conversation with your surgeon about your dreams and aspirations.

While not every dream can be fulfilled, victory belongs to those who take the first step.

Oh, and thank you, Papa for getting me that new bike so many years ago.

Originally written on 7 October 2020 in Sungai Buloh Hospital, Selangor

Image credits: Stella Wong