ABU DHABI // Safia Kamel had been confined to a wheelchair for more than four years. She needed knee replacement surgery but could not find a doctor willing to take her on as a patient.
Health problems and an obstructive sleep apnoea condition that made it difficult for her to breathe when lying down meant anaesthesiologists were afraid of putting her under.
"I even sleep in an upright position, propped up with pillows, because I cannot breathe when I am lying down," said Mrs Kamel, 60, a retired university professor. "Every doctor I met or hospital I visited would tell me it is impossible for me to do the surgery because it is too dangerous for me to be under anaesthesia."
Mrs Kamel was also diagnosed with pulmonary fibrosis, which is the scarring or thickening of the lungs. This meant that she could not be placed on a ventilator.
"There were just too many complications so I was stuck in my wheelchair, with no solutions," she said.
The situation changed when Mrs Kamel was directed to Mafraq Hospital in Abu Dhabi. Her medical team, led by Dr Rashed al Shaeel, the chief of orthopaedics, does not perform knee replacement surgeries on patients under general anaesthesia.
Instead, Dr al Shaeel said he preferred localised anaesthesia, with the patient awake and involved.
The procedure, which takes between 60 and 90 minutes, is minimally invasive.
"We create the smallest incision possible, around five centimetres long, never more than 7cm or 8cm," he said. Most other surgical teams cannot do it with an incision that is less than 10cm to 12cm, he added.
"We have developed our own instruments with the manufacturers to enable us to work in such a small incision, which is why it is such a delicate procedure that takes a little more time than the old way."
This way, the damage on the surface of the skin and within the tissue is minimal, and a patient's recovery time is faster.
Dr al Shaeel said the challenge in Mrs Kamel's case was her inability to lie down.
"She is the first person we have operated on in a sitting position; the muscles of the leg have a different shape when the torso is sitting up and the leg is extended, so we had to adapt to the awkward positioning," he said.
Mrs Kamel was awake throughout, with an epidural blocking sensation from the waist down.
"This meant she had no pain, but by the end of the procedure, I could ask her to move her knee for me and make sure everything was working well," said Dr al Shaeel.
Nine months ago, Dr al Shaeel replaced Mrs Kamel's right knee. Two weeks ago, she underwent the same procedure for her left knee.
"When she walked into my office a little after her first knee replacement, leaning on a cane, so happy and proud that she can finally walk and stand, I told her she's ready to get the second one done - that was my condition," said Dr al Shaeel.
Mrs Kamel said it was her dream to be able to walk again. "I am undergoing physiotherapy now, and before long, I'll be walking next to my family and ready to get my life back," she said.
