The knee is the largest joint in the body and is made up of three main parts: the lower end of the thigh bone (femur), upper end of the shin bone (tibia), and the kneecap (patella). These are all joined by ligaments, tendons, and muscles. A minor problem with any of these structures can lead to pain and restrict movement. Because of the complex nature of the knee and the large amount of weight it carries, it is more vulnerable to injury or developing osteoarthritis compared to any other joint. Anatomical differences in the shape of the thigh bone just below the hip can also cause increased stress on the knee, leading to increased rates of arthritis in certain groups of people.
According to a study commissioned by the Singapore General Hospital (SGH) in 2014, about 30 percent of Singaporeans have reported knee pain, with the rate of incidence increasing with age. Knee pain can severely limit a person’s mobility and quality of life. In older adults, chronic knee pain is a common by-product of degenerative (wear and tear) changes that are often the result of osteoarthritis. The presence of osteoarthritis in Singaporeans aged 60 years and above is significantly higher in comparison to the worldwide incidence rate.
Overview of Knee Pain
With the wide range of symptoms, there are also many causes of knee pain. Often, knee pain is the result of an injury. The most common is a sprain or strain of the anterior cruciate ligament (ACL) or a meniscus tear. These injuries can cause bleeding and swelling around the knee, and over time, result in osteoarthritis. This is also a common cause of knee pain in older adults, even without a specific injury, as the cartilage in the knee joint begins to deteriorate. Rheumatoid arthritis is another joint condition that can be a cause of persistent knee pain. Finally, there are various infections and bone tumors that can cause knee pain, though these are much rarer cases.
The point where it becomes difficult to put weight on the knee is the beginning of severe pain, and at this stage, patients may begin to limp. Deformity can be present if dislocation or other injury has occurred. On and off swelling is common and may become increasingly severe, resulting in an accumulation of fluid on the knee, known as water on the knee.
Knee pain is a common symptom affecting people of all ages. Whether as a result of vigorous physical activity or simply part of the aging process, knee pain can be a distressing condition to live with. The level of pain can be divided into three categories: slight, regular, and severe. Even those with slight knee pain can have difficulty performing daily activities such as climbing stairs, rising from a sitting position, and bending down. The knee can become weak, and the pain may become more persistent.
Importance of Seeking Expertise in Singapore
Orthopaedic surgeons in Singapore have increasingly gained expertise in diagnosing and treating knee pain. While experience is being gained, surgical expertise is often obtained through fellowship training and over time when surgical volume is increased in a subspecialty. The management of the knee pain patient can be both challenging and clinically rewarding. There are techniques of mentored reality training methods to increase the learning curve and newer tools and instruments for minimally invasive surgical techniques. Expertise is important when considering the vast array of tools and techniques available to treat the patient with knee pain. An expert algorithm can be used to help guide treatment decisions. This comes from education and experience in using these informational tools. An expert is defined as ‘a person with a high level of knowledge or skill in a particular subject’. It is important for the patient to make informed decisions regarding their surgical care. This may also vary depending on the extent of the injury and the patient’s own goals and expectations. The pros and cons of the specific procedure in the context of the patient’s needs should be discussed. A patient facing total knee arthroplasty has different desires and expectations than a high level, competitive athlete considering an ACL reconstruction. Expertise is important in outlining realistic goals and expectations with the patient. A high level of expertise should be able to predict which patients will do well with non-operative rehabilitation. Currently there are several classification schemes to help determine which patients will benefit most from surgery. A recently published clinical guideline is now available from the Osteoarthritis Research Society International (OARSI) for the non-surgical management of knee pain. This is valuable information to the expert treating knee pain and should be discussed with the patient. In summary, expertise is important in determining the type of surgical or non-operative techniques that are best suited for an individual patient given the extent of their injury and their own desires and expectations. This requires a high level of knowledge that may only be obtained through subspecialty training and experience in treating a particular condition. High volume surgeons in a particular procedure or subspecialty may have a greater level of expertise and better patient outcomes. This has been shown with total joint arthroplasty and other orthopaedic procedures. An informed patient should not hesitate to question their surgeon with respect to their level of expertise in a particular area of knee pain treatment.
Advanced Surgical Procedures
Ligaments are tough, non-stretchy bands that connect the bones, providing stability and support to the joints. The knee joint is surrounded by a joint capsule which is reinforced by ligaments. Collateral ligaments are found on the sides of the knee, preventing the knees from moving too far side to side. Cruciate ligaments are found inside the knee joint itself. They cross over each other to form an “X” with the ACL in front and PCL behind. The main role of the cruciate ligaments is to provide rotational stability to the knee. Twisting injury to the knee while changing direction or pivoting can often result in tears of the ACL. This is commonly associated with a popping noise and giving way of the knee. Damage to the ACL leaves the knee feeling unstable and can lead to further injury of the knee joint.
Arthroscopy is a procedure in which a small camera is used to visualize the inside of a joint. In the case of the knee, the procedure will be done to visualize the inside of the knee joint to determine the cause of knee pain. It is done through small incisions and is generally a day surgery procedure. If your knee pain specialist recommends surgery for your knee arthritis, a total knee replacement may be an option. More than 95% of people who have total knee replacement experience dramatic relief of knee pain and are better able to perform common activities of daily living. Both the patellofemoral and the tibiofemoral joints can be resurfaced. Resurfacing the patellofemoral joint alone is known as a patelloplasty. In cases of isolated patellofemoral arthritis, resurfacing just the patellofemoral joint can lead to excellent results. Often it is suitable for younger patients with isolated patellofemoral arthritis to have a patelloplasty. This is because the recovery time is quicker and the procedure is less complex than total knee replacement.
Arthroscopy: Minimally Invasive Diagnostic Procedure
Arthroscopy can be used for the following conditions: torn floating cartilage, torn surface cartilage, ACL reconstruction, inflamed joint lining, joint infection, torn ligaments, or Baker’s cyst removal. Torn cartilage can be a result of getting hit on the knee or twisting or pivoting the knee. If the torn cartilage is not treated and it keeps catching on the other cartilage in the joint, it can result in more damage. This damage is usually to the articular cartilage. The surface cartilage can become softened and in severe cases result in exposed bone. These conditions often lead to arthritis in the joint. Arthritis is a breakdown of the cartilage in the joint. Usually, there is excess fluid in the joint and pain. Joints with arthritis are often limited in the range of motion. An arthroscopy will remove loose pieces of cartilage, repair the torn cartilage, and wash out the excess fluid getting rid of debris in the joint which can reduce swelling and extend the time before a knee replacement will be necessary.
According to the table of contents, the first procedure discussed will be arthroscopy. This is a surgical procedure in which a physician uses a tiny camera to look inside of a joint. The camera is inserted through a small incision. An additional incision may be required to insert the medical instruments to be used to repair damage in the joint. A great benefit of arthroscopy over traditional open surgery is that the patient will recover much faster due to the smaller incisions. The small incisions cause less damage to the surrounding tissues resulting in less pain. Often there is less scarring after an arthroscopic procedure compared to open surgery. The rate of infection is much less with arthroscopy than with open surgery.
Total Knee Replacement: Restoring Mobility and Function
The Surgery The surface of the femur and the tibia in TKR are resurfaced with metal components, which are fixed to the bone with polymethylmethacrylate (PMMA) cement or are coated with a substance that encourages bone to grow into the implants so that they become fixed to the bone without the need for cement. Alternative methods of fixation are constantly being devised. Between the metal components, high-density polyethylene is used, which is molded to an exact fit in between the metal pieces. In the past, this was the weakest part of the artificial knee and is liable to wear out over ten years or so, mainly in active patients. Nowadays, however, the polyethylene is treated to make it last a lot longer. The back of the patella can be resurfaced with a polyethylene button, which is held by the natural groove in the patella. This is also an area prone to wear, and there are other types of implants for the patella.
Knee pain sometimes becomes too unbearable for patients with chronic knee. Total knee replacement (TKR) is a highly successful operation for knee pain. It is an operation performed for severe arthritis of the knee joint and is usually performed on an elective basis. A significant improvement in the patient’s quality of life is the usual result, although the convalescence can be prolonged and the function of the knee will continue to improve for at least a year.
Partial Knee Replacement: Targeted Treatment for Specific Areas
Partial knee replacement is indicated for patients whose arthritis is confined to a limited area of the knee. When non-operative treatments have not been successful, the most effective treatment beyond this point is a partial knee replacement. Using minimally invasive techniques, the orthopaedic surgeon replaces only the diseased portion of the knee with metal and plastic parts. This procedure is designed to enable the patient to quickly return to less demanding activities with a rapid recovery period. Mr. Tan has patients who have been able to go back to playing competitive sports such as tennis within a couple of months of their partial knee replacement. This is in complete contrast to total knee replacement, which usually requires a recovery period of over 6 months. If the arthritis later becomes severe throughout the knee, the partial knee replacement can be converted to a total knee replacement, utilizing the same incision.
Knee Ligament Reconstruction: Restoring Stability and Strength
Surgery to the meniscus is considered when there is a possibility to repair the meniscus tears. When there is no possibility to repair a tear due to the location or type of tear and the tear causes pain and swelling, then the meniscus tear is removed or partially removed.
The ACL is the ligament that holds the tibia and femur in place; a tear to the ACL causes the knee to give way. ACL tears often occur with other injuries, such as meniscal damage or other ligament injuries. Studies have shown that a patient who has a torn ACL and has normal activity demands should consider surgery. About half the people with ACL injuries sustain damage to the meniscus. As stated above, 90% of the meniscus is avascular. Because of this, only the outer third of the meniscus has the potential to heal itself.
Ligament injuries mostly involve the anterior cruciate ligament (ACL). ACL tears are among the most common knee injuries, often occurring during sports that involve sudden stops or changes in direction, direct blows to the knee, or landing poorly from a jump.
Specialized Treatment Approaches
Robotic-assisted surgery is a technique which uses a robotic arm to aid the surgeon in performing minimally invasive surgery. The robot does not perform the surgery, but instead assists the surgeon in executing the preoperative planning with a greater degree of precision and accuracy than conventional tools. This is achieved via a combination of computer navigation and haptic guidance – the latter of which restricts the surgeon’s hand to the pre-planned pathway so that it does not deviate into healthy tissue. High levels of precision and accuracy in surgery are particularly important for procedures involving tissues with poor healing capacity, such as ACL reconstruction or surgery on elderly patients with degenerative joint disease. This is because the margin for error in damaging healthy tissue is smaller, and damage to vital structures may compromise the success of the surgery and the patient’s recovery. Damage to healthy tissue can be a major contributor of post-operative pain and the development of arthritis, so the ability to mitigate this will lead to better long-term outcomes for patients.
Regenerative medicine is an exciting and emerging branch of medical science that aims to repair, replace, or regenerate damaged cells, tissues, or organs. This type of treatment is said to be minimally invasive and has a shorter recovery period as the treatment is more focused towards the damaged area. These qualities make it an attractive option for patients seeking to optimize their recovery and return to a high level of function. The most common form of regenerative medicine is the injection of hyaluronic acid or platelet-rich plasma into the knee joint. Hyaluronic acid serves to lubricate the joint and act as a shock absorber, thus can temporarily relieve pain and improve mobility in patients with mild to moderate osteoarthritis. Platelet-rich plasma is a more involved and expensive option which involves a small amount of the patient’s blood being taken, and then spun in a centrifuge to separate the platelet-rich plasma. This ‘super-concentrate’ of autologous growth factors is thought to enhance the body’s natural ability to heal itself, and thus has the potential to repair damaged cartilage and delay the progression of arthritis.
Regenerative Medicine: Harnessing the Body’s Healing Power
Regenerative medicine is a fascinating field that aims to stimulate the body’s own healing mechanisms to repair damaged tissues. Knee pain specialists have developed several innovative regenerative medicine techniques to target specific knee injuries and to expedite your recovery. The most common regenerative medicine techniques include Platelet Rich Plasma (PRP) and stem cell injections. PRP consists of drawing a small amount of blood from the patient and spinning it in a centrifuge to separate the platelets and growth factors from the red blood cells. The concentrated platelets are then re-injected into the damaged tissue to stimulate healing. Stem cell therapy involves harvesting stem cells from the patient’s bone marrow or fat tissue, and injecting them into the injured area. Stem cells have the unique ability to develop into many different types of cells and are able to replace the damaged cells with new cells to effectively heal the tissue. The second common regenerative technique is Autologous Chondrocyte Implantation (ACI), which is a surgical procedure suitable for patients with large cartilage defects. Healthy cartilage cells (chondrocytes) are harvested arthroscopically from a non-weight bearing area of the knee. The next stage involves securing the cells in a laboratory environment where they are then cultured to increase the cell number. The third stage is implanting the cultured chondrocytes back into the cartilage defect with the use of a special membrane. The membrane keeps the cells in place and is sealed onto the surrounding healthy cartilage. ACI has now extended to MACI, where the cultured cells are implanted onto a special type of membrane before being secured into the knee. This procedure has recently had promising long-term results in clinical studies.
Robotic-Assisted Surgery: Precision and Accuracy in Procedures
Robotic technology was first used in surgery in an attempt to find a way to safely and accurately maneuver a scope. The first surgical robot that was introduced was the Automated Endoscopic System for Optimal Positioning (AESOP) developed by Computer Motion. This simple robot, just a voice-activated arm, proved to be a major advancement in the surgical field. AESOP was quickly followed by the groundbreaking Da Vinci Surgical System. The Da Vinci Surgical System was considered to be the first of its kind, designed to overcome the limitations of both traditional open surgery and conventional minimally invasive surgery. By integrating computer-enhanced technology with the surgeon’s capability, the goal of the da Vinci system is to provide the surgeon with superior visualization, enhanced dexterity, greater precision, and ergonomic comfort while minimizing the effects on the patient. Although these robots are now widely used throughout the surgical field, many of the general public are still unaware of the intricacies of this technology and are skeptical about the competence of a robot when compared to a human surgeon. This article will detail some of the basic types of surgical robots and their surgical applications, give insight into the current role of robotic surgery in orthopedics, and lastly, look at the future of surgical robotics and its implications on the orthopedic surgeon.
Non-Surgical Options: Exploring Conservative Treatments
Physical therapy and exercise Commonly, the first line of approach to addressing joint pain is to mobilize and strengthen the musculature surrounding the joint. This, in turn, helps to stabilize and unload the joint surfaces. Range-of-motion and strengthening exercises may be performed by the patient, and supervised physical therapy can be arranged. Supervised exercise therapy has been shown to have good short- and long-term outcomes for people with OA of the knee. High tibiofemoral compression will cause pain due to bone marrow lesions and lead to further chondral loss. An exercise program was found to improve knee function and reduce structural progression in those joints showing bone marrow lesions.
Conservative treatment essentially occupies a place between watchful waiting and invasive surgical treatment. The primary thrust behind conservative treatment is to address pain and enhance the function and range of motion of the affected joint. It does not change the underlying structural pathology associated with the degeneration of the joint. It is most useful in early, mild to moderate osteoarthritis, but often a worthwhile treatment to consider when the patient’s age or associated medical problems make the risk of surgery prohibitive.
Choosing the Right Knee Pain Doctor in Singapore
To find the right knee pain doctor, it is key to look at the specialist’s experience and expertise. An orthopedic doctor specifically dealing with knee problems and surgeries would be the best candidate. Research has shown that surgeons who often perform specific procedures will produce better outcomes. A study done on ACL surgeries demonstrated that patients who went to a doctor who performed 100 or more ACL reconstructions had a lower rate of complications and lower re-operation rate. This data is compared to those who got treated by doctors who performed less than 10 ACL reconstructions a year. This shows a good correlation between the frequency of which a doctor performs a specific procedure and the rate of complications. This suggests that patient outcomes are better with doctors that have more experience. In addition to experience, it is important to find a surgeon who is well trained. This can be noted by the academic qualifications, fellowships and the institutions from which they trained from. These could be good measures of a surgeon’s expertise in the field of knee surgery. Therefore, taking note of a surgeon’s experience and expertise in the field of knee surgery would greatly help in finding the right doctor.
Factors to Consider in Selecting a Specialist
It is important to have a clear diagnosis. A good knee specialist should be able to get that diagnosis and make sure you understand it. The diagnosis should be individualized for you. Many patients leave the office after seeing a doctor and realize they really do not know what is wrong with their knee. They can only remember the doctor saying something about “wear and tear” or “a touch of arthritis”. They also may realize that the doctor did not seem to understand the specifics of their condition. A clear diagnosis is the cornerstone to understanding your condition and what treatment may be best for you. Only with that understanding can the doctor and patient consider the possible benefits and drawbacks of different treatment options.
Knowledge of different knee conditions: Not all conditions in the knee are the same. One person’s anterior cruciate ligament (ACL) tear is quite different from another person’s. One person with cartilage damage may have no pain or disability, while another person with the same findings has significant symptoms. The treatment for the two individuals may be different. The individual with the painful symptoms may benefit from a procedure to shave the damaged cartilage. The person with no symptoms does not need anything done. In addition, the locations of the cartilage damage can vary a great deal, and may dictate a change in the type of surgical procedure recommended.
Importance of Experience and Expertise
In an interview-based article, Dr. Robert Litchfield, the medical director at the Fowler Kennedy Sport Medicine Clinic, stresses the importance of experience and expertise in minimally invasive knee surgery. The best technical skill can be obtained from those surgeons who have performed similar surgeries a great number of times.
The article also highlights the fact that knee joint pain can be a result of various conditions, some of which may require surgical treatment. With surgeons who have vast knowledge of the knee joint, the patient may obtain options of various treatment methodologies rather than just one.
The knee specialist will be the best choice given the fact that he would have spent a large proportion of his career treating knee-related problems. An example of a knee specialist would be Dr. Kevin Lee, an orthopedic surgeon with the SingHealth group who also has a subspecialty in sports medicine. He is highly specialized in the management of soft tissue and joint injuries using reconstructive techniques. Being treated by someone like Dr. Kevin Lee would give the patient the assurance that they are in the hands of a specialist who is familiar with the problem and its effect on the patient.
When choosing the right knee pain Singapore doctor, one of the most important factors to consider is the specialist’s length of experience and expertise in the field of knee joint treatment. knee pain has to be treated by professionals with deep knowledge of the knee joint. While there are many general orthopedic and trauma surgeons in Singapore with comparable years of surgical experience, the knee joint, being a complex joint whose function is highly dependent on being pain-free, deserves a knee specialist who may also hold a subspecialty in sports medicine.
Patient Testimonials: Real Stories of Successful Treatments
One patient offered this account of his autologous chondrocyte implantation experience. This relatively new procedure is showing promising long-term results for the repair of articular cartilage defects. Seven years ago, when I was in my late 30s, I discovered a patch of missing cartilage in my right knee that resulted in a lesion in the surrounding bone. My orthopaedic surgeon told me I was too young for joint replacement and suggested that I try to find a clinical trial for chondrocyte implantation. I was about to relocate to Singapore so I decided to postpone my search until I got settled in. I scheduled to see a doctor at the Sports Medicine Centre about my knee and he actually suggested the same thing. He referred me to another one of his patients who was about to undergo the chondrocyte implantation procedure. I spoke to that patient and after learning about his success I consulted with the doctor and decided to go forward with the procedure. Now, 1 year post-op, I am able to do activities that I have not done in years and my knee feels great. I am now looking to do the same for my left knee in the near future.
The most persuasive evidence of a knee doctor’s competence comes from patients who have undergone treatment under their care. Many of our Singapore readers are doubtless seeking an alternative to joint replacement surgery. The doctors we surveyed share a similar goal. They’re looking to help patients increase their active years and delay the need for joint replacement as long as possible. For some patients, though, joint replacement is unavoidable and turns out to be the best option. We offer a sampling of patient stories to give readers a sense of what kinds of results are possible with the right doctor and the right treatment regimen. These stories represent just a few of the scenarios patients might encounter. But they all highlight the potential for positive outcomes.