MISALIGNMENT and increased weight are a big part of the issue with osteoarthritis of the knees, one of the most common causes of knee pain, say specialists. There is a higher prevalence of bow-leggedness among Asians, compared to Caucasians, and there's also quite a high prevalence of knee arthritis in Asia, says Thorvaldur Ingvarsson, medical advisor to Singapore's Inliven Center for Osteoarthritis Solutions.
But a new knee brace now available in Singapore could help, and delay the need for knee replacement surgery. Correcting small misalignment will do much to alleviate pain as well as reduce the pressure on the affected joint compartment, adds Christopher Goh, resident doctor at the centre who focuses on non-surgical management and treatment of knee osteoarthritis through rehabilitation, pain management, biomechanics and physical therapy.
"The main crux of arthritic problems is that mild misalignment gets worse if it is not corrected, and the pressure will gradually increase on the affected cartilage compartment of the knees," says Dr Goh, who adds that Asian society does a lot of squatting, which can exacerbate misalignment of knees.
Most malangulations of the knee joint, be it due to previous trauma, congenital deformity or muscular imbalance, gets worse over time. An X-ray can be taken to measure the angle from the femur to the tibia to assess this angle and determine if the angulation is beyond the normal degree. Common angulations include "bow-leggedness", common in obese individuals as well as patients who do a lot of squatting and heavy manual labour. The other less common angulation is "knock-knees" which is most common in patients who were obese as a child and also patients with a history of rheumatoid arthritis.
"Any injury to the knees can commonly result in the degeneration of the cartilage. Once the degeneration process overwhelms the regenerative properties of the cartilage, then osteoarthritis begins to set in. This results in the thinning of the affected cartilage as well as the growth of bone spurs, subchondral bone cysts and sclerosis. In late stage arthritis, deformity in the joint occurs with significant malalignment," explains Dr Goh.
Inliven has brought in the Ossur UnloaderOne knee brace which is one of the more effective, non-invasive ways to correct misalignment for patients. In the market for about five years, the lightweight brace has been designed so that it corrects misalignment of the knee joint. It is also clinically proven to be effective in reducing the pressure on the affected knee joint compartment, thus providing protection for the already injured cartilage. Being an extremely light weight brace and low-profile, patients find it easier to be compliant and use the brace daily during their exercises as well as their activities of daily living. "Patients wear them for a few hours a day, and we also show them targeted exercises which they can do at home daily," he explains.
Besides the use of the knee UnloaderOne brace, the clinic also uses a comprehensive range of treatment modalities such as intra-articular hyaluronic injections in the knees to help relieve pain and inflammation. Rehabilitation is also a strong suit of the clinic whereby the patients work hand-in-hand with their doctor as well as the in-house physiotherapist to assist the patient in attaining improved levels of functionality and strength in their limbs.
Prof Ingvarsson, who helped in the development of the Ossur brace, says that some 200,000 patients worldwide have used this UnloaderOne brace extremely successfully. "A large part of the osteoarthritic knee is biomechanical. Tests show patients are better off using the brace, as it alleviates pain and increases functionality." says Prof Ingvarsson.
He adds that research has shown that the brace is able to correct about two degrees in angle. "The key outcome is decreased pain and increased function and life quality - which are the main issues," says Prof Ingvarsson.
Treatment protocols are tailor-made for each person, but it's not a cure for osteoarthritis. "Patients use the brace to alleviate pain and it can be adjusted for small change. The brace becomes a part of their limbs. Patients who were unable to be very active before are now able to walk," says Prof Ingvarsson. "The good thing is that the moment you put the braces on, you know whether it works or not. People actually feel better immediately," he adds.
"Is there a cure for osteoarthritis? No. Even a total knee replacement is not your original knee. However, for patients who do not want surgery or are unsuitable for surgery due to risk factors, treatment at Inliven will assist them in regaining their functionality as well as control their knee pain. There is no magic bullet. The patient must come with the right frame of mind and not to expect a 'quick-fix'. With the use of a wide range of treatment modalities, we are able to gain very satisfactory results from most of our patients." explains Dr Goh.
"Patients who follow our clinic protocol show reduced pain frequency and intensity while improving their strength, flexibility and functional status such as climbing stairs as well as being able to do longer walks and runs."
In summary, there is definitely hope in the future management of osteoarthritis especially of the knee. While embracing a comprehensive range of advanced treatment modalities, such as the UnloaderOne Knee Brace, most patients will be able to attain satisfactory treatment which is less expensive than surgery, plus delay the need for it.