Preventing knee pain in Singapore

THEY say there's no gain without pain, but what happens when the pain becomes too much to bear?

As the number of high-achieving professionals who engage in extreme sports or work out regularly to keep fit grows, so too does the risk of injury and chronic pain conditions. But taking precautionary steps can make exercise as safe and beneficial as they are meant to be, says orthopaedic surgeon Henry Chan of HC Orthopaedic Surgery.

In his practice, Dr Chan notes that five to 10 per cent of his patients are top managers in their 50s who take part in marathons or triathlons, and skiing or snowboarding in the winter months. He also sees quite a few patients in their 30s who engage in MMA or Muay Thai.

It's important, he says, to be aware of the risks that accompany each specific sport. Take running for example, where knee problems are the top issue. "Humans are like cars and the knees are like the tyres, so wear and tear problems come with all the 'extra mileage' clocked up. MMA is a highly combative sport, so we see a lot of problems like torn knee ligaments, shoulder dislocations or even open fractures (where the bone breaks and protrudes from the skin). For skiing and snowboarding, people may think it's 'safe' because snow is so soft and fluffy but it actually can cause a lot of injuries (especially for Singaporeans used to tropical weather) such as torn ligaments, wrist and ankle fractures, even head or cervical spine injuries."

Many injuries are also due to overexertion and inadequate training, adds Dr Chan. "They tend to happen during the 'last game' or the 'last ski', when you are exhausted and your muscles completely fatigued. That's when freak accidents happen." Weekend warriors who are sedentary during the week but play aggressively on the weekend are also at risk because their body conditioning and stamina are not strong enough to keep them going, unlike those who work out regularly.

Although he is a surgeon, Dr Chan recommends surgery only after he has exhausted non-invasive options. He illustrates this in the case of two patients - one sedentary and one active - who both tore their anterior cruciate (knee) ligament, but were treated differently.

The first was a radiologist who injured herself in a skiing accident in Hokkaido, but did not undergo surgery. "She was managed conservatively with a brace and now even continues to go jogging."

In turn, his other patient tore his ligament during a rugby game but didn't want to give up playing. "So we reconstructed it using a minimally invasive technique. He has since returned to the game and resumed training to be an orthopaedic surgeon."

Still, even if surgery is required, technological advancements in computer navigation and robotic surgery offer a level of precision that is impossible for humans to achieve, particularly in knee replacements. With 3D printing technology, "patients undergo a pre-op MRI scan of the lower limb, allowing the sizing, positioning and alignment of the implants to be pre-determined. The (resulting) moulds fit onto the patient's knee joint anatomy perfectly, and allow the surgeon to perform the knee replacements quickly and accurately."

As for robotic surgery, it allows surgeons to make micro adjustments right down to 0.25mm and 0.1mm, which is humanly impossible. "This way, we can make sure we put the implants in the optimal position in every patient every time". He should know, since the Hong Kong-born and Singapore-trained Dr Chan has performed over 1,000 joint replacements to date.

While prevention is always better than cure, age-related degenerative joint diseases such as osteoarthritis and osteoporosis are inevitable in a rapidly ageing population. But it's not the end of the world, says Dr Chan. "I always tell my patients, don't let your golden years become the painful years. Osteoarthritis is not incurable, so don't let it ruin your life. There are many ways to treat it."

Medication, physiotherapy and lifestyle changes can help early osteoarthritis while viscosupplementation (intra-articular injection of hyaluronic acid) offers six to 12 months of relief for moderate cases. For severe osteoarthritis where the lower limbs are severely misaligned or when knee pain is unresponsive to conservative treatment, then knee replacements are the only long-term option.

While osteoporosis is another silent elderly killer in Singapore with one in three hip fracture patients likely to die within the first year, technological advancements mean that the illness can be treated and fracture risks minimised. "We would recommend a new anti-osteoporosis injection treatment called Prolia - a six-monthly injection that is more efficacious than the previous generation of medications," says Dr Chan.

Chronic pain and bone injury are part and parcel of life, but if treated and managed properly, one can live a pain-free life, says Dr Chan. "It brings great joy to my heart to see my patients walking normally again, to enjoy life without any pain."

HC Orthopaedic Surgery is at: 3 Mount Elizabeth #15-14 Mount Elizabeth Medical Centre. Tel: 6732 8848. http://www.hcortho.sg/. Email: drhenry@hcortho.sg