Experienced Orthopaedic Specialists Onboard Our Clinic

We like to thank all our patients for the support so far and to better serve you, we now have 2 experienced orthopaedic specialists onboard.

Dr. Ambrose Yung who is a specialist orthopaedic consultant with experience in partial knee replacement, complex primary total knee replacement, revision knee replacement, minimal invasive knee and shoulder sports surgery.

Dr. Fong Shee Yan who is an experienced Spine-specialised Orthopaedic Consultant in Singapore practising Minimally Invasive Spine Surgery.

Join us in welcoming Dr. Ambrose & Dr. Fong and feel free to contact us if you’d like to understand more about our Clinic

 

Knee Dislocation Surgery

Dislocation of the knee or more specifically the patella is a common knee injury that is typically caused by a sudden trauma in the form of a twist or direct hit on the knee, causing the patella to pop out of its usual position in the femoral groove towards the end of the femur. Knee dislocation will be accompanied by a sudden acute pain followed by periods of immobility leading to disability. In order to treat it, open or arthroscopy surgery will be required to repair the damages.

Almost immediately following injury, the extent of injury will be unable to be determined accurately due to the swelling and pain present. Therefore, surgery will not be recommended until a few weeks later. In the mean time, physical therapy will need to be performed in order to strength the thigh and quad muscles to provide a better support and prevent muscle wastage. Once the injured knee is strengthened and swelling has subsided, knee dislocation surgery can then be carried out and there are many types out there:

Bone realignment

In mild cases where the extent of injury is not severe and there is not much damage to the ligaments and tissues, bone realignment may be all that is needed. The tibial tubercle which is at the shin bone will simple have to be shifted and this will cause the position to be pulled towards the inner part of the knee.

Lateral Release

Lateral release is a common type of knee surgery performed to stabilise the patellar. When the knee is dislocated, it pulls the knee cap to the outside of the knee. Lateral release surgery seeks to cut the retinaculum in order to centre the knee cap back into the grooves.

Reefing

Reefing or medical imbrications is a surgical procedure performed with the intention to tighten the soft tissues that are located towards the inner portion of the knee. It is often done in conjunction with Lateral Release with the latter loosening the exterior part while the former tightening the interior part.

Trocheleoplasty

Trocheleoplasty is a less common surgery which works by deepening the grooves on the femur for the patellar. This will require the removal of some bone and increasing the depth of the grooves in which the patellar can then be held firmly in place with the aid of biodegradable stitches which will be reabsorbed into the body after a period of time.

Patellar dislocations can still happen after surgery but this is less than 5% of all cases. Patients are usually able to return to pre-injury level of activities after a couple of months if a disciplined recovery plan is followed religiously.

What Are The Advantages Of Minimally Invasive Surgery For Knee Replacement?

Knee replacement is a surgery that is commonly performed with the intention to replace a knee joint damaged due to degenerative diseases. More than half a million people undergo this surgery yearly and this number is set to increase. As its name suggests, minimally invasive surgery is a minimally invasive procedure that involves the usage of small incisions between 3 to 5 inches to carry out the surgery. Unlike its open surgery counterpart, the knee does not need to be cut open and stitched back post operation. This leads to a faster recovery time, shorter hospitalization and also better looking aesthetically. In this article, we will look at some of the advantages of minimally invasive surgery for knee replacement.

Medically, there are no significant differences between a traditional surgery and a minimally invasive surgery. Smaller incisions between 3 to 5 inches are made instead of 8 to 10 inches incisions with traditional methods. In traditional surgery, the quadriceps muscles as well as the tendons at the front of the knee and thigh are cut. In minimally invasive surgery, these two are spared and left untouched. Instead, 3 small incisions are made near the patella in order to insert a camera and robotic arms.

The main aim of minimally invasive surgery is to minimise trauma to the tissue by conventional surgery, leading to less pain, less unwanted injuries, less infections, shorter recovery time and lower cost for the patients. Patients typically require only half the time now to get rid of a walker and use a walking cane to move around. Most importantly, minimally invasive surgery has a higher success rate due to the usage of small robotic arms to aid the surgery. The surgeon is able to view high definition magnified images of the knee throughout the surgery. This will enhance the accuracy as well as ensure a higher success rate.

There are many advantages of minimally invasive knee replacement surgery compared to its traditional counterpart. However, minimally invasive surgery is not for everyone. Patients who suffer from knee deformity are better suited to the traditional type and repeat patients who had knee replacement surgery before will also require traditional surgery. Also, some artificial knee components may not be able to fit through the small incisions. Other than that, higher success rates, lesser pain and lesser trauma are the few strong unique selling points of minimally invasive knee replacement surgery.

How To Prevent And Treat Runner’s Knee?

What is Runner’s Knee (PFPS)?

Patellofemoral pain syndrome (PFPS) or commonly known by its nickname as Runner’s Knee is a common problem among runners. Due to the extended hours of pounding on the asphalt, the patella can be irritated when it rests on the thighbone. The pain experienced can be sudden and is often on and off. It can be felt before and after running, but not during the run itself. In this article, we’ll look at how to prevent and treat Runner’s Knee.

Causes of Runner’s Knee

One of the main causes of Runner’s Knee is due to the hard surface that runners run on. Most runners choose to run on pavements along the roads instead of stadiums or on grass surfaces. Although running on the roads may seem less boring and make the run more enjoyable, the hard surface is extremely bad on the knee.

Preventing PFPS

To prevent PFPS, you should run on softer and natural surfaces like turf. Running shoes also play an important role in the prevention of PFPS. A pair of cushioned and stability shoes provide great support to the knee, calf and ankles during the run and helps to absorb any shocks experienced by the leg. Recently, barefoot running has been the craze but this is still being debated. When we run barefoot, the foot can run naturally instead of being forced to in a direction when wearing shoes. This way, the load of the patellofemoral joint is reduced but instead, it creates additional stresses on the calf and Achilles tendon. So, instead of PFPS, runners may now suffer from calf or tendon Achilles pain.

Runner’s Knee Treatment

In order to treat Runner’s Knee, the simplest way is to cut back on your running mileage when you first experience pain and start to avoid activities that will involve working out the knee. As the pain subsides, strengthening exercises on the knees, quadriceps and hips should be performed in order to increase strength and flexibility to better support the knee. During the transitional period, you should still continue to work out your body using equipments that are less damaging to the knee such as the usage of a stationary bike or swimming.

Final Thought

To be honest, PFPS is not exactly a serious condition and it’s simply a chronic failure of tissues in the knee. Plenty of rest is required in order to prevent any further aggravation to the knee. If the pain gets unbearable, you may request for pain relief medication from your doctor to provide temporary relief.

How Do I Know If I Need Knee Replacement Surgery?

Knee replacement is considered a major surgery and there are many factors to consider first before making a decision. It is a question that cannot be answered easily. Rather, it requires you and your orthopaedic surgeon to sit down and ponder through all the possible options available to you before deciding on it. What exactly is knee replacement surgery? How do you know if you require knee replacement surgery?

Oral medications do not work

Your doctor will usually prescribe nonsteroidal anti-inflammatory drugs such as Ibuprofen or Naproxen Sodium to help make the pain more bearable and reduce inflammation. However, these drugs are only able to help counteract the pain to a certain extent and they do not treat your knee condition. You should not be consuming drugs for the rest of your life as they might harm your body. After a certain time span and it has no effect, surgery will be required.

Physical therapy has little effect

Oral medication will often be accompanied by physical therapy sessions. Physical therapy helps to build up the muscles around the knee, strengthening them so that they can better support your knee. It also helps to make the knee joint much more flexible and restore joint mobility. However, when this still does not help, surgery will be required.

Daily activities are limited

When simple daily activities are severely limited due to knee pain, surgery may be the only option left. You do not want your quality of life to be affected by your knee and there is always the option of knee replacement surgery. Some patients may not even be able to sleep as the pain will keep them up throughout the night. For others, simple actions such as walking may also be a chore.

You wish to engage in competitive sports

This is the most common reason for total knee replacement surgery. Athletes who wish to continue engaging in competitive sports will definitely require surgery to replace the damaged joints with artificial biomaterials in order to regain near full strength and mobility.

There are many reasons for one to undergo knee replacement surgery. Knee replacement surgery is a major surgery and requires one to consider many factors before deciding on it. It does not come cheap and for most patients, physical therapy and medication will usually suffice. If you are seeking a return to sports, knee surgery may be the only viable option for you.

2 Exercises to Prevent ACL Injuries

There are a total of four major ligaments in our knee whose function is to provide stability to the knee joint. One of the most important one is the Anterior Cruciate Ligament (ACL). There are numerous fibrous bands attaching the ACL to the bones and that helps to keep motion in check and prevent excessive ones. It also prevents the lower leg from going into hyper extension. Due to the many types of forces experienced by the ACL, it is much easier to be injured compared to the other 3 ligaments. In this article, we will look at some exercises that can help to prevent ACL injuries.

ACL injuries are the most common knee injuries. Every year, many people tear or rupture their ACL due to various reasons, with the most common being sports. When the ACL is extended to beyond its maximum capability, it ruptures. Unlike bones that can heal on its own over time, ligaments do not heal on its own and once it is damaged, it will be permanently damaged and will require surgical means to aid in a full recovery. Situations where the ACL can be ruptured usually involve sudden directional changes or deceleration. In soccer, it can be as simple as a sudden change in direction to shield the ball from an opponent, with a hard twist while the studs of the boots are still firmly in the ground, causing the knee to twist and rupturing the ACL.

Lateral hops

Lateral hops simulate jumping and landing actions which are extremely common in almost every sport and is one of the major causes of ACL injuries. The body is designed in a way where the knee will cushion the impact from any jumps and hence it is important to “teach” our knee muscles how to properly absorb shocks. The main idea of lateral hops is to cultivate a good landing technique and thus it is important to land firmly on the ground without any shuffling actions.

Leg balance squats

Leg balance squats as the name suggests help to cultivate balance in the legs. It drives the legs forward and a quick switch to the other, creating a chain reaction. This way, the body can easily drive one leg to the side in order to work the hips and lower extremities to provide balance to the body when faced with any trauma, reducing the chances of an ACL injury.

Since our body is designed as a linkage system where every muscle group contributes to the control of the knee and the ligaments, a total body core muscle strengthening program should be put in place to help prevent ACL injuries.

5 Types of Orthopaedic Impairment

Orthopaedic impairments are impairments to the body which can cause a huge amount of disturbance and affect the quality of life you can achieve. It is a disability that may affect the ability to sit or walk. However, orthopaedic impairments may be treated with conventional treatments such as surgery and physiotherapy. Aids such as crutches, splints, braces and wheelchairs can also greatly improve the quality of life.

Osteomyelitis

Osteomyelitis is a chronic disease that affects the bone and joints and is triggered by bacteria. It will slowly “eat” away and destroy the bone and joints. Due to the presence of bacteria and infection, pus will be produced by the body’s immune system and this will cause discharges with bad odour. Osteomyelitis is often introduced by actions which we least expect. Walking barefooted outdoors may cause slight abrasions and bacteria can enter the body from those places. If osteomyelitis is not discovered and treated early, reconstructive surgery will be required.

Cerebral palsy

Cerebral palsy is actually a group of chronic medical conditions that affects the body’s motor conditions. It will lead to the inability for body movements, muscle tones and coordination. In serious cases, it will cause the patient to lose their mental capabilities. Cerebral palsy is due to damages to the brain that usually occurs while the baby is still in the wound. It can be caused by injuries or deformities.

Spinal tuberculosis

Tuberculosis is a deadly infectious disease and when it happens in the spine, it will slowly but surely destroy the backbone and nerves. During the process, it will cause huge physical impairment and can be deadly if it is not treated properly. Spinal tuberculosis can be easily recognised by the thickening of chest after experiencing a sharp bend at the backbone region.

Cleft lip

Cleft lip is an extremely common deformity. During the development of the body, different parts of the face are being formed on its own and the body will naturally fuse them together. Cleft lip occurs when the fusion between the maxillary and medial nasal process does not happen successfully, causing a cleft to form.

Angular bone deformity

Angular bone deformity or simply bending of the bones above the knee is caused by a variation in the normal growth pattern. Angular deformity will cause knock knees or bow legs that will become worse as the child grows. Eventually, he will have problems walking and this will cause an unavoidable joint damage over time.

Childhood Obesity and Musculoskeletal Problems

Obesity is an ever increasing global problem that results in an increase in the risk of contracting diabetes, hypertension, cardiovascular diseases and musculoskeletal disorders. This is especially so in children as the obesity rates are rising at a shocking rate. Studies have concluded that overweight and obese have double the risk of suffering from musculoskeletal disorders compared to children who are fit and healthy. Is there any way to combat this problem and what exactly is the link? Let’s discuss about this in the article below.

Childhood obesity and musculoskeletal problems are influenced by the morphology of the development of connective tissues such as ligaments and tendons. Children who are less active will have a reduction in cartilage accrual and this is associated with obese kids who are less inclined to participate in sporting activities. Childhood time is the most crucial for body development including the hips and knees. A reduction in cartilage accrual led to an externally rotated lower limb due to the need for the lower body to support the added weight. An increase in body weight also affects the knee alignment directly. Obesity is linked to Blount’s disease due to the biomechanical overload of the proximal tibial physis. Obesity also leads to a decrease in bone density. Biomechanical factors affects bone metabolism and it is the childhood period where the strength and quality of bones are often decided. This can lead to long term complications when transiting into adulthood.

Obesity also leads to an increase in musculoskeletal pain. There is a clear relation between increased weight to pain and this is due to biomechanical changes in obese kids resulting in compensatory mechanisms for the body, causing it to misalign joints to better support the body. There have been reports of increases in fracture cases for obese children lately. In fact, the fat mass protects the hip and vertebral from fractures but increases the chances of fracture at the ankle and humerus. Parents should advise their children to take in Vitamin D and minerals supplementation to build strong bones.

The increase in the number of obese children is shocking and of concern since there is a direct link between obesity and musculoskeletal problems. It is important for parents to monitor the nutrition level of the foods provided and restrict excessive intake of junk food. Parents should also engage in sports with their kids to promote a healthy lifestyle from young.

The Relationship between Flips Flops and Arthritis

Arthritis or osteoarthritis is a joint disease that can occur anywhere in our body. Although it is more commonly found in people who are older, it still can happen in younger people. Arthritis will happen in people who bear a lot of weight on their joint. In Singapore where the weather is always hot and rainy, flip flops are the ideal choice of footwear for many due to the comfort and convenience. However, some people suggest that flip flips and arthritis have a relationship. So what exactly is this relationship? Let’s explore further in this article.

If you look closely at your feet, you will realise that our foot lands differently when we wear flip flops compared to a pair of shoes. Shorter steps are made when wearing flip flops and the heel strike amount is significantly reduced. When we wear normal shoes, our toes are flexed in an upwards direction. However with flip flops, the toes are flexing downwards instead in order to keep the flip flops on our foot. This incorrect flexing motion can cause the body mechanics to be affected due to wear and tear of the cartilage, causing pain and discomfort.

However, there are differing views on this! A medical study performed by Rush University discovered that flip flops help to reduce the amount of stresses experienced by the knee as compared with a pair of supportive and well cushioned shoes. A pair of supportive footwear works by providing maximum support to the ligaments, tendons and muscles in the foot and aim at maximising comfort. However, it pays little attention to the biomechanical effect on the foot. Shoes have a significantly higher load on the knee as compared to flip flops and this increased load is found to be a cause of arthritis. That aside, walking barefoot was found to be the least demanding action for the knee. Walking barefoot causes the foot to flex naturally without any external help and allows a natural stride as compared to artificial ones caused by wearing shoes or flip flops.

Despite flip flops appearing to be better at reducing arthritis on the surface, it does not mean that you should rush out and buy a pair to walk around daily. While flip flops are better for the knee, it is not best for the foot. Flip flops are badly cushioned and can cause foot injuries and problems.

3 Things to Expect During a Physical Therapy Visit

It’s not surprising that you are a headless chicken with regards to a physical therapy visit. No one wants to go for it if ever possible. If you are a greenhorn, you must definitely be curious about what you will be doing and prepare yourself for it. Firstly, you must know that a physical therapy visit non-surgical and there is no need to worry about needles and blood. The one and only aim of your physiotherapist is to bring you back on the road to recovery. So what are some things to expect during a physical therapy visit?

Initial evaluation

The initial evaluation part of the session is the most important. It gives the therapist a full picture of your past lifestyle, your cause of injury and what you wish to achieve in the future. This way, your therapist can then design an efficient programme for you in the most suitable timeframe and physical level. If your goal is just to be able to walk properly after a knee surgery for example, he will simply prescribe you exercises to strengthen the core muscle groups to provide stability. However, if you intend to go back to competitive sports post surgery, the plan will be totally different. This part will also include your medical history which can affect your recovery progress.

Treatment

After a proper warming up session, you will start to perform exercises designed specifically for your condition. A post knee surgery patient will need to perform balancing as well as stability exercises to strengthen the surrounding muscles so that they can bear the weight better. Some common exercises would be the leg press and stairs. Stretches will also be performed with the intent of achieving a full range of motion at places such as the knee and elbow joint.

Review of session

After a proper cooling down session, your physiotherapist will then sit down with you for a review of your physiotherapy session. Throughout the session, he is busy noting down the amount of weight you can bear, degree of motion as well as your flexibility. A good therapist will go through these figures with you so that you know whether you are improving or lagging behind. He will also inform you what to expect during the next session and prescribe you some exercises you can do in the comfort of your own home.

A physical therapy session is actually fun and enjoyable to the patients. Although it may be physically tiring at times, patients are given exercises which are manageable to them and they are able to review their progress at the end of each therapy.