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Knee pain affects close to a quarter of the population in Singapore. To date, knee pain continues to be the most common musculoskeletal complaint in Singapore. According to the Singapore Burden of Disease Study 1972-1999, knee pain is the biggest contributor to the “can’t walk nor climb stairs” category. It also contributes to loss of mobility and affects the ability to participate in activities of daily living and employment. Due to the significant impact of knee pain in our lives, there has been an increase in the number of healthcare professionals specifically specializing in knee care. These professionals generally consist of orthopedic surgeons and rehabilitation physicians who specialize in managing patients afflicted with knee problems. There are also many healthcare professionals who treat knee pain on a part-time basis or may further their sub-specialty in knee care. This may include family physicians, rheumatologists, and physiotherapists. The purpose of this guide is to assist you in finding the most appropriate healthcare professional or specialist to deal with your knee problem. This guide will outline who the knee pain specialists are, their scope of practice, and how best to find a specialist most suited to your needs. Orthopedic surgeons are medical doctors who have completed postgraduate training in orthopedics and specialize in the treatment of musculoskeletal conditions like bone, joint, ligament, muscle, tendon problems, and joint replacements. They sub-specialize in different areas of orthopedics and some manage various musculoskeletal conditions, including knee problems. They are capable of making an accurate clinical diagnosis and use investigations for a variety of knee conditions. They are also trained in various forms of medical, surgical, and rehabilitative methods of treatment for the many musculoskeletal conditions that affect the knee. Following their management of your knee problem, there are some who might even consider a total knee replacement from them.
Overview of Knee Pain Specialists
When knee pain gets in the way of your daily activities, it may be time to see a knee pain specialist. With the number of knee pain specialists present in Singapore, choosing the right one can be a daunting task. Orthopaedic surgeons are doctors who specialize in bone and joint problems and are well-suited to treating knee pain. Some orthopaedic surgeons may sub-specialize in the treatment of knee conditions. Rheumatologists are internal medicine specialists who have a particular interest in the immune system and autoimmunity. They are well placed to diagnose and treat systemic causes of knee pain. Sports physicians are doctors who have completed general post-graduate medical training with a specialist training in sports medicine. They are well-suited to managing sports injuries to the knee. Physiatrists are doctors who specialize in physical medicine and rehabilitation. They often sub-specialize in areas such as sports medicine or pain management. On the more conservative side, there are family physicians and general practitioners who manage a wide variety of medical conditions. At the paramedical level, there are physiotherapists, occupational therapists, and podiatrists who are trained in specific interventions for knee pain. With such a variety of knee pain specialists available, it is important to choose the right kind of specialist depending on the nature of your knee condition, as well as keeping in mind the specialist’s experience in treating your condition.
mportance of Seeking Specialist Care
A year later, Miss Ngiam is very pleased with the result. The pain in her knee disappeared one month after the operation and has never returned. She is now able to walk for exercise and climb stairs, which she was previously unable to do.
Miss Ngiam, a 68-year-old lady, was told that she had bow legs but was not given any treatment for this. Eight years later, she developed wear and tear arthritis on the inside of her knee. She then saw a knee specialist who explained that the alignment of her legs had caused uneven loading on the inside of her knee and that if this was corrected, the pain would disappear. A simple knee brace would be insufficient treatment. A special osteotomy (bone cut) would be needed to realign her leg and offload the damaged part of her knee. She had complete trust in her knee specialist and proceeded with the surgery.
Clinics that specialize in knee pain treatments are well equipped to provide solutions for nearly all types of knee pain. Early diagnosis is important to avoid unnecessary complications. Clinics are staffed by specialist doctors and supported by on-site x-ray and ultrasound imaging. Your consultant will take a detailed history of your knee problem and then perform a thorough examination. This will be followed by an explanation of what the problem is and how best it should be treated. Whether the problem is simple or complex, the explanation should be understandable.
Top Knee Pain Specialists in Singapore
Dr. Kevin Lee obtained his medical degree from the National University of Singapore. He then pursued advanced specialty training in the UK and Australia and obtained his Fellowship of the Royal College of Surgeons of Edinburgh in 2000. He then sub-specialized in knee and sports surgery in the year 2002 and spent a year-long fellowship working with world-renowned knee surgeon, Dr. John Bartlett at the University of Western Australia. In September 2007, Dr. Kevin Lee received the Health Manpower Development Plan HMDP award by the Ministry of Health to undergo further training in the latest techniques in keyhole surgery and cartilage transplantation in the knee at the University of Pittsburgh Medical Centre, USA.
The first specialist highlighted in this article is Dr. Kevin Lee. Dr. Kevin Lee is a prominent consultant at the Orthopedic Department in the Singapore General Hospital. He is also the Chief of the Orthopaedic department at the Campus of the Outram Division.
Specialist 1: Expertise and Qualifications
Specialist 1 qualifications: He qualified from Liverpool University in 1986 and has 24 years of experience in treating knee problems. He became a fellow of the Royal College of Surgeons of England in 1991. After basic surgical training in Liverpool, he carried out higher surgical training in traumatic and elective orthopedics in the South West. He spent a year on an overseas fellowship specializing in knee and hip surgery before being appointed as a consultant in trauma and orthopedic surgery at the RD&E in 1998. He has…
He is a member of the specialist training committee in trauma and orthopedic surgery and is Director of Medical Education in the department of orthopedic and trauma surgery at the Royal Devon & Exeter Hospital. He has been an honorary lecturer at the University of Exeter for over 10 years and been involved in teaching medical students and postgraduate doctors of various specialties. He has an interest in postgraduate education and is involved in the development of web-based learning for surgeons.
Specialist 1 is a surgeon who has an interest in healthcare management and has been working to improve healthcare in the United Kingdom by working with NICE and the British Medical Association. He has spent several years researching knee problems and their impact on people’s lives. He has published many papers and original articles in medical journals, national publications, and has presented his research nationally and internationally. He has been invited to speak about knee surgery and knee problems in various countries.
Specialist 2: Experience and Specializations
This sub-specialty mainly involves the treatment of knee ligament and cartilage injuries, which can lead to chronic joint degeneration as well as early onset of degenerative joint disease in young and active individuals. This can be quite disabling, and the early use of Unicompartmental knee replacements has been shown to be favorable compared to high tibial osteotomies in selected cases. Full knee replacements have been associated with a high incidence of clinical failure and revision surgery in relatively young and active adults. There have been continuous improvements in the results of partial knee replacements, and this would be a treatment of choice for these patients in the next decade.
This specialist is a knee surgeon in Mount Elizabeth Hospital and also a visiting consultant to the Singapore General Hospital. He received a scholarship to study medicine at the National University of Singapore. After that, he completed his orthopaedic training and obtained his Master of Medicine in Orthopaedic Surgery. He was an HMDP scholar and underwent further training in the subspecialty of knee surgery. He visited centres of excellence in the United States and Europe, including the Hospital for Special Surgery, the Insall Scott Kelly Institute, and the University of Western Ontario. He has a special interest in Partial Knee replacements, Patellofemoral disorders, and Patella instability. His further sub-specialty training in Knee Surgery was obtained under Professors John Bartlett and John O’Donoghue in London, Ontario. He has pioneered the Unicompartmental knee replacement in Singapore and is one of the few Asian surgeons experienced in this procedure.
Specialist 3: Innovative Treatment Approaches
This specialist has a cranial cruciate ligament repair in dogs using a method called the Lateral Suture Stabilization. This is an extracapsular repair method that involves using a strong suture material to stabilize the knee joint by running it around the fabella of the femur, through a hole in the neck of the tibia. This effectively bypasses the need for postoperative cage rest to allow for fibrosis, as bone and suture anchor provide a very stable fixative point. This ensures a rapid return to function and provides a better outcome for dogs of all sizes and activity level. Another area of special interest is managing arthritis in the knee joint. We often see patients from middle age to geriatric, who may not be suited candidates for surgery or who aspire to have a conservative treatment option. We offer both medical management (pain relief, disease-modifying osteoarthritis drugs) as well as Platelet Rich Plasma injections into the joint. A newer and very exciting neovascularization technique for humans with arthritic joint pain and regenerative tendinopathy is using an ultrasound-guided injection into the affected area called high volume injection therapy. This involves injecting saline solution quickly to open up delta in the tissue through high-pressure infiltration. This will then attract inflammatory mediators, anabolic factors, and cells to facilitate collagen repair and tendon regeneration. This technique is currently in clinical trials in Australia, and if shown to be effective, would be a very useful and low morbidity treatment option for arthritic tendinopathy in dogs and horses.
Choosing the Right Knee Pain Specialist
There are several factors to consider when it comes to choosing the right specialist. These include the nature and severity of the injury, the sport that the patient plays, and the age of the patient. Often, a family physician will make a referral to the right specialist. Other times, the individual has to make this decision on their own.
Factors to consider:
The right specialist is often a sports medicine doctor or orthopedic surgeon. Before deciding on the right specialist, a correct diagnosis has to be made to ascertain the origin of the knee cap pain. This is important as the treatments may be different for the various conditions causing the pain. For example, a dislocated knee cap will require different treatments compared to excessive loading of the knee cap. Osteoarthritis of the knee is another condition that may cause knee cap pain. In an older patient with knee cap pain and arthritis, the options may be limited to anti-inflammatory agents or care for the knee cap.
What kind of knee pain specialist can provide knee cap treatment for a dislocated knee cap?
Factors to Consider
Availability of the specialist is crucial when considering who to see, an appointment with a reputable and experienced specialist may require a longer wait. This is reasonable if it is a non-urgent situation. However, he should be taking the necessary time to monitor and evaluate your progress. More serious conditions such as fractures, ligament and meniscus tears or recurring dislocations requiring surgical treatment would need closer attention. This may mean considering a private specialist who will have more time compared to a public sector specialist with a busy schedule.
Avoid jumping straight into a decision without proper consideration. A Lokun suggests that deciding on a knee pain specialist should be considered an interview to determine who is the best fit. He advises to get recommendations from family and friends. People who you know are comfortable performing the procedure you are looking for. Board certification and fellowship training indicates a specialist with a serious interest and an excellent standing in that particular field. Make sure you feel comfortable around the specialist and that he/she takes your concerns seriously. A good specialist should perform a detailed examination, ask you for your full medical history and explain in detail the cause of the problem. They should also explain all possible options of treatment and make clear recommendations as to which would be the most effective.
Evaluating Credentials and Reviews
When evaluating a healthcare provider’s competency, education and experience are important things to consider. Some of the things you might want to consider include where they went to school, what year they graduated, what kind of experience they have, and how recent it is. Board certification is also an important factor to consider. It ensures that your doctor has completed the necessary education and training to practice a given specialty. It also shows that they are committed to their practice by completing a rigorous exam. To maintain their certification, they must regularly demonstrate their clinical knowledge and performance. Board certification can be verified through the Singapore Medical Council (SMC) or through any of its specialty/subspecialty colleges. Currently, just 2 of the 39 registered knee specialists in Singapore are certified under the Orthopaedic Surgery specialty. Board certification is important, but note that the lack of certification does not indicate incompetence. There are also well-qualified doctors who, for some reason or another, never became certified. Stepwise qualification can also be an important factor for some patients and is generally associated with a doctor’s age. This can be particularly relevant for younger patients or elderly patients with multiple existing co-morbidities.
Accessibility and Availability
You should also consider whether you will need to see specialists other than an orthopedic doctor. It is fairly common for knee pain to stem from or result in back problems. In order to determine the best course of treatment for knee pain, you may find yourself needing to consult with a rheumatologist or a physical therapist. If it is not feasible for you to see multiple doctors, you may wish to find a knee pain specialist who is well-versed in a variety of different treatments. A doctor who is affiliated with a larger medical group will have a greater chance of recommending you to other trustworthy specialists.
A knee pain specialist may be too busy or located too far away to give you proper treatment. It is important to have an idea of which doctors will be most accessible to you. If you have to take off work or spend a lot of time in transit to see a doctor, this may end up influencing your treatment. Most doctors will be able to accommodate new patients within a week or two. If you anticipate needing urgent treatment at any point, this is something to consider when choosing a doctor. Some doctors are willing to make special accommodations for urgent cases, while others are not equipped to handle them.
Cost and Insurance Coverage
For an accurate breakdown of cost and coverage, it may be necessary to schedule an appointment with your insurance agent. At the knee pain specialist‘s end, clinic staff may not always have detailed knowledge about the criteria for knee pain treatment claims. It is advisable to check with the insurance company directly or through its website for further information. Do note that Medisave and Medishield have similar considerations and limitations. A comprehensive referral letter by the knee pain specialist will help in processing claims.
Unfortunately, healthcare insurance and hospitalization means are not a surefire way to offload the cost of seeking treatment for knee pain Singapore. Knee pain is often considered to be a chronic problem, and as such, insurance companies and Medisave have various restrictions and sub-limits when it comes to claims. Pre-existing conditions, in particular, may not be covered. Therefore, it is important to be well-informed about the various terms and conditions in your insurance policy and the exact coverage that you are eligible for.
