​There is growing concern over the increased prevalence of knee arthritis in the younger population. This could largely be attributed to the more active lifestyles people currently prefer, as well as the rise in popularity of vigorous sporting activities enjoyed by adolescents.

For these patients, the current treatment option is largely limited to arthroplasty, which is costly and has a finite lifespan. Knee preservation osteotomy surgery can be a viable and more cost-effective option for the younger population in dealing with this emerging issue.

Knee osteotomy has gained increasing popularity since the introduction of new techniques and implants in the early 2000s. This knee preservation operation improves function, quality of life, and the rate of return to sporting activities.

PREVALENCE OF KNEE ARTHRITIS IN SINGAPORE

In 2007, the Ministry of Health’s (MOH) National Health Surveillance Survey found that about 10% of Singaporean adults aged between 18 and 60 are reported to be suffering from arthritis or chronic joint problems.1

Looking to 2020 and beyond, this figure is set to increase significantly due to our active lifestyles and demands.

WHY KNEE PRESERVATION OSTEOTOMY?

In recent years in Europe, South Korea and Japan, there has been a surge in knee preservation osteotomy surgeries utilising improved techniques and implants.
In Singapore General Hospital (SGH), we are adopting and modifying best practices available to suit our local population, in particular:

Techniques
With computer-aided planning, we are able to plan the surgery precisely in terms of the location and amount of correction needed to achieve optimal knee alignment and function.

Better understanding of the philosophy of knee preservation enables us to create stronger and safer constructs, hence allowing patients to recover faster to premorbid status.

Implants
New smaller and stronger implants from Europe enable us to perform the osteotomies in a minimally invasive manner, resulting in less pain and disability stoperatively, and faster recovery.

Benefits
With these vastly improved techniques and implants, patients can expect to:
a. Stay in the hospital for 1 to 2 days
b. Return to work within 2 to 3 months
c. Return to sports and make a full recovery within 3 to 6 months, depending on the extent of preoperative arthritis and amount of correction performed

Other benefits of joint preservation knee surgeries include:

Firstly, the cost of osteotomy surgeries is about 20 to 30% cheaper than that of arthroplasty with equivalent outcomes. Moreover, arthroplasty has a limited lifespan of about 15 to 20 years, therefore making joint preservation surgeries more cost-effective in the long run.

Secondly, knee osteotomy can delay or stop the progression of knee arthritis in the younger population, and allow patients to return to an active and vigorous lifestyle.

Thirdly, knee arthroplasty in young patients will lead to early revision due to wear and tear of the prosthetic joint, from higher activity levels and longer life expectancies. If the patient requires further revisions in future, it would be costlier in terms of longer hospital stays and utilising more expensive arthroplasty implants.

THE JOINT PRESERVATION OSTEOTOMY SERVICE IN SGH

Anticipating this increasing prevalence of knee arthritis in the younger population, SGH’s Department of Orthopaedic Surgery established the “Joint Preservation Osteotomy Service” in July 2019 to tackle this emerging condition.

Setting up a dedicated joint preservation osteotomy service helps to raise awareness amongst the public and healthcare providers that there is a viable option in tackling an arthritic knee.

Increased Efficiencies
With this service, our surgeons are able to create an efficient perioperative workflow, thus reducing hospitalisation stays and costs, and enabling patients to regain their premorbid functionality faster.

This includes standardised preoperative assessments and investigations, and postoperative management and care.

Improved Outcomes
A critical outcome of knee osteotomy is survivorship, which is defined as the duration that the osteotomy remains in situ without conversion to knee arthroplasty. Focusing on medial opening high tibia osteotomy, which is a newer technique that SGH currently adopts, studies2 show that:

a. At 5 years, survival range varies from 94 to 99%
b. At 10 years, survival range varies from 84 to 92%

With these promising survival rates, knee osteotomies can substantially improve the outcomes of the knee joint, and ultimately patients’ quality of life.

 

​CASE STUDY

To treat his symptomatic arthritic knees, a male patient in his 50s opted for knee preservation osteotomy surgery.

 


CONCLUSION

With improved techniques and implants, knee osteotomies represent an excellent surgical joint preservation option for arthritic knees with good long-term survivorship results.

REFERENCES

1. National Health Surveillance Survey 2007. (2009, January 1) Ministry of Health. https://www.moh.gov.sg/docs/librariesprovider5/resourcesstatistics/reports/nhss2007.pdf?sfvrsn=3437dfc_0
2. Improved Methods to Measure Outcomes After High Tibial Osteotomy. Lorbergs AL et al. Clin Sports Med. 2019 Jul;38(3):317-329.

Dr Lee Kong Hwee is a Consultant with the Department of Orthopaedic Surgery at Singapore General Hospital (SGH). He sub-specialises in knee surgeries, with particular interest in knee preservation, such as complex osteotomies and ligament surgeries.

In 2018, he did his HMDP knee preservation fellowship in London with Professor Adrian Wilson, who is a renowned pioneer in knee osteotomy. Under the mentorship of Prof Wilson, Dr Lee learned numerous novel techniques in knee joint preservation, which gives his patients more options in treating their knee conditions.

Medical professionals who would like more information about this procedure, please contact Dr Lee at 9666 2237 or lee.kong.hwee@singhealth.com.sg.

GPs can call for appointments through the GP Referral Hotline at 6326 6060.