SGH orthopaedic surgeon Dr Chia Zi Yang says every patient is unique so a one-size-fits-all treatment cannot be used for everyone.

When his dog had a dislocated hip, Singapore General Hospital (SGH) orthopaedic surgeon Dr Chia Zi Yang decided to treat it himself instead of having it undergo surgery to excise the hip. Using orthopaedic principles, he applied traction to ease Sumo’s hip back into the socket.

The creativity in applying his medical knowledge and skills to treat his pet extends to his work on the group of adults who see him for largely sports-related injuries.

As Singaporeans take a greater interest in physical activity, some of which can be strenuous, they are also finding themselves with knee and other joint injuries. Bad knees, for instance, used to be an age-related problem, but his patients are increasingly “youngish middle-agers”, he said.

“Our patients come in with different profiles and enjoy different levels of activity. There are many kinds of requirements so treatment is tailored to each person,” said Dr Chia, Consultant, Department of Orthopaedic Surgery, SGH. “When the patient comes to hospital for treatment, he doesn’t want to feel he’s entering a factory. He appreciates having the doctor understand his problems and then customise a medical solution to his problem. With a wide array of treatments, picking the right one or a combination can help the patient reach a good outcome and keep the knee that he was born with.”

Dr Chia specialises in osteotomy knee preservation, and underwent fellowships at the US’s University of Pittsburgh Medical Center and France’s Assistance Publique Hopitaux de Marseille to further hone his skills in sports medicine. He focused on the soft tissue and bony components of the knee at the US and French centres respectively.

For joints like the knee to work properly, having a stable foundation — the bony structure of the joint — is needed, Dr Chia said. “So my time in Marseille was spent learning how to spot the bony problems and bony solutions, how to have a balanced platform on which the soft tissues can then be added on and corrected accordingly,” he added.

He likens joints to a car where if all the weight is placed on one side, the wheels on that side would get worn out more quickly. Similarly, when walking, a bow-legged person places pressure on one side of the knees, wearing out that side more over time. The surgeon’s job would then be looking at balancing the joints through surgery or other treatments.

The practice of sports medicine is different from those overseas centres. In Pittsburgh, the sports medicine team looked after professional athletes who had their own medical teams comprising surgeons and therapists, not unlike Formula 1 car racing with their teams of state-of-the-art mechanics. Dr Chia hopes to bring this team-based emphasis on peri-operative care into the treatment of orthopaedic patients in Singapore.

During his fellowship training, Dr Chia also learnt about the US and French health systems as well as their cultures and lifestyles. “In Marseille, people go hiking in the mountains on the weekends. But in Singapore, we tend to hike in the next best thing with air-conditioning — our malls,” he said. He noted, though, that the healthier lifestyle is starting to be replicated, with more Singaporeans exercising more and adopting more sports-related hobbies like cycling.

As more patients seek treatment earlier, many are not ready for a joint replacement. Instead, they look to knee preservation options in this dynamic and innovative field. Dr Chia sees his role as helping patients pick the best a la carte option.

Dr Chia also works on developmental projects for which he has won $700,000 in grants. One is an implantable spacer device for patients with early knee arthritis. Still in its developmental phase, the device uses a principle similar to the padded cushion in Nike Air sneakers — except that his device is in the knee rather than the shoe.

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