In recent years, Singapore has fostered an atmosphere to promote new technologies. The medical field has been no exception, as the push for continual improvement is in line with the goal of becoming a global standard for health care. The work being done in the field of medical imaging in knee pain Singapore perfectly exemplifies this notion of progress. High-field magnetic resonance imaging (MRI), is now capable of providing exquisite soft-tissue detail up to the resolution of histology. Dual-energy x-ray absorptiometry (DEXA) has been used to provide a non-invasive means of measuring bone mineral density, a vital tool in assessing osteoporotic fracture risk. Singapore has played a huge role in the area of image processing and its applications to orthopaedics. From the development of all digital, web-based musculoskeletal image archives, to the creation of visual biofeedback systems using functional MRI, it is apparent that this will soon be a new age in how the musculoskeletal system is assessed.
In the past, musculoskeletal radiographs were taken infrequently. The x-ray machine and cassettes were large and cumbersome. They required special storage accommodations and, as a result, were not easily accessible. When a film was posted, the focus was on the image. Little thought went into the process itself, and its impact on image quality. Fluoroscopy had been used in some procedures for quite some time, but the capabilities of early machines were severely limited and the image quality was relatively poor. Radiographic positioning and the techniques used to examine patients had not changed dramatically since the discovery of the x-ray. Then came computed radiography (CR). This may have been the tipping point with regards to imaging’s contribution to orthopaedics. The ability to view an image within seconds of exposure, and to repeat that view at the push of a button was revolutionary.
Advanced Techniques for Knee Pain Treatment
Robot-assisted knee surgery, using the da Vinci Surgical System, is a type of minimally invasive surgery. Surgeons make smaller incisions by using this method, leading to a smaller scar on the patient. An advantage of the da Vinci Surgical System over hand-assisted minimally invasive surgery is that the surgeon can sit away from the operating table, operating from a computer console, guiding the robotic arms that actually perform the surgery. The robotic arms are able to move in ways that human hands cannot, filtering out any tremors to ensure that the surgery is precise. This system is most commonly used for treating an early to mid-stage knee osteoarthritis. Unloader or offloader knee braces, or a knee wedge, can be used to shift the weight off one side of the knee to the other and are perfect candidates for this type of knee surgery. Because this is a relatively new surgical procedure, there is potential for more developments in robotic knee surgery in the future.
Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Most knee surgeries can now be performed arthroscopically. During arthroscopy, a small incision is made in the patient’s skin and then pencil-sized instruments are inserted into the incision. These are used to view the joint, remove any debris, and/or repair any damaged tissue. Arthroscopy is not for everyone, but it can be very effective for those people who suffer from degenerative joint disease, meniscus tears, ligament damage, and for removal of Baker’s cysts. Unfortunately, those people with severe rheumatoid arthritis and with an infection in the knee would not be considered good candidates for the arthroscopic procedure.
Arthroscopic Surgery
The perfect arthroscopic prospect is a client who not just has discomfort or useful constraints in their knee, however likewise an issue that has actually not reacted to more conservative treatment choices. It is likewise perfect to have a client with a clearly identified, localised single (or perhaps two) compartment pathology. Because arthroscopy is a strategy based on visualisation, the much better we can see exactly what is incorrect, the most likely we are to be able to repair it. Problems such as unclear discomforts or pains or multi-compartmental osteoarthritis are much more difficult to deal with.
First of all, anybody thinking about arthroscopic surgical treatment needs to comprehend what the essentials of arthroscopy are. In arthroscopy, a joint is taken a look at utilizing an arthroscope. The arthroscope is placed through small cuts in the skin to examine the within the joint utilizing a little video camera. The video camera connects to a screen that permits the cosmetic surgeon to see the within the joint. The cosmetic surgeon can then identify the issue from exactly what is seen on the screen. In the case of a knee replacement, we are seeking to see whether the whole knee needs to be changed or simply one compartment.
Robotic-Assisted Knee Surgery
Robotic-assisted surgery is a technique that uses a robotic arm to aid the surgeon in performing the surgery. It is generally used in very intricate surgeries. This is a newer technique in arthroplasty, and research is being conducted to develop a robotic arm specifically for knee resurfacing procedures. At the present time, there is a specific robotic arm designed for a unicompartmental knee replacement. This is a very precise surgery, and the robotic arm is said to help make it even more exact. After the surgeon uses the robotic arm to make the cuts, he will put in the prosthetic. This part of the surgery is not done using the robotic arm and is done in the traditional fashion. Because this is a newer technique, there is no definitive answer as to whether or not this is the best way to resurface the knee, but some patients are excellent candidates for this type of surgery.
Robotic-assisted surgery is among the newest developments in orthopaedics. This technology is used to help your orthopaedic surgeon perform the surgery with precise cuts. This exactness is important in resurfacing damaged joints. In comparison with traditional surgical methods, robotic surgery carries several potential advantages. The incisions can be much smaller using a robotic approach, preserving more of the healthy tissue and leading to a quicker recovery. Implants may also last longer because they were precisely aligned. This could save the patient from needing a future surgery.
Minimally Invasive Procedures
Reconstructive implant is another method that has benefited from technology. They are used for patients who are too young or active for knee replacement surgery and have damaged an isolated area of the cartilage. The implants consist of metal and plastic that act as a replacement for bone and cartilage. Over the past decade, significant improvements have occurred during the manufacturing and design of these implants. Brain Hitchen, COO of ConforMIS, a company that develops and manufactures MRI-based patient-specific implants, has commented that conventional methods of creating implants featuring rod and simple shape have many limitations. The new approach of using MRI of the patient’s leg to produce a 3D model that is used to design the implants is more accurate. This will result in a better fit for the patients, which will reduce potential damage to the surrounding tissue and meniscus. Another advantage is that this method can be used to produce implants for patients who have complex damage to the cartilage. A study performed in early 2007 at the Hospital for Special Surgery, New York, shows that the newer models of the implant provide promising clinical outcomes. An increase in the mean athletic score and a reduction in the symptoms and daily activity score were observed, and an overall American Knee Society Score shows improvement in the patients’ knee after the surgery. This would not have been possible using conventional treatment and provides a new treatment option for patients with isolated cartilage damage.
Health professionals from the National University Hospital have found a method to treat knee pain caused by degenerated cartilage by using the technology for radiofrequency (RF) energy. This method is popular for minimal side effects and the use of a needle-like probe that causes less scarring. What RF does is make a small incision and insert the probe into the area where the lesion is located. Then it will heat the area to about 60-70 degrees Celsius for 12 minutes. This will cause the surrounding tissue to form a protective barrier, which results in less chance for the lesion to grow back. An estimated 30-40% of patients have claimed that they experience good pain relief, and the procedure has delayed their progression to a higher stage or even prevented knee replacement surgery.
The Role of Technology in Rehabilitation
In some cases, the progress has been so impressive that we have had to create a new, pain-free model of the functional task to avoid patient frustration at their previous failure using the ‘painful’ strategy. Adding a competitive element by comparing the patient’s ability to normal age-matched controls has also been successful in increasing the patient’s retention of the new strategy. High-level success is known to elicit relapse to previous strategies in the home environment, so periodic phone call reminders have been implemented to maintain the patients’ adherence to the preferred method. This has seen patients go from task to task scavenging for remnants of the old strategy to complete consolidation of the new method for all relevant tasks.
Modern advances in rehabilitative technologies have opened promising opportunities for knee-pain patients. Singapore General Hospital has utilized virtual reality in a 3-stage process designed to improve their patients’ ability to control functional tasks and thus reduce pain and effusion that may accompany these tasks. Biographic and forceplate equipment create an accurate profile of the patients’ knee problems. This information is then used to intervene both at a motor-learning level and a biomechanical level. At the motor learning level, patients are taught an alternative, pain-free strategy for a given functional task. This is achieved through virtual reality using an animated figure who instructs the patient on the successful method and provides visual feedback in the virtual environment.
Virtual Reality for Pain Management
With virtual reality therapy, the experience is controlled by the therapist. This means that the therapist has total control over the speed and intensity of the simulation. The simulation can also be paused, and discussion between the therapist and patient can occur. This is useful for patients receiving therapy for PTSD because they can talk about their experience in the virtual world pertaining to their trauma, in the safety of the therapist’s office. The margin for error in this therapy is huge, and in the future, virtual reality therapy will be the standard for exposure therapy. For these reasons, virtual reality exposure therapy is the perfect gateway to exposing various cognitive and behavioral therapies in a virtual environment, such as treatment for anxiety and depression, and even a “virtual therapist” for certain disorders.
According to the article, the difference between virtual reality exposure therapy and the exposure therapy used today is that patients will not actually be exposed to the situations that trigger their anxiety. Today’s therapy is quite effective, but going into the virtual world and experiencing the situations firsthand will be far more effective. Another aspect of today’s therapy that makes it less effective is that the patient must use their imagination to construct the feared stimulus. Using imagination creates a margin for the patient to construct the stimulus in a way that may not be completely true to life, or the patient may not be able to create the scenario at all. Creation of the feared stimulus can also result in a high anxiety level for the patient, and in some cases, the session can be so distressing that the patient terminates the therapy.
Wearable Devices for Monitoring Progress
Wearable devices can also help to identify patients who are doing too much. For example, patients with knee OA often feel that more intense pain after exercise signifies further damage to the knee joint and will avoid exercise as a result. One group has labeled this exercise avoidance behavior (EAB) and has shown that increased EAB is associated with an increased number of knee joint replacements. By monitoring the patient’s activity and the severity of their knee pain post-exercise, a wearable device can determine the exercise done by the patient and if it is resulting in increased knee pain. This would enable the physician to educate the patient that an acute increase in pain does not signify further joint damage and prevent the patient from doing more detrimental exercise.
The dataset from the wearable device can be used to identify patients who are inactive or not improving and allow the physician to intervene with these patients. An example is the use of a pedometer to measure the number of steps a patient takes a day. This can be adopted to set a daily step goal, with the aim to increase the number of steps taken each day. A study has shown that a daily step goal improves pain and function in patients with knee OA.
Under the section “3.2 Wearable Devices for Monitoring Progress,” the rapid advancement in technology has also resulted in the development of small wearable devices which can monitor a patient’s progress in real time. These devices will be able to provide the physician with accurate data on the patient’s level of physical activity and response to exercise. This is important as patient compliance to exercise is often poor, and clinical feedback is reliant on patient recall, which tends to be inaccurate.
Future Innovations in Knee Pain Treatment
3D printing is a revolutionary technique that involves creating a three-dimensional object by successively adding material to form the shape of the object. While the use of 3D printing for customized knee implants is still in the early stages of development, it has huge potential as a long-term solution to knee pain. The idea is to take a scan of the patient’s knee and use it to print an implant that is exactly tailored to the shape of their knee. By using an implant that is a perfect fit for the patient’s knee, discomfort and wear on surrounding tissue can be minimized. It is hoped that this will provide a more permanent alternative to current forms of knee replacement surgery and avoid subsequent degeneration of the implant and surrounding bone.
Artificial intelligence (AI) is a broad field that aims to create intelligent machines that can perform tasks which normally require human intervention. While the use of AI is not in itself a treatment for knee pain, it can be used to develop new treatments and improve healthcare in a number of ways. One particularly interesting use of AI is in the development of expert systems. Expert systems are computer programs that utilize AI to mimic the thought process of a human expert in order to solve complex problems. An expert system has been developed to diagnose knee pain, which is capable of outperforming a specialist in sports medicine. Use of AI is also being used to develop more efficient rehabilitation programs and predict patient outcomes following surgery.
Stem cells are a type of undifferentiated cell that is capable of changing into a specialized cell type; for example, a skin cell, muscle cell, or cartilage cell. Adult stem cells used for treatment are most often harvested from bone marrow and are used to regenerate certain tissues. A well-known example of stem cell therapy is the use of it to treat some forms of leukemia through bone marrow transplant. In terms of knee joint regeneration, the idea is to inject stem cells into the knee joint, and through a yet to be determined mechanism, direct the stem cells to form new cartilage cells. While the technique is still in the testing phase, it has shown very promising results and may hold the key to regenerating arthritic knee joints.
Continual advancements in biotechnology and bioengineering suggest that the future of knee pain treatment is extremely promising. There are many exciting techniques currently being developed that could completely change the way we think about knee pain, and possibly even make it obsolete. Three current technologies that show great promise in revolutionizing knee pain treatment are stem cell therapy, use of AI for diagnosis and treatment, and 3D printing of custom knee implants. It is important to note that while these techniques are still in the development phase, they represent a real possibility of a cure for knee pain in the future.
Stem Cell Therapy
As an alternative to joint replacement surgery, some patients may benefit from a less invasive procedure known as stem cell therapy. Much attention has stem cell therapy garnered, and unfortunately much of it due to very aggressive marketing strategies or cost cutting by many practitioners. Tune in to get a clear understanding when stem cell therapy is a good alternative for knee joint replacement and why success is not all dependent on the ‘nastiness’ of a given treatment. Patients considering stem cell therapy often ask if it is successful, where and by whom it is done, and does insurance cover this therapy. This webinar will help patients better understand what questions to ask when considering regenerative therapy. Coming from an orthopaedic surgeon, we do not have any financial incentive for any given treatment you do. Our objective is to provide patients with a comprehensive understanding of what is available today, what it does and why it works.
Artificial Intelligence in Diagnosis and Treatment
In recent years, machine learning, a subset of AI, has been successfully applied in areas such as image and speech recognition. A research team at the Singapore Centre for 3D Printing in Nanyang Technological University has successfully developed a deep learning-based AI system for the automatic and real-time detection and diagnosis of knee injuries. This AI system can aid in minimizing the backlog of cases and improve wait times for patients by providing instant evaluation of injuries. An MRI scan is sent into the AI system. The system will then determine the nature of the injury, whether it is a ligament, cartilage, or tendon injury. Once it has determined the location of the injury, image analysis is then performed, starting with simple image processing techniques to detect the edges and shapes of the region in question, followed by texture and feature analysis using pattern recognition to determine the nature and type of injury. The results have shown a high level of accuracy and with further refinement, it is possible that real-time analysis of MRI scans and X-rays of knee injuries can be conducted during consultation with patients. This would have a great impact on what the future landscape of diagnosis would be, potentially reducing the reliance on consultations with knee pain specialist and reducing the overall cost of diagnosis for knee injuries.
3D Printing for Customized Implants
As a cheap and reliable alternative to animal testing, doctors at the National University of Singapore created a 3D printed model of a knee joint, which could be used to simulate different knee conditions. This product is known as the iKnee and is a first-of-its-kind model. The purpose of the iKnee is to research methods of improving or preserving the condition of the knee joint. This will be done by testing different surgical methods and treatments on an iKnee simulation to determine the best form of treatment without having to risk the actual knee. The iKnee may potentially lead to an increase in success rates for knee surgeries and a decrease in the occurrence of failed treatments.
What they do is start with a CT scan of the knee joint and input the data into a computer. Using this data, they create a 3D virtual model of what the implant should look like in comparison to the undamaged knee. Once the implant has been created on the computer, they then use a 3D printer that uses metals such as titanium alloy to create the implant. The use of a material like titanium is beneficial, as it has been proven to be durable enough to withstand the harsh conditions of the knee joint. Due to the strong and metal joint replacements, it will not result in the harmful wear and tear of the knee joint. This method has already been put into practice for hip replacements and has seen a lot of success. By introducing customized 3D printed knee implants to the scene, it will bring a whole new level of treatment to those with knee pain caused by arthritis.
In the current medical scene, total knee replacements have been all the rage in treating knee pain caused by severe arthritis. The mode of this procedure is to remove one’s damaged knee and replace it with a metallic or plastic joint. However, due to the cons involved in total knee replacements, many patients have been in search of alternate solutions to avoid getting a knee replacement. One of these solutions being researched is having a partial knee replacement done, where only the damaged parts are replaced. While this method has been proven to be better than a total knee replacement, there has been very little variance in the mode of treatment. This is where 3D printing comes into play, as it is now possible to create an implant that is customized to the specific shape and size of the damaged area of the knee.
