Our orthopaedic surgeon Dr CC Kong talkes about regrow torn knee pad in South China Morning Post, 11 Dec 2012
Our orthopaedic surgeon Dr CC Kong talks about a case study about repairing a meniscal tear in South China Morning Post issued on 11 Dec 2012. Please click here to view the full article, "Case history: surgery to regrow torn knee pad".
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Avascular Necrosis and Osteoarthritis in Hip Joints Hip Resurfacing Surgery
Press Release: Avascular Necrosis and Osteoarthritis in Hip Joints - Hip Resurfacing Surgery for young & active patients
(Hong Kong, 3rd December 2012) Over a thousand people in Hong Kong are diagnosed with serious hip joint damage each year, mainly due to avascular necrosis (AVN) or osteoarthritis. Many of them have the need for a total hip replacement surgery. The traditional total hip replacement surgery cannot fully recover patients’ hip functions and patients may need to re-do the surgery in future, so this option may not be suitable for young and active patients. Fortunately, Birmingham Hip Resurfacing (BHR) is a more bone conserving surgery introduced in Hong Kong recently, the surgery takes approximately 2 hours and patients can return to normal life in 3 months. A western athlete even won medals in international competitions after his recovery from BHR.
The hip joint is a ball and socket joint: the ball is formed by the head of the femur (thigh bone) and the socket is in the pelvis, to support our upper body weight and maintain balance, it works with other joints to complete complex motions including running, jumping and kneeling, it is very important in the musculoskeletal system. Nevertheless, the common cause of hip joint damage is AVN in Asians whilst osteoarthritis for Westerners, serious damage in hip can lead to loss in physical motion.
AVN is common in Asians
Dr. Jason Brockwell (Specialist in Orthopaedics & Traumatology) pointed out that roughly 1000 hip surgeries are done each year in Hong Kong, in which half of them are due to AVN. The major cause of AVN is reduced or lack of blood supply in the bone, resulting in the bone collapsing and dying. Patients will experience pain and discomfort, seriously affecting physical ability.
There are many causes to AVN, such as overdose of steroids, serious decompression sickness, vasculitis, systemic lupus erythematosus, radiation, etc. “In Asia, AVN is common because steroids is a common component in medicine, Asians tend to abuse the use of steroids.” Dr Brockwell added.
Sports Leading to Repetitive Stress Injury in Hip Joints
Dr Brockwell further explains that many athletes may have joint damage or inflammation due to sudden weight bearing or extreme body movement. Running a marathon, walking long distances, hiking, etc, may overwork the joint, resulting in repetitive stress injury, causing degenerative osteoarthritis.
Limitations of traditional hip replacement and post-operational hip functions
Most of the current hip damages are treated by the traditional method: Total Hip Replacement Surgery. During the surgery, the whole femoral head is removed even if the bone is undamaged, the artificial implants including a metal acetabular cup, a plastic acetabular insert, and a stem is then positioned in. .
As this surgery aims to reconstruct the hip joint, the recovery period is longer, usually over 6 months, there is also a lot of limitations for physical activity, the joint is relatively easily dislocated, and will wear out. The average survival of the implant is 20 years, after that, another surgery may be required; therefore, many young and active patients are unwilling to receive this surgery until the last minute despite the extreme pain for years.
Regaining the joy of physical activities after Birmingham Hip Resurfacing Surgery
Birmingham Hip Resurfacing (BHR) is a more bone conserving surgery introduced in Hong Kong recently to cater for the downsides of the traditional method. Dr. Derek McMinn, the developer of BHR & Specialist in Orthopaedics & Traumatology, explains that BHR only removes the damaged surface of the femoral head and conserves the undamaged bone. The artificial femoral head is fixed on the end of the femur, and the cup is implanted in the pelvic socket to act as a “cap” for protection and to resemble the original joint structure.
This implant is made of Carbide Cobalt Chrome Alloy, is more durable than the one used in the traditional method, with higher joint mobility, movement speed, better balance, and movement direction. Patients are able to enjoy normal life and usual sports including yoga, swimming, running, etc.
Dr. McMinn also introduced the latest Birmingham Mid Head Resection (BMHR) to patients with serious AVN or femoral head cysts. In this procedure, approximately half of the femoral head is removed, the implants including the artificial femoral head and cup are similar to those in BHR, with the same advantages; whilst conserving more undamaged bone compared to traditional total hip replacement surgery.
Young AVN patient returning to work after surgery
Mr Chan (undisclosed true name), is 47 years old, and spends most of his time working outdoors for his job. In 1997, he felt pain in the left thigh as the hip joint was wearing out, and could not walk for long durations. To the extreme that he could not walk for longer than 5 minutes, and the range of motion in the leg reduced gradually. Due to the worn out joint, he started feeling length discrepancy in his legs, imbalanced movement, along with the extreme pain. His supervisor also noticed his situation and reduced his outdoor working time, and shifted him to administrative work.
Governmental Orthopaedic specialist diagnosed his situation and concluded AVN as the cause. At the time, total hip replacement was the only option given by the public hospital. Mr. Chan repeated, “The attending specialist did not recommend taking this surgery as I was only around 30 years of age at the time, so I may have to re-do the surgery in 10 years as the implant would start wearing out. Despite the pain I had, I decided not to accept the surgery due to technical limitations.”
Until 2003, Mr. Chan learnt about BHR and its advantages, he received the surgery in 2004 on his left hip, and the second surgery in 2006 on his right hip. “The pain was significantly reduced after the surgery with a wider range of motion. I was discharged from the hospital 4 days later, and returned to sports in half a year. Nowadays, my leg motion is even better than before the hip joints were damaged. Not only can I return to my original duties, I run 4 kilometres each day and go hiking regularly.”
Patient with Osteoarthritis, Painless after Surgery
37 years old Gavin is a personal fitness trainer, and incorporated vast amount of sport in life since childhood. At the age of 17, he felt pain in the left femur, with increasing pain and narrowing range of movement, especially when intaking stimulative flavours such as sweet or spicy. He was forced to stop doing his favourite sports like swimming and Muay Thai. Nevertheless, as he cannot avoid sport during work, he just had to rely on pain killers.
Until 2011, medication was no longer able to control his pain, so he went to the doctor and was diagnosed with degenerative osteoarthritis. After considering his young age, he was advised to undertake BHR. Gavin did some research on it and underwent the surgery in Aug 2011.
The pain disappeared after the surgery and the range of movement in the leg was back to normal. A year after the operation, his hip functions returned back to normal.
Another 60 year old Charles had rheumatoid osteoarthritis 17 years ago. Not only was the hip function affected, it was too painful to sleep. He was introduced to BHR in 2001 through a friend and received the surgery in UK. He later received another BHR surgery in 2009 in Hong Kong. Similar to Mr. Chan, the pain was significantly reduced 2 days after the surgery, and the pain had not returned ever since.
The first Meniscal Regeneration Surgery in Hong Kong, to make “irreparable meniscal tears” reparable
- Article: Meniscal Regeneration By Meniscal Scaffold Implant Actifit Polyurethane Scaffold
- Press Release: The first Meniscal Regeneration Surgery in Hong Kong, to make "irreparable meniscal tears" reparable
- Sporting chance in knee injury first (The Standard, November 19, 2012)
- Surgery to regrow torn knee pad (South China Morning Post, December 11, 2012)
(Hong Kong – 13 November 2012) The meniscus is a crescent-shaped fibro-cartilaginous structure located between the thigh bone and the tibia, acting to disperse the weight of the body, absorb shocks and reduce friction during movement. In Hong Kong, meniscal tear is a common injury caused by intense actions when exercising. Some meniscal tears are more severe, which can only be removed but not repaired. When the meniscus is removed, the knee joint is not protected, hence increases the chances of early osteoarthritis.
Sport Injury leading to meniscal tears
According to Dr. Terence Chan, Orthopaedics & Traumatology, meniscal tears are common in 20 – 40 year olds, especially in males. He added: "most tears are related to sport injury or falling accidently, causing sudden forceful twisting in the knee, resulting in a meniscal tear." For example, when basketball players change direction too quickly after a jump, or when footballers collide into each other, will all increase the likelihood of a meniscal tear.
Dr. Chan also highlighted some of the symptoms associated with meniscal tears, including pain, swelling, popping when bending or straightening the knee, or even locking. Not only will it affect the functioning of the lower limbs, development of early osteoarthritis is also common due to damage to the surrounding cartilage.
Traditional Treatment has its limitations - Meniscal tears fail to recover
Dr. C.C. Kong, Orthopaedics & Traumatology, pointed out the limitations of traditional meniscus repair and partial meniscectomy, and in some of the more complex cases, the meniscus cannot be repaired.
The innovative "Meniscal Regeneration Surgery" has been introduced in Hong Kong recently, helping patients with damaged meniscus to heal. A local patient successfully received this minimally invasive treatment on Monday, the very first case in Hong Kong.
The first successful Meniscal Regeneration Surgery in Hong Kong
This surgery conducted by Dr. Chan and Dr. Kong has been successfully performed. Professor Verdonk, the core developer of this surgery, was also very pleased with the procedure finished at Matilda International Hospital. Professor Verdonk further explained: "The principle of Meniscal Regeneration Surgery is to clear the site of the meniscus defect, fill the defect with a trimmed scaffold, then suture the implant and the host meniscus together. The meniscal scaffold implant supports the in-growth of new "meniscus like" tissue with the aim of alleviating post-meniscectomy knee pain and preventing further articular cartilage degeneration."
Professor Verdonk emphasised that the meniscal scaffold would be degraded and absorbed in about 5 years, where the new "meniscus like" tissue would have replaced the scaffold. The high interconnected porosity property of the scaffold enables tissue in-growth, leading to self-healing. This ground-breaking Meniscal Regeneration Surgery has made recovery possible to the damaged meniscus.
Mr. William, a 33 years-old local citizen, educated in UK and working in advertising industry, is very fond of active and aggressive sport, including wakeboarding, hockey, adventure racing, and scuba-diving. He has also won an award in adventure racing. Unfortunately, he experienced a meniscal tear in the left knee 10 years ago during a wakeboarding incident, and suffered another hockey injury shortly after his recovery.
Diagnosis showed there was over 50% of damage in the meniscus, and thus unsuitable for a traditional meniscus repair, William underwent partial meniscectomy in 2006. Nevertheless, the functionality of his left knee was still affected, and was no longer able to enjoy active sports, but to play moderate sport such as running or swimming. William also felt irregular knee pain, in which he had to meet the doctor again due to recurrent knee pain whilst running half a year ago.
William was introduced to the new Meniscal Regeneration Surgery, and learnt that many European athletics have undergone this surgery, he finally accepted this new treatment and became the first patient of Meniscal Regeneration Surgery in Hong Kong. The surgery held on Monday in Hong Kong was very successful, doctors have reported that William is in good condition and recovery progress is expected.
Hong Kong Spine and Pain Centre commences!
Hong Kong Spine & Pain Centre is a one-stop comprehensive multidisciplinary medical care provider, with specialist doctors and physiotherapists to treat a wide range of spinal problems and other conditions causing pain.At hong kong spine & pain centre, our team of experts are dedicated to helping you better understand your condition, provide prompt clinical assessment, accurate diagnosis, explain and discuss the best treatment options with you, from non-surgical to surgical treatments. We aim to help you physically and psychologically, maximising your daily functions while minimising pain, returning or even enhancing your quality of life.
For more information, please visit www.spineandpain.hk.
Opening of Kowloon Clinic in Tsimshatsui
Our Kowloon clinic opens in Tsimshatsui offering same services as Central, equipped with O-scan, an open design musculoskeletal MRI scanner.
AMS 5th Anniversary!
5th Anniversary, we now employ over 40 full-time staff and have helped countless patients get back to sports, or just get on with their lives.
Achieved ISO9001:2008 accreditation
We aim to provide high quality medical and paramedical services by providing a one-stop shop that focuses on service excellence through continuous improvement.
Greater China's first open weight-bearing MRI scanner
As a private clinic, we installed greater China's first (and until now, only) open weight-bearing MRI scanner which provides invaluable images of the spine on weight bearing.
Sports Physicians renamed as Asia Medical Specialists
Sports Physicians renamed as asia medical specialists to better reflect the coverage of specialities, not only on orthopaedics, but also devoted to expand other surgical and non-surgical services.
Sports Physicians Limited won the 2005 Hong Kong Awards for Industries: Innovation & Creative Award
Sports Physicians Limited won the 2005 Hong Kong Awards for Industries: Innovation & Creative Award.