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Our Location
East Shore Medical Centre
Suite 03-05A,
319 Joo Chiat Place,
Singapore 427989
Tel: (65) 6348 2605
Fax: (65) 6348 2606
Mount Elizabeth Medical Centre
Suite 12-10,
3 Mount Elizabeth Road,
Singapore 228510
Tel: (65) 6738 2628
Fax: (65) 6738 2629
Gleneagles Medical Centre
Suite 05-13,
6 Napier Road,
Singapore 258499
Tel: (65) 6474 0600
Fax: (65) 6474 0700
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Medical Treatment
Do I require surgery if I have osteoarthritis of my knee? Is there any non-surgical treatment?
Having knee pain does not mean that you require surgery. In fact, most surgery is a last option in most cases. Most cases can be treated by non-surgical means. This includes
- Pain killers
- Injections into the knee
- Physiotherapy & Walking Aids
Not all degenerative knee conditions require a knee replacement as the initial treatment. Your doctor may suggest several alternative treatments to put off the decision for replacing the knee as long as possible. Using a cane may help alleviate some of your pain and allow you to walk more comfortably. Anti-inflammatory medications may reduce the inflammation from the arthritis and reduce your pain.
Painkillers
What are painkillers, which my doctors always talk about? I hear that they can cause problems. Is this true?
Pain in the knee can be treated by a variety of medications. These include anti-inflammatory medications also commonly known as NSAID’s by health professionals. Common examples are Ponstan or voltaren. These however are not without risk. Common complications include
- gastric problems like ulcerations or bleeding
- kidney problems
Most of these problems tend to develop after long term use. Unmonitored use of NSAIDs is not
advised and your doctor will be able to advise you on the duration of usage. There are new NSAIDs in the
market now. These are known as the Cox-2 inhibitors and have been said to have less side effects on the
stomach due to their selective action.
COX-2 specific inhibitors
COX-2 specific inhibitors are new NSAIDs that have been recently developed. They are just as effective as the older ones, but less likely to cause stomach problems.
What is COX-2?
Some of the signs and symptoms of inflammation (pain, swelling, etc) are caused by substances called prostaglandins. Prostaglandins are made through the action of an enzyme called cyclo-oxygenase (or COX, for short) on arachidonic acid, the raw material for prostaglandin.
There are two types of COX, called COX-1 and COX-2. They are very similar to each other in structure, but have different functions in the body. COX-1 is responsible for maintaining some of the normal functions in the body, such as protecting the stomach lining from the harmful effects of acid. COX-2 is primarily involved in producing the inflammatory response to an injury or illness.
What is a COX-2 inhibitor?
 Most NSAIDs inhibit COX-1 and COX-2 because both enzymes are very similar. So, while they prevent COX-2 from producing inflammation, they also stop the stomach lining from producing the prostaglandins that protect it from acid. Without “housekeeping” prostaglandins, the stomach lining is exposed to the harmful effects of acid, and may develop an ulcer. This is why people taking older NSAIDs are at such a high risk of developing a stomach ulcer. The COX-2 specific inhibitors (such as CelebrexÔ) have been specially designed to inhibit COX-2 and to have little effect on COX-1. This means they are very good at suppressing inflammation by inhibiting production of “inflammatory” prostaglandins, but they have limited effect on the stomach lining. Studies in patients with arthritis have shown that these drugs are significantly less likely to cause a stomach ulcer than older NSAIDs (the ones that are not selective for COX-2).
In osteoarthritis, COX-2 inhibitors can be taken orally as a once daily medication, which is convenient.
Can I use traditional medications?
Artrex
Other commonly used medications are ginger tablets. These have been in use for thousands of years. They are now available as non-prescriptive items, which can be bought over the counter. Common examples include arthrex and xinacin. These medications have no significant side effects and may help in some cases.
What is this new medication called glucosamine and chondroitin sulphate? Will I benefit from it if I have OA of my knees?
Glucosamine and chondroitin sulphate These are newly marketed in Singapore. These were thought to help restore the worn out cartilage in the knee joint. At the present moment, there have not been sufficient clinical data to support these claims completely other than initial anecdotal reports. However, these drugs do not have significant side effects.
Injections into the knee
Are there any other medications?
Should these medications fail, the next mode of treatment is to inject into the knee joint. This should be carried out by a doctor who is trained in the procedure as the possibility of knee infection should it occur will be devastating to the patient.
What injections are there into the knee? Are they safe?
There are currently 2 types of injections for the knee.
1. Synvisc
This is a hyaluronic acid, which is one of the components of the knee joint fluid. Basically, as OA sets in, the joint fluid loses its viscosity i.e. becomes more fluid like and loses its normal “bounciness”. Synvisc is developed from the cockerel’s comb and is supposed to help in the regeneration of the synovial fluid of the knee i.e. to enable the knee to produce its own new lubricant to lubricate the knee.
How do I go about getting it?
Your doctor will advise you on its use as well as whether you are a suitable candidate for it.
How often will I need it?
3 weekly injections will be given on an outpatient basis. This should be given using strict aseptic (free from bacteria) techniques. Currently, in Singapore the Ministry of Health guidelines have stipulated that only orthopaedic surgeons and rheumatologists are licensed to prescribe and inject Synvisc into the knee.
How long will it last?
It is supposed to last for about 1 year after which it can be repeated.
Will all patients benefit from it?
No. Currently reports state that about 60-70% of patients experience some degree of pain relief. At Tan Tock Seng Hospital, we tend to use it more for patients with less advanced OA of the knee as we feel that it will not benefit those with advanced OA of the knee.
What are the side effects of injecting synvisc into the knees?
The side effect although relatively uncommon is effusion of the knee (swelling). This may develop a few hours after injections and could be due to a mild allergic reaction to the synvisc. This would mean that further injections should not be carried out and some other alternative treatment be prescribed.
What should I do if I develop swelling after injection of synvisc?
You should call your doctor immediately to let him reassess your knee. Most of the time the swelling should subside with a short period of rest and ice and with NSAIDs
2. Corticosteroids
What about steroids into the knee?
The other common injection into the knee joint is steroid injection. The medication injected is a combination of marcaine as well as kenacort. The marcaine is a short acting local anaesthetic, which offers immediate pain relief but lasts for about 5-6 hours. Kenacort, the steroid helps to contain the inflammation in the knee and this may last for few months.
I hear that steroids are bad for me. Should I get a steroid injection into my knee then?
Oral steroids have numerous side effects. All steroidal medications should be prescribed by a doctor especially if taken by mouth. However, local injections of steroids will act only in the knee and are NOT absorbed by the body. Hence, there will be no side effects on the body.
How many times can I get a steroid injection into my knee?
You can have it 2-3 times a year at the most. However, if there is no effect, there is no use in repeating the steroid injection into your knee.
Physiotherapy & Walking Aid
Are there any exercises that I can do to help avoid surgery?
Physiotherapy is a very important component of orthopaedics. However, there are no known specific exercises that can prevent surgery or slow down the progression of OA. More importantly, you should stay active and continue walking as much as you can. Once you feel that the pain is getting you down, it is probably the time you should talk to your surgeon about the other alternatives. The use of a walking aid or cane helps to reduce the load on the knee joint and is a good aid from the beginning.
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