Practising in an environment that has a reputation for breaking new ground in medicine has inspired consultant orthopaedic surgeon Dr Kevin Koo to explore innovative techniques in treating conditions and injuries to the body’s lower extremities.
The director of foot and ankle service at Singapore General Hospital’s Department of Orthopaedic Surgery says such injuries, if not treated on time, could be irreversible should arthritis set in. Persistent foot conditions can also lead to a whole lot of other problems which can affect a person’s mobility and quality of life.
A common malady is the bunion, a painful, bony bump on the big toe joint that can be hereditary, but is often formed through the long-term use of footwear with heels and a tapered or pointed toe box. While it usually afflicts women, Dr Koo says a growing number of men suffer from it.
There is also another trend occurring. He and his colleagues are seeing an increasing number of foot and ankle injuries with the rising popularity of high intensity sports such as futsal, basketball and even mixed martial arts. Dance injuries are also on the rise, thanks to the increasing popularity of traditional forms like ballet and salsa, as well as exercises like zumba.
“I like to stay active and used to play football and badminton in school,” says the doctor, who studied at the National University of Singapore, and trained at the United Kingdom’s Royal College of Surgeons (Edinburgh) and Imperial College London Healthcare. He qualified as a specialist orthopaedic surgeon in 2014, treating conditions pertaining to the musculoskeletal system (bones, joints, ligaments, tendons, and muscle).
“I can understand when a patient says he injured his arm or leg and cannot get back to the game,” adds Dr Koo. Hence the satisfaction he derives from being able to repair a ligament or even replace a worn-out joint.
Moreover, he took the words of senior orthopaedic surgeon Dr Seow Kang Hong to heart when the latter told him that the latest advances and innovations in medicine are in orthopaedics. Indeed, one such innovation is keyhole surgery – a minimally-invasive procedure that significantly reduces complications and is less painful for patients afterwards.
“Applying this method for bunions was a game changer for us,” says Dr Koo. “In the past, bunions were corrected via large incisions roughly 5cm to 8cm long. Now, we can do the job with tiny incisions, which not only results in fewer wound problems for the patient but less pain as well.”
There are very few orthopaedic surgeons in Singapore who routinely offer this procedure to patients with mild to moderate bunions. Early diagnosis and treatment is essential to benefit from this innovative technique. Dr Koo says the potential for further advances in this area of speciality is huge. In the past 10 to 20 years, the techniques and technologies in orthopaedics have progressed by leaps and bounds. Anaesthesia and pain management, as well as superior imaging techniques in MRI and CT scans have significantly improved post-operative pain control and enhanced the way problems are diagnosed. Implants are also now more biocompatible, durable and can even be customised.
Arthroscopy is another keyhole procedure that has revolutionised the way surgeries in and around the joint are performed. “In the past, this involved making a large incision and dissecting down to the joint, before we can see and correct the problem,” Dr Koo explains. “With arthroscopy, we only need to make small incisions, insert a camera to visualise the joint, and fix the problem. I now routinely do ankle cartilage and ligament repair surgery via this method.”
Dr Koo says he has been able to make progress in his field because SGH is equipped with some of the most advanced technologies and equipment in Singapore. It also has a collaborative tradition among its doctors and nurses, and its track record, he says, attests to this.
In March 2019, Newsweek ranked the 198-year-old Hospital third among the world’s 10 best hospitals, in part for its clinical research and “outstanding nursing”. Needless to say, it has been relentless in its pursuit of better care for Singaporeans. In 2017, for instance, it performed Singapore’s first blood-group incompatible living donor liver transplant.
And in 2013, SGH and the Nanyang Technological University joined hands to develop a biopsy tool to detect prostate cancer. That very same year, the Department of Orthopaedic Surgery announced the results of its successful collaboration with Mayo Clinic in the United States on a new tennis elbow treatment. At the time, SGH was the only centre in Asia to offer the minimally invasive tennis elbow procedure.
“At SGH’s Department of Orthopaedic Surgery, we practise tertiary orthopaedics, with each individual surgeon sub-specialising in a particular field of orthopaedics such as foot and ankle surgery, sports surgery, joint replacement surgery, spine surgery, fractures and trauma, as well as musculoskeletal tumours,” Dr Koo says. “This allows me to practise at a high level and offer the latest, best treatment options to my patients.”