By SeeFoon Chan-Koppen
Afraid of going to the doctor with your joint pains for fear of his recommending surgery? So you suffer in silence until the pain is unbearable and your mobility and lifestyle is seriously affected?
A lot of people, especially the elderly who are afflicted with osteoarthritis, believe that the options are either replacement (hips and knees—even shoulders) and the costs are too high; or they doubt the surgery’s effectiveness in helping them relieve their pain.
Having had both knees replaced as well as Lumbar fusion and walking around like a Bionic Woman with metal in my body setting off X-ray alarms at airports, I can vouch for surgery as an effective solution to relieve pain but I wish I had options to explore then, over 20 years ago.
Recently, I met up with an amiable Orthopedic Surgeon who was enthusiastically expounding on some of the latest techniques on dealing with orthopedic issues.
Dr. Rajkumar Veerakumaran received his medical degree from Manipal Academy of Higher Education India with Masters in Orthopedics in Ortho & Trauma at UKM; followed by attachments in Arthroplasty (Primary Knee & MIS HIP replacement; Complex Primary & Revision Surgery) in India and Thailand, as well as an attachment in Chronic Pain management.
Dr. Raj also has a special interest in Musculoskeletal Ultrasound & Ultrasound Guided Nerve Blocks (knee, hip, shoulder and ankle) to manage chronic pain, tendonitis, enthesitis and inflammatory joint pain. The good news here is that treatment with pain killers can be eliminated, avoiding the long-term side effects of NSAIDS and opioids.
This is one Orthopedic doctor who has such a wide range of interests related to his specialty that it’s almost impossible to list them all. One of these is related to accelerated diabetic wound healing and limb salvage procedures involving application of serial Vacuum Assisted Closure Dressing and early coverage of wounds by skin grafting, collagen mesh dressing or local flaps. Photobiomodulation—a novel technique of treating chronic slow healing wounds/eczema and neuropathic ulcers using light spectrum is available at KMC Medical Centre (KMC).
Dr. Raj’s main area of interest is in HIP and KNEE surgery (replacement). Using implants from the US or Germany, he ensures a dedicated and personalised follow-up till recovery of each patient. The Knee and Hip replacement packages at KMC are priced much lower than in other private hospitals and offers: pre-op pain relief and strengthening/conditioning exercises; short hospital stay (3 days); intraoperative pain relief medication with no painful drains or tubes ensuring ambulation on the same or next day with less dependence on painkillers. Post-operative LASER sessions and customised physiotherapy sessions enable patients to walk confidently by two weeks. KMC has a dedicated and trained physiotherapy team and centre for joint replacement rehabilitation.
After orthopedic procedures, Dr. Raj believes in intensive physiotherapy. He performs a lot of ultrasound-guided specific nerve blocks to reduce pain and improve the threshold for joint mobilisation/manipulation and strengthening. “I also do immediate shock wave, trigger point release or pain portal injections. High intensity LASER is used as an adjunct to treat acute painful conditions in the clinic,” he said. The FIRST session of PHYSIO is incorporated in his joint replacement treatment after which the patient is then referred to other therapists for regular sessions.
If a patient is not keen on knee replacement surgery, other options include Genicular Knee Blocks (for pain), IPACK blocks (for stiffness/spasm), intra-articular HA injections and a less invasive fibula osteotomy for very early knee arthritis.
Will Physiotherapy alone take care of some patients’ issues? “Yes,” he answered, “Nearly 70 percent of clinic patients come with pain and inflammatory states that respond very well to non-surgical modalities of treatment. Examples such as Frozen shoulder, Sciatica, Piriformis syndrome, elbow tendonitis, heel spurs, plantar fasciitis and achilles tendonitis can be IMMEDIATELY relieved by BLOCKS /PAIN PORTAL injection; then I will apply shock wave to the pathological site to relieve any spasm at the affected site as well as promote healing.”
“Physio-Ultrasound and electrotherapy followed by regular shock waves (3 to 4 sessions) can show significant relief,” he added.
“The most PREVENTABLE ortho problems are those related to obesity such as Arthritis and degenerative spine disease; Osteoporosis (accelerated by deconditioning & sarcopenia); diabetic and Charcot foot; fungal infections with chronic cellulitis as well as diabetic dermopathy,” he stressed. “The earlier they come for treatment, the sooner we can resolve the problems.”
Wide Awake Local Anaesthetic No Tourniquet (WALANT)
Another interesting technique practised by Dr. Rajkumar is the use of WALANT, which is surgery performed while the patient is wide awake, involving injection of anaesthetic mixture that enables numbing of extremities during which procedure can be performed!
Surgeries performed under WALANT include removal of implants; release of contracture/scars; ganglion and cyst removal; AV fistula; carpal tunnel release; tendon release or repairs; trigger finger release; ligament repairs and other arthritic conditions.
These are all carried out under their newly introduced Orthopaedic Day-Care Services which involves hassle-free admission and discharge with shortened or no hospital stay, no drowsy medication and deleterious anaesthesia effects, minimal blood loss and, most importantly, at a much affordable cost.
The physiotherapy centre is near complete, catering to all needs of geriatric physio workup and conditioning especially with regards to management of chronic pain and degenerative arthritis as well as neurological deficiencies such as stroke and Parkinsons. These include traction, manual therapy and massage, progressive exercise programmes, balancing and muscle conditioning, stroke, cardiac and chest rehabilitation, post surgery rehabilitation, as well as the latest modalities of pain relief such as electrotherapy, HIT LASER, shock wave therapy and radiofrequency therapy.
This will be ready by February 2022.
JOY OF MOVEMENT Total Knee Replacement
Estimated Fees RM16,000++
The package includes:
- Pre-operation optimization of pain & muscle strengthening
- Pre-surgery blood tests & anaesthetic consultation
- 3-days hospital stay
- Implant from USA (high flexion range & ligament preserving)
- Pain killers into joint to ensure confident & early mobilisation (no drainage tubes—easy wound care, no drowsy medications)
- Personalised physiotherapy session for successful results
- Regular monitoring until complete healing
- Walking frame, ice pack & consumables
For further enquiry, please contact:
Dr. RajKumar Veerakumaran
Orthopaedic Specialist Clinic (Suite 3A)
+605 242 5333 (Ext 252)
KMC MEDICAL CENTRE
Yetkai Hospital Sdn Bhd 201201019810 (989955-X)
20A, Jalan Chung Thye Phin, 30250 Ipoh, Perak