2002 Combined Orthopaedic Meeting

16 Oct 2002

By Dr Khong Kok Sun

Venue: Raffles City Convention Centre

I am very happy to be here this evening, at this 2002 Combined Orthopaedic Meeting. I would like to warmly acknowledge the overseas delegates who have come from various parts of the world to Singapore, to participate in this meeting. Welcome to Singapore.

SIGNIFICANCE OF THE COMBINED MEETING

This occasion marks 50 years of Orthopaedic Surgery as a specialist service in Singapore. To commemorate this occasion, the organisers have combined 5 orthopaedic meetings into one mega-gathering. The 5 meetings are:

(i) 25th Singapore Orthopaedic Meeting

(ii) 22nd ASEAN Orthopaedic Association Meeting

(iii) 5th Combined Meeting of Spinal and Paediatric sections APOA

(iv) 7th meeting of Sports Medicine Section, APOA

(v) 3rd Meeting of Asia-Pacific Orthopaedic Society for Sports Medicine

Such a combined meeting will not be possible, unless there is a strong spirit of co-operation and cohesion and enlightened leadership within the orthopaedic fraternity. This is highly commendable and should be held up as an excellent example for other specialty groups.

DEVELOPMENT OF ORTHOPAEDICS IN SINGAPORE

Orthopaedics in Singapore has come a long way since its beginnings in the 1950s. In the pre-war era, orthopaedic surgery was practised by general surgeons who had an interest in the management of musculo-skeletal trauma and fractures. In 1952, the first Department of Orthopaedic Surgery, the University Orthopaedic Department, was set up in the Singapore General Hospital. Our first orthopaedic trainees started their training in 1958.

In the 1970s, orthopaedic training for doctors from Indonesia and eventually other countries in the region was started. Orthopaedic departments were set up in 3 other general hospitals i.e Alexandra Hospital, Toa Payoh Hospital and Tan Tock Seng Hospital.

Today, we have an orthopaedic department in every general hospital providing high quality clinical care, training the next generation of orthopaedic surgeons and carrying out research in a wide range of subjects

KEY ORTHOPAEDIC PROBLEMS

Over the years, orthopaedics as a discipline in Singapore has grown from strength to strength. The challenges facing the medical and orthopaedic community have also evolved during this time. I would like to illustrate this by highlighting 2 key challenges, at different ends of the orthopaedic-related disease spectrum as it were.

Osteoporosis ? A Key Public Health Issue

The first area is osteoporosis and osteoporosis-related fractures.

Osteoporosis is a global problem. With the aging world population, the significance of osteoporosis as a major public health threat will escalate. Between 1990 and 2000, the local prevalence of osteoporosis has increased from 36 per 100,000 population to 57 per 100,000. Osteoporosis is often a silent disease and remains undiagnosed till the affected patient presents with a fracture. The personal, social and financial impact of such fractures are significant. It is estimated that as many as one third of patients with osteoporotic hip fractures suffer considerable loss of function and become dependent on others, and about one in five patients die within a year of sustaining an osteoporotic hip fracture.

Fractures are also a major cause of admissions to our community hospitals and nursing homes.

In responding proactively to this problem, prevention must be our primary aim. To this end, the Health Promotion Board has intensified its public education programmes on osteoporosis and targeting them at groups with higher risk such as the elderly and women. The programmes stress the importance of regular exercise to maintain strength and balance, taking an adequate amount of calcium in the diet, avoiding obesity and taking simple steps to prevent falls.

Education targeted at primary care physicians is also important. To assist medical practitioners to better identify patients at risk of osteoporosis and to institute appropriate management in a timely fashion, clinical practice guidelines on osteoporosis were produced by my Ministry in 1998 and revised in 2002 to incorporate the advances in treatment that had occurred.

Members of the orthopaedic community have assisted in these efforts. However, to address the challenge of osteoporosis, which is a long-term public health issue, requires a consistent and sustained effort. This is an area where orthopaedic surgeons and professional groups are well placed to contribute to the overall national effort.

Keeping Up With Rapid Advances In Medical Practice

The second area, which may be considered to be at the other end of the spectrum, relates to how Orthopaedics as a discipline is to keep up with the rapid advances in medical science, practice and technology. The challenge is not to unthinkingly acquire the latest equipment or to adopt the latest methods, but to be able to critically evaluate new treatments and to introduce those which are most cost-effective and of greatest clinical benefit. In this way, we can ensure that Singaporeans will continue to receive a high level of clinical care but at a cost which is affordable to them and the nation.

The most important way to ensure that the discipline keeps apace of changes in practice is to have well-trained doctors who keep up with their continuing professional development. My Ministry?s Health Manpower Development Programme or HMDP is a key funding mechanism which has ensured that nearly all our specialists have had the opportunity for a period of training in excellent centres overseas. Our specialists are also well networked to their colleagues and peers in top centres internationally and this has also helped us to keep apace of changes. Additionally, conferences such as this one provide valuable opportunities for our doctors to learn and to share their expertise with others.

Beyond this, another important way of keeping apace of the changes in medical practice is for our specialists to carry out high quality research, particularly if these are in clinical areas relevant to our local population. Funding from the National Medical Research Council, has supported a wide range of research projects in orthopaedics. One such project I was told about was the work being done on the development of a biomechanical model of the stump prosthesis for transtibial amputees. This project involved the generation of a finite element model of the amputee?s stump that is capable of predicting the pressure distribution at the stump/prosthesis socket interface. The quality of socket fit is predicted with the model, prior to manufacture of the artificial limb. Such information can help prosthetists and bioengineers to improve on design of prosthetic sockets and components for artificial limbs. At the same time, it may reduce fitting errors with the end result of better prosthesis design and fit for patients.

Two years ago, my Ministry introduced a new stream of funding under the Health Service Development Programme, or HSDP. One of the aims of HSDP is to allow us to critically evaluate the clinical value and cost-effectiveness of important new treatments or technologies.

One of the projects we are supporting under HSDP this year is the use of ?soft tissue engineering ? for joint disorders. At present, patients with damaged articular cartilage of the knee, due either to trauma or degeneration, are mainly treated with analgesics. If the knee degeneration is severe, joint replacement with prostheses is a treatment option particularly for older patients who are suitable for the surgery.

Soft tissue engineering of articular cartilage offers an alternative treatment approach. This treatment involves harvesting cartilage from the patient, culturing this in the laboratory and reimplanting the cultured cells into the articular defect. The funding from HSDP will allow our specialists to develop our cell culture laboratory expertise and capabilities and to evaluate the clinical benefit and cost-effectiveness of using this treatment modality for suitable patients in Singapore.

CONCLUSION

Orthopaedic speciality has come a long way from its modest beginnings. I would like to congratulate the orthopaedic community in Singapore on an excellent and highly productive first 50 years. I am confident that the discipline can only go from strength to strength in the years ahead. I wish all participants at this landmark mega-conference, a stimulating and fruitful meeting.

On this note, ladies and gentlemen, it is now my pleasure to declare the 2002 Combined Orthopaedic Meeting open.