Limb Salvage and Revision Arthroplasty Surgery - Orthopaedic, Singapore

Limb Salvage and Revision Arthroplasty Surgery - Orthopaedic, Singapore The orthopaedic specialty committed to saving limbs with tumors, trauma and joint replacement failur

This encompasses all aspects of local and systemic control of disease and requires a multidisciplinary approach comprising the talents of orthopaedist, pediatric and adult medical oncologists, pediatric and adult general surgeons, plastic and hand surgeons, radiologists, radiation oncologists and musculoskeletal pathologist. Work in this area typically revolves around the traditional oncologic mod

els based on therapeutic and molecular etiology but has, in addition, the aspects of functional issues and issues of social re-integration. Sarcomas pose challenging life-threatening problems and require great expertise not just in surgery but also in organizing multidisciplinary teams to tackle individual specific problems. Some musculoskeletal oncology conditions may not be life-threatening but, nevertheless, these problems provide unique challenges for medical practitioners because they often hamper daily activities and hence need to be dealt with urgently. This is one of the few specialties that encompass both pediatric and adult disease. There is an annual incidence of 30 cases of bone sarcomas and 120 cases of soft tissue sarcomas annually in Singapore alone. In addition, patients with metastatic disease will often require the care of the musculoskeletal oncologist for the management of metastatic disease.These various skills makes the limb salvage surgeon particularly adept at handling treatment failures in trauma and joint replacement surgery. Our Director and Resident Senior Orthopaedic Consultant, Associate Professor Saminathan Suresh Nathan, is a world authority on the subject with multiple Publications and Leadership in the field. Keywords: orthopaedic, orthopedic, bone cancer, orthopaedic singapore, arthroscopy, knee replacement, hip replacement, sarcoma, osteosarcoma, osteoarthritis

Avoid knee replacement and conserve the knee with 3D printed patient specific instrumentation.We are proud to be the onl...
06/06/2024

Avoid knee replacement and conserve the knee with 3D printed patient specific instrumentation.

We are proud to be the only centre in Singapore to provide 3D printing technology for tumor, osteotomy and knee replacement technologies. These are as accurate as navigation and robotics and are cheaper. In combination with stem cells, we can now preserve joints deferring the need for knee replacement surgery.

04/05/2024

Response to Straits Times article "New surgical method for hip replacement surgery promises less pain, quicker recovery" April 3, 2024. We wish to clarify the following errors in this article:

1. It is untrue that this is a new procedure in Singapore. Our principal surgeon, former Prof Suresh Nathan, has been performing this procedure since 2005 and has taught the procedure in multiple centres in South East Asia and has even adapted the technique to robotic surgery. He has taught many orthopaedic surgeons this technique that they perform both in Singapore and around the world.

2. It is not a superior procedure and needs to be appropriately selected. Our own website has discussed and offered the procedure since 2012 (https://www.limbsalvagesurgery.com/approaches).

3. A meta-analysis of over 2000 cases failed to show any difference between anterior and posterior approaches (Higgins et al JOA March 2015).

4. A randomized controlled trial of over 50 patients failed to show any difference between the two approaches (Moerenhouf et al CJS Sept 2020).

5. Either approach is appropriate for revision surgery and we perform some of the most complex hip procedures in the country through either approach. In fact at the extremes of surgery the anterior approach is more appropriate than the posterior approach in our experience.

6. The anterior approach obliges uncemented implants and is associated with higher risk of component malposition, thigh pain, nerve injury and wound complications due to stretching of the wound. We also find that blood loss is greater although this is controversial in the literature.

7. The posterior approach is associated with cemented implants and is associated with hypotension and longer operating time due to an extra half hour for cement setting.

The orthopaedic specialty committed to saving limbs with tumors, trauma and joint replacement failur

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Associate Professor Saminathan Suresh Nathan specialises in bone and soft tissue tumours of the musculoskeletal system and complex problems in joint replacement or adult reconstruction surgery (e.g. bone transplants and custom implants in revision joint surgery). He obtained his medical degree from the National University of Singapore (NUS) in 1992 and trained in Orthopaedic Surgery at the National University Hospital (NUH), Singapore joining NUH in 1999 after he obtained his Masters of Medicine and Fellowship of the Royal College of Surgeons of Edinburgh. He was awarded the Yahya Cohen Gold Medal Award for Best Clinical Performance and Academy of Medicine Gold Medal Award for Best Overall Performance at the regional fellowship examinations of the Royal College of Surgeons of Edinburgh.

In 2006, he joined NUS and achieved tenure as an Associate Professor in Orthopaedic Surgery continuing his clinical practice at NUH. He trained at the Memorial Sloan- Kettering Cancer Center in New York (affiliated with the Hospital for Special Surgery and Weill Medical College of Cornell University) between 2003 and 2005 and is a fellowship - trained musculoskeletal oncologist. At these institutions, he learned many advanced techniques in adult reconstruction in the context of restoring function to defects secondary to tumour resections and in difficult situations resulting from revision arthroplasty surgery. In addition, he has worked in the Children's Hospital of the Montefiore Medical Center, Albert Einstein College of Medicine and Sloan-Kettering Institute in New York on molecular and chemosensitivity research in osteosarcoma - a type of cancer of the bone.

Dr Nathan served distinguished leadership roles as Clinical Director, Head of the Musculoskeletal Oncology Division and Senior Consultant in Joint Replacement Surgery in NUH; and Musculoskeletal Oncology and Sarcoma Group Leader of the National University Cancer Institute of Singapore (NCIS). He was the Principal Investigator of the Musculoskeletal Oncology Research Laboratory in the NUS Clinical Research Centre. He served as the Chairman of the Clinical Competency Committee. In 2007, he was one of the only two members from Singapore inducted to the International Symposium of Limb Salvage Surgeons. In 2008, he was the only member from Singapore elected to the Advisory Committee of the Asia Pacific Musculoskeletal Tumour Society. He provides consultancy to 2 joint replacement companies as a joint replacement specialist. He contributes actively to the American Orthopaedic Research Society and has been cited in Marquis Who's Who in the World, a publication recognizing individuals of distinction in their respective fields, since 2008.

Associate Professor Nathan has a consistent and passionate interest in research with more than 100 articles in high impact journals and abstracts of international meetings (Pubmed search 'Nathan S') and chapters in important surgical textbooks. He has received numerous research awards locally (Singapore Orthopaedic Association Young Orthopaedic Investigator Award and NUH - NUS Young Doctor Award in Research) and internationally (New Investigator Recognition Award, American Orthopaedic Research Society, 2004). He was Programme Director of Singapore's Ministry of Health (MOH) Musculoskeletal Oncology Cryosurgery initiative. He established the inaugural Musculoskeletal Oncology Fellowship Programme in the National University Health System in 2006. In 2009, he was awarded the Yahya Cohen Lectureship by the Academy of Medicine for his work in angiogenesis and chemo-responsiveness in solid tumours. He serves as one of only 3 established senior orthopaedic surgeons on the Domain Specific Review Board (DSRB) that determines the ethics of research in the National Healthcare Group (NHG) and National University Health System (NUHS) of the Ministry of Health.