Dr. SS Sathappan, Senior Consultant, Orthopedic Surgery, Farrer Park Hospital

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Curing the Pain

What made you specialize as an orthopedic surgeon? Can you give us brief accounts of your work in the other subfields?
Orthopedics excites me mainly because of reconstruction; the ability to build back from the structural damage to the bones and joints. The return of function, return of a sense of normality, of lifestyle, getting back into sports; giving the ability back to the patient and empowering them through their physical ability, is something that makes me very happy. I derive satisfaction from their own satisfaction.

I do a variety of orthopedic procedures, it expands to both the young and the old. The older patients, I do a lot of joint replacements, through robotics, computer navigated or a customized joint replacement. The procedures extends from the knee, hip, shoulder and even elbows. Vast majority of these patients are in their 60s, 70s and even 80s. However for patients who have rheumatoid or inflammatory conditions, if my rheumatologist colleagues tell me that the medicine isn’t working, then, I might even need to perform joint replacement surgery on patients who are in their 30s.
Other subgroup that I deal with a lot is sports surgery because of my close affiliation to cartilage and ligaments. Hence, I treat a lot of sportsman who are soccer players who have knee injuries especially, and muscle tears on their shoulders. Subset to this, I do a lot of redo surgeries. Patients who have suffered from complications from past surgeries that didn’t lead to a proper outcome. They consult me for second and even third opinions.

According to you, what are the prominent healthcare challenges of the 21st century?
Compared to 20-30 years back, the biggest issue now would be patient’s expectations; which, now are a lot more. They want normality and don’t accept anything second place to it. Back in my academic days, we used to hear the statement, ‘you are too old or too young for this surgery’. Now, we have so much more advancement in technology that patients are able to be made optimized medically, irrespective of their age. Thus, ensuring good results by having a solid pre-operative planning so that the post-operative result can be predicted and executed very well.

Give us an account of the emergence of robotics in surgery. What challenges are you experiencing in this venture?
I think the robotics technology is the upcoming next big thing in orthopedics. The objective – achieving a successful replacement whilst fine tuning that precision. So, year’s back we depended on road maps for navigating that led way to the GPS system; if you don’t update the system it becomes outdated because the newer roads might not be there. My point being, if you stick to the earlier method, you will reach your destination but it will be a tough journey, prone to errors on your part. So, when such a technology is there to execute with least amount of error, we should slant towards that way; that’s where robotics comes in. Experience gives you good outcome, with robotics, that experience is made multiple fold, thus the outcome becomes more strengthened and solid. Any slight leeway of error is reduced so dramatically that the outcome can be predicted and you can tell your patients that they will have a successful surgery. Hence, the primary challenge for us is to stay open and constantly re-educate and update ourselves with upcoming advancements; just like a software update.

In your opinion, what is the most orthopedics related problems faced in the South-East Asian region?
Increasingly, people are living longer and want to be just as active as they were in their 30s and 40s. I’ve got patients who are in the late sixties and play rugby, patients who are in their 60s and play cricket, they have grandkids who they want to play games with like tennis. And if you’re telling them your joints are too arthritic please sit down, they respond by saying that if so, they rather not be around anymore. Lifestyle and expectations have changed. Hence, we have to move with the flow with accordance to the patient’s expectations by educating them about the procedure process. After that, if they are prepared to take on the journey, we can then try to improve their overall outcome and give them a good end product at the end of it. Overall, as ageing population increases, the expectation of the outcome from a joint replacement procedure to be near equal as they were ten years back is expected and we should try our very best to achieve it. All in all, being able to achieve their own means of normal functionality. We are more accustomed to a means of movement that requires high flexing in the knee and hip joint, as compared to the European or Caucasian counterparts. So, executing that function by optimizing the anatomy with robotics along with optimizing the longevity of the procedure through improved bio-materials; will ensure a successful outcome for the patients.

Dr. Sathappan, could you briefly explain Osteoarthritis and its ailments? What lifestyle measures can we adopt to better manage the risk of developing it?
In terms of Osteoarthritis, you have your cartilage in the joint which is like a soft lubricating surface and it reduces joint forces. Basically, if you jump, run etc. every time there is a ground reaction force that goes through the joint to the knee to the ankle to the hip. If you have healthy cartilages, muscles and good lubricating fluid; you don’t experience any pain. But, overtime due to the loss of cartilage, the bone experiences excessive loads i.e. pain. The nerve endings are located in the bone and any excessive loads makes it painful. As a result, the patient walks less and the muscles start to weaken. Following that, the already weakening muscle leads to more joint force, as they are not offloading. Hence, a vicious cycle develops. We need to try and break that vicious cycle in the early stages by optimizing the pain management to jumpstart the physio better. In the intermediate phase, sometimes you can give them lubricating injections and reduce the frictional abrasion between the two bony surfaces. However, the advanced stages require careful observation and resulting complicated procedures. The presentation of problem may be similar but we need to fine tune the process with respect to patient’s state and ensuring the longest outcome for them.

Dr. Sathappan, if you had one piece of advice for your patients what would it be?
In order to maintain a healthy lifestyle, you need to understand the importance of maintaining a good muscle mass. Whether you’re young or old, you attain your peak body mass at the age of 30+. The muscle mass, as we get older, for women when they enter their menopause and men when they enter their 50s and 60s; leads to muscle atrophy. So, it’s important to maintain a certain degree of muscle endurance and muscle strengthening because that will keep you going for the long road. A healthy lifestyle incorporates exercises regularly throughout the week and not just being a weekend warrior. All in all, if you start high, you end low at a much lower rate but if you start low you end at an even lower rate.

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