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Klinefelter Syndrome

Management Team

Klinefelter Syndrome

Overview

Klinefelter syndrome is a genetic condition in males caused by an extra X chromosome. Many men with Klinefelter syndrome are not diagnosed with infertility until they realise they are unable to father a child.

Reduced muscle mass, enlarged breast tissue, infertility, and learning difficulties.

Genetic testing and evaluating physical and developmental symptoms.

Testosterone replacement therapy to address hormonal deficiencies, physical therapy to improve muscle strength, speech and educational support, and fertility treatments if desired. Early diagnosis and intervention are important to address developmental and health challenges, enabling individuals with Klinefelter syndrome to lead healthy and productive lives.

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Kidney Cancer

Management Team

Kidney Cancer

Overview

This is a condition where the cells of the kidney begin to divide uncontrollably. There are many treatment options for kidney cancer.

The following are symptoms of kidney cancer:

  • Incidental detection of the tumour mass during imaging
  • Blood in the urine
  • Unexplained weight loss
  • A mass or bulge on the side of the abdomen

Kidney cancer can be diagnosed using the following investigations:

  • CT urogram: A CT scan of the kidneys, ureters, and bladder
  • Cystoscopy: A surgical procedure to examine the lining of the bladder, urethra, and ureters

The following options exist to treat kidney cancer:

  • Robot-assisted partial nephrectomy: A surgical procedure to remove the tumour from the kidney using robotic assistance
  • Open partial nephrectomy: A surgical procedure to excise the cancerous tissue from the kidney
  • Laparoscopic/robotic radical nephrectomy: A robot-assisted surgical procedure to remove the complete kidney, along with adjacent organs such as adrenal glands, fat tissues, and lymph nodes
  • Open radical nephrectomy: This is a surgical procedure in which the entire kidney, along with nearby fat tissue, adrenal glands, and lymph nodes, are removed
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Kidney Stones

Management Team

Kidney Stones

Overview

This is the accumulation of mineral and salt deposits within the kidney. It is a painful condition. The risk of kidney stones is increased by certain dietary choices, excess body weight, as well as certain medications and supplements.

The symptoms of kidney stones include:

  • Pain in the flank (between the back and abdomen/upper belly)
  • Blood in the urine
  • Lithuria, which refers to excess acid or salts in the urine
  • Fever with chills
  • Burning sensation during urination

Kidney stones can be diagnosed using the following methods:

  • Ultrasound KUB: An ultrasound of the kidneys, ureters, and bladder
  • NCCT KUB: A non-contrast CT scan of the kidneys, ureters, and bladder
  • Urinalysis: A routine urine test
  • Kidney function test, C-reactive protein, and complete blood count: These are blood tests that check for the markers of kidney dysfunction 

The following treatment options exist for kidney stones:

  • Ureteroscopic laser lithotripsy: A non-invasive procedure that uses a laser to break down the kidney stones
  • Retrograde intrarenal surgery (RIRS): Surgery is performed on the kidney to treat kidney stones
  • Percutaneous nephrolithotomy (PCNL): This is a surgery that is used when the kidney stones are large and other non-invasive methods of treatment cannot be used
  • Extracorporeal shockwave lithotripsy: This is a non-invasive method that breaks up kidney stones using shockwaves  
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Knee Joint Arthroplasty

Management Team

Knee Joint Arthroplasty

Overview

Knee joint arthroplasty, commonly known as knee replacement surgery, is a surgical procedure to replace a damaged or diseased knee joint with an artificial joint. This procedure is typically performed to relieve pain and restore function in people with severe knee arthritis or other knee joint issues.

Knee joint arthroplasty involves removing the damaged cartilage and bone from the knee joint and replacing them with an artificial joint. There are two main types of knee arthroplasty:

  • Total knee arthroplasty (TKA): It involves replacing all compartments of the knee joint.
  • Partial knee arthroplasty (PKA): It involves replacing only the damaged part of the knee joint, leaving the healthy parts intact.

  • Severe and persistent knee pain that does not improve with rest or medication.
  • Knee joint stiffness or reduced range of motion, especially in the morning or after sitting for long periods.
  • Persistent swelling in the knee.
  • Trouble with walking, climbing stairs, or performing daily activities.
  • Weakness or instability in the knee joint.

  • Ageing (> 50 years of age), arthritis, and joint wear and tear.
  • Obesity that stresses the knee joint.
  • Previous knee injuries.
  • Family history of arthritis or joint problems.
  • Jobs or activities that stress the knees.

  • Severe primary osteoarthritis, which leads to the breakdown of cartilage and causes pain and stiffness.
  • Rheumatoid arthritis or other inflammatory arthritis types with knee involvement.
  • Secondary arthritis, which develops after an injury or infection of the knee.

Diagnosis is made by a knee specialist who will perform various examinations to confirm the need for knee joint arthroplasty:

  • Physical examination by assessing knee pain, swelling, range of motion, and functional limitations.
  • Medical history review to discuss symptoms, their duration, previous treatments, and overall health.
  • Investigations such as:
    • X-rays: To evaluate the extent of joint damage, bone alignment, and overall joint structure.
    • Magnetic resonance imaging (MRI) or computed tomography (CT) scan: To assess the soft tissues around the knee and provide detailed information about cartilage and bone damage.
    • Blood tests: To rule out infections or other conditions that might affect the surgery or recovery.

Non-surgical treatment

These include physical therapy, medications (analgesics and anti-inflammatory drugs), weight management, and injections like corticosteroids or hyaluronic acid to reduce pain and inflammation.

Surgical treatment

  • Conventional partial knee replacement or total knee replacement surgery
  • Navigation-assisted knee surgery
  • Robotic-assisted surgery: It is more precise and requires fewer bone cuts (Bone preserving). It is associated with fewer complications, faster recovery, and good functional outcomes.

Pre-surgical evaluation

These include assessing overall health, preparing for anaesthesia, and planning post-surgery rehabilitation.

During surgery

The surgeon will remove the damaged parts of the knee joint and replace them with an artificial implant. The procedure typically lasts 1–2 hours.

Post-surgery measures

  • Rehabilitation: Post-surgery physical therapy is crucial to regain strength, mobility, and function in the knee. This often begins immediately after surgery.
  • Pain management: It includes medications and ice therapy to manage pain and swelling.
  • Lifestyle modifications: It is necessary to follow recommendations for activity levels and joint care to ensure optimal recovery and prevent complications.
  • Ongoing physical therapy is the key for continuously improving strength and flexibility.

After the surgery, patients are suggested to undergo basic or advanced physiotherapy. However, returning to daily activities should be discussed with the orthopaedic expert for further injury prevention and rapid recovery.

Knee joint arthroplasty can significantly improve the quality of life by reducing pain and restoring mobility. However, it requires careful planning and commitment to rehabilitation for the best outcomes.

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Knee Arthroscopy

Management Team

Knee Arthroscopy

Overview

Knee arthroscopy is a minimally invasive surgery used to diagnose and treat knee injuries. It involves making small incisions to insert a camera (arthroscope) and tiny surgical tools into the knee joint. The camera provides real-time images of the knee's interior, helping the surgeon diagnose and address issues with cartilage, ligaments, and other soft tissues.

Knee arthroscopy procedures are recommended:

  • When knee pain persists despite nonsurgical treatments like rest, ice, non-steroidal anti-inflammatory drug (NSAID) therapy, and physical therapy.
  • To examine injuries related to ligaments, tendons, and cartilage.
  • To treat conditions, such as bursitis and synovitis.

Preoperative planning

Before the procedure, patients may need to stop certain medications and fast. Anaesthesia options include local, regional, or general.

Surgery

During the procedure, the knee is cleaned and secured, a small incision is made, and the arthroscope is inserted. The surgeon uses the camera’s images to guide the repair of damaged tissues, remove inflamed or damaged material, and close the incisions with stitches or bandages.

Postoperative care

Most arthroscopies are outpatient procedures that take about an hour. After the surgery, patients may need crutches, pain medication, and rest with their knees elevated. Following recovery, physical therapy can help regain strength and mobility. Patients are suggested to undergo advanced physiotherapy regimens. However, recovery times vary, and returning to strenuous activities should be discussed with the healthcare provider for injury prevention and rapid recovery.

Knee arthroscopy generally offers a quicker recovery and less pain compared to traditional surgery. However, the possible risks include:

  • Bleeding
  • Infection
  • Blood clots
  • Knee stiffness
  • Swelling

Please contact your healthcare provider if you experience severe pain, bleeding, or signs of infection.

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Knee Cartilage Damage

Management Team

Knee Cartilage Damage

Overview

Cartilage is a tough, flexible connective tissue that acts as a cushion between joints. It reduces friction while supporting weight. Knee cartilage damage can result in knee joint pain, stiffness, and inflammation. In severe cases, a piece of cartilage may even break off.

  • Elastic cartilage: Found in the ears and nose, known for its flexibility.
  • Fibrocartilage: The toughest type, found in spinal discs and the hip and pelvis.
  • Hyaline cartilage: Springy and tough, found in the ribs, windpipe, and joints.

  • Knee swelling, warmth, tenderness, and pain.
  • Knee stiffness and limited range of motion.
  • In severe cases where a piece of cartilage may break off, the knee joint may lock and bleed (hemarthrosis).

  • Falls, accidents, or sports.
  • Chronic joint stress, especially in obese individuals or individuals with osteoarthritis.
  • Prolonged inactivity increases the risk of cartilage damage.

  • Physical examination for initial assessment by a clinician.
  • Magnetic resonance imaging (MRI) to identify the extent of cartilage damage.
  • Arthroscopy procedures: inserting a tube-like instrument into the joint for examination and repair.

Non-surgical treatment

  • Exercise and advanced physiotherapy techniques for strengthening the joints
  • Non-steroidal anti-inflammatory drugs (NSAIDs) and sometimes, steroid injections to alleviate pain and inflammation
  • Awareness regarding injury prevention can also help patients adopt a healthy, low-risk lifestyle.

Surgical treatment

  • Surgical treatment depends on the severity and specifics of the damage and includes:
  • Debridement
  • Marrow stimulation
  • Mosaicplasty
  • Autologous chondrocyte implantation

Furthermore, in recent years, several advanced surgical options, such as partial knee replacement, total knee replacement, knee implant technology, robotic-assisted surgery, knee joint replacement, and advanced knee surgery, have become available, which are associated with rapid recovery and improved outcomes for patients with damaged knee cartilage.

If left untreated, cartilage damage can lead to severe joint impairment and chronic pain, potentially resulting in conditions like osteoarthritis.

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Knee Bursitis

Management Team

Knee Bursitis

Overview

Knee bursitis is defined as inflammation of bursae, tiny fluid-filled sacs that minimise friction. It serves as a cushion between bones, tendons, muscles, and skin around joints, absorbing pressure and protecting the joints. This condition frequently affects the region above the kneecap or the inner region of the knee (beneath the joint); it limits knee movement and causes pain and discomfort.

Knee bursitis can result from prolonged pressure on the knees (e.g., kneeling), overuse of the knee joint, direct blows, bacterial infections, or medical conditions like osteoarthritis, rheumatoid arthritis, or gout.

  • Extended pressure on the knee from activities like prolonged kneeling (common in carpet layers and plumbers).
  • Repetitive knee strain associated with specific sports (e.g., wrestling and football) or from direct impact.
  • Underlying health conditions, including bacterial infections, osteoarthritis, rheumatoid arthritis, gout, or obesity.

Preventive measures include wearing kneepads, taking breaks between intense physical activities, and maintaining a healthy body weight.

Symptoms differ depending on the bursa involved and the cause of inflammation.  

  • Common symptoms include warmth, soreness, swelling, and pain while moving or resting the knee.
  • Sudden symptoms may occur after a direct hit.
  • Kneeling on hard surfaces can cause chronic symptoms.
  • Fever, bruising, swelling and skin changes near the knee, along with difficulties moving the knee, may also be observed.

  • Reviewing medical history.
  • Conducting physical examinations.
  • Performing imaging tests (e.g., X-ray, MRI, and/or ultrasound) or fluid aspiration.

Non-surgical treatment

Non-surgical options include medications, such as antibiotics for infections, and physical therapy. At-home care may involve rest, over-the-counter pain relievers, applying ice, compression, elevation, and, if necessary, weight management.

Surgical treatment

In some cases, corticosteroid injections or fluid drainage through aspiration may be recommended; this enables outpatient recovery. Surgery to remove the bursa is rarely needed. Following treatment, patients are advised to engage in basic or advanced physiotherapy. However, returning to normal activities should be discussed with an orthopaedic specialist for injury prevention (especially, reinjuries) and ensure a faster recovery.

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