Understanding and Treating Elderly Knee Pain
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- Understanding and Treating Elderly Knee Pain
As we age, our bodies undergo various changes, and one area that often experiences the impact of these changes is our knees. Elderly knee pain is a common concern that many older adults face, and it can significantly affect their mobility and quality of life. In this article, we will delve into the complexities of elderly knee pain, explore its various causes, discuss treating knee pain in elderly available to provide relief and improve the overall well-being of older individuals, and exercises for seniors.
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Knee pain is a common symptom that is more prevalent in older adults. Knee pain is usually caused by degeneration of the joint (often a result of a prior injury) and is more common in older patients. 1 Women are two to three times more likely than men to report having had knee pain or stiffness in the past 6 months. 2 Data from the National Health Interview Survey, United States, 2006, showed that self-reported prevalence of doctor-diagnosed arthritis increases with age, and was 49.7% among those 65 years or older. 3 Another study examining the prevalence of radiographic knee osteoarthritis in the elderly from Framingham, Massachusetts showed an age-adjusted prevalence nearly of 40%. 4 This emphasizes the burden elderly patients experience from chronic knee pain. Women showed a higher prevalence of knee OA than men (47% vs 34%). 4 Among women, the prevalence of knee OA was higher for African Americans compared with Caucasians. Osteoarthritis is a significant cause of mobility disability among elderly persons in the United States. Data from the 1990s indicated that about 80% of those with knee OA had some limitation in movement, and 25% could not perform their major daily activities. 5 With a greater number of older adults still working and remaining active compared with previous generations, 6 the number of adults with symptomatic knee OA is likely to increase over the next decade.
Obesity is a significant public health issue worldwide and the number of obese individuals is still increasing. It is a condition of excessive body fat and this can be defined by using the body mass index or BMI. Obesity places a biomechanical burden on the knees and it has been postulated that the force across the knee joint is increased three to six times higher than body weight in obese individuals during normal daily activities. This increased force is detrimental to the knee joint and over time it can cause degenerative changes to the articular cartilage in the joint and subchondral bone which may lead to osteoarthritis. Increased fat mass can also lead to weakening of the quadriceps muscle due to the increased mechanical load placed on it, and this can also be detrimental to knee joint loading and may lead to an increased risk in developing knee pain and osteoarthritis. Studies have shown that weight loss can significantly reduce the risk of knee osteoarthritis and if a cause and effect relationship between weight loss and symptomatic relief in knee osteoarthritis is established, this will present an opportunity to prevent and treat knee osteoarthritis through weight loss and management of obesity. This could lead to a reduction in national disease burden and a more cost-effective use of healthcare facilities.
The inflammation caused by repeated injury to a knee or to several joints can lead to the development of osteoarthritis. This may occur several years after the initial injury to the meniscus (cartilage) in the knee. Meniscal lesions occur frequently, often as the result of a twisting injury to the knee. High levels of damage occur in sport-related activity where sudden changes of direction, the need to stop abruptly, and direct contact are common. The phrase “sports injury” is often related to loss of function in joints and development of osteoarthritis later in life. In a more elderly population, it has been shown that those who have suffered a knee injury that required non-bone surgery are four times more likely to develop osteoarthritis in later life. It is widely accepted that knee OA can develop in younger individuals over a number of years following a significant knee injury. This does not mean to say that everyone with a knee injury will develop knee OA, but the risk of doing so is significantly increased. This increased risk of developing knee osteoarthritis among those with previous knee injuries creates a high level of relevance to the understanding and also the preventing of arthritis in the knee. Due to the significant damage caused by injuries to the knees and the high risk of developing knee OA, attention should be taken to attempt to slow down or prevent the progression of damage to the knee joints in those with previous knee injuries.
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In the group of those who have had a previous traumatic knee injury, athletes and active individuals remain a high risk group for developing knee pain, especially knee osteoarthritis. The risk of developing knee osteoarthritis post anterior cruciate ligament (ACL) tears has been reported to be from 50-100%. Considering the fact that roughly 200,000 ACL injuries occur annually in the United States, it poses a significant problem. The prevalence of knee osteoarthritis for individuals with isolated meniscal tears is estimated to be 25% at 10-20 years post injury, a rate that is 5 times that of the general population. Any kind of malalignment, ligament injury, or meniscal injury present in athletes and active individuals predisposes them to developing knee osteoarthritis.
Elderly individuals are at a high risk for developing knee pain due to the biological and degenerative changes that occur with aging. It is estimated that 30% of men and 56% of women suffer from knee pain, with osteoarthritis being the most common cause of painful knees in those aged 50 and older. Knee osteoarthritis can lead to pain, stiffness, and decreased function and mobility, all of which prey on the independence of elderly individuals. It exacts a heavy toll, impacting the ability to perform both basic and complex motor functions. Reduced mobility further exacerbates the sedentary lifestyle that many elderly individuals have already adopted, and promotes the cycle of disability.
Elderly individuals are among the most commonly affected by osteoarthritis, as it is estimated that 50% of people aged 65 or older develop symptomatic osteoarthritis in at least one joint (Lawrence et al. 1998). The knee joint is the most common site of pain, as approximately 7-16% of the elderly population have symptomatic knee pain (Cooper et al. 2000), and when seeking treatment for this ailment, it is estimated that the elderly make up 83% of visits to general practitioners (Jordan et al. 2003). The severity of knee pain is a troublesome issue with the elderly, as 37% report their knee pain is being a constant source of discomfort (Cooper et al. 2000), and 55% report severe pain and activity limitations (Hochberg et al. 2001). This restricted activity is a major concern, as physical functioning is essential for maintaining independence with the elderly, and those developing mobility limitations have an increased risk of developing disability and decreased quality of life (Katz et al. 2000). Overall, these statistics highlight the significant impact that knee pain has on the elderly, and the strong need for effective interventions to alleviate the pain and prevent further degeneration in this population.
The knee is known to withstand a force of 3 to 6 times a person’s body weight while walking and even more while engaging in physical activities. Consequently, active individuals and athletes of any age are at risk for traumatic injuries and those that result from chronic overuse. For all athletes, the risk for knee injury is increased by physical activity that puts added stress on the knees. The most common knee injuries in athletes are tears in the menisci and ligament sprains and tears, most notably tears of the anterior cruciate ligament. These injuries are most often treated by some form of surgery and usually require extensive and prolonged rehabilitation efforts. A successful outcome in returning to full function and minimizing symptoms of osteoarthritis is somewhat dictated by the type of injury and the surgical procedure, but more strongly associated with the motivation and attitude of the individual athlete. On the other hand, a major knee pain outcome for most individuals in the general elderly population is total knee replacement, an option that is not typically sought out or desired for most older adults. Although there is some evidence to suggest that the functional and symptomatic benefits of joint replacement are similar in elderly compared to younger individuals, the general perception is that joint replacement is reserved for those in their late years. High hopes and desires to return to previous levels of physical activity and function from elderly individuals in comparison to athletes may point to lesser satisfaction with outcomes of disabling joint pain and wishes to consider more aggressive treatments.
Demographics of knee pain in individuals with a sedentary lifestyle have been examined in a few research studies. The objective of the study by Corti et al. was to assess the prevalence, severity, and impact of knee pain among community-dwelling older adults who self-reported a sedentary lifestyle. In a case study of 1998 individuals aged 55-75, knee pain and disability were assessed using various surveys. Before the completion of surveys, all exercise and recreational activity was stopped for 7 days in order to better understand the symptoms of individuals with a truly sedentary lifestyle. Measures were scored and compared to similar data in the same surveys from individuals without activity limitations during age-matched time frames. Corti’s study found that the prevalence and severity of knee pain in sedentary older adults is high compared to their non-sedentary counterparts. This group reported more pain, stiffness, and physical functional limitations related to knee pain. The Multicenter Osteoarthritis Group (MOST) suggests that a sedentary lifestyle is associated with a significant decline from normal to severe frequent knee pain over a brief 30 months in both women and men. Individuals in the Osteoarthritis Initiative (OAI) who decreased their physical activity levels from baseline were more likely to have further progression of their knee pain and a higher incidence of mobility disability two years later. These incidence rates were much higher than in individuals who increased their physical activity levels over the same time period. In a systematic review, Steultjens et al. found compelling evidence that low levels of physical activity are associated with the onset and progression of knee OA. Although an effective prevention strategy is undefined, it would seem intuitive for individuals with knee pain to attempt to avoid a sedentary lifestyle.
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Symptoms and diagnosis of chronic knee pain and osteoarthritis Chronic knee pain is pain that persists beyond the normal time it takes for an injury to heal. It often occurs despite medical intervention and can affect the patient’s quality of life. Chronic knee pain can be the result of a number of different issues or pathologies, with osteoarthritis being just one of the many possibilities. One of the most common symptoms of chronic knee pain is crepitus, a grating sensation that is felt and sometimes heard when the knee is flexed. Disability begins to become an issue with chronic knee pain, as it is a frequent cause of reduced muscle strength which leads to decreased function and decreased physical activity. Osteoarthritis is a frequently occurring pathology found in those who suffer from chronic knee pain. Osteoarthritis is defined as the degeneration of joint cartilage and the underlying bone, causing pain and stiffness. It is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage which leads to bony overgrowth and the formation of osteophytes. Osteoarthritis is the most common form of arthritis and the leading cause of chronic disability in the elderly. With an increasingly aging population the impact of this condition is being more acutely felt.
The definitions of chronic knee pain and osteoarthritis have evolved in recent decades, with knee pain being seen less as a mere symptom of disease and more as a disease process itself. Osteoarthritis is now regarded as a disease involving the entire joint, including the cartilage, joint lining, ligaments, and underlying bone. It is often accompanied by secondary effects on the muscles and one’s mental outlook due to disuse of the painful joint and other comorbidities such as diabetes, heart disease, and obesity. Knee pain can be classified as localized (if the pain is confined to a small area and is easily identified) or generalized (if it is more vague in nature, difficult to localize, and often described as an overall ache in the knee). Pain may vary in intensity and quality and may be felt on the surface of the knee joint, deep within the joint, or radiating along nerve distributions and can be accompanied by sensations of ‘giving way’ or joint buckling, as well as joint swelling. These sensations and swelling are often intermittent, with ‘flares’ of varying severity, and can lead to recurrent episodes of more intense pain and disability. Osteoarthritis is the most common cause of knee pain and is a primary cause of activity limitation and work disability among elderly people in the United States. Its high prevalence and impact make it an important public health issue.
Definition & Symptoms In the initial stage, the main symptoms are pain which increases on movement, occurs after prolonged sitting, or at night. There is often some stiffness in the knee, and it may be difficult to get out of a low chair and use the stairs. These symptoms can be frustrating; a person may begin to think that they are just due to getting older. It is therefore useful to know which of these symptoms are linked to osteoarthritis in view of the various effective treatments that are available. At any stage of the disease, if the pain is more severe than the joint damage would suggest, other causes should be considered. This is especially important if there are a few swollen and tender joints. These symptoms may be due to a different type of arthritis or an inflammation of the joint lining. Both can respond well to treatment and it is essential to make the correct diagnosis. Osteoarthritis can also be confused with pain referred from the lower back when spine and lower limb pain often overlap. Primary care physicians may sometimes take an x-ray of knees or blood tests to help rule out other types of arthritis or systemic causes for symptoms.
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In recent years, many people have come to view osteoarthritis and chronic knee pain as a natural process of aging, and that nothing can be done to stop their progression. However, there is a consensus that treatments do exist that can effectively control pain and improve function. The intent of treatment is to reduce pain, increase joint mobility and strength, and improve functional capacity with the hope of slowing or halting the progression of the disease. Although no treatment will change the underlying pathophysiology of OA, there are numerous interventions that can be effective in dealing with symptoms. Given the nature of knee OA and the fact that it is not a curable condition, the treatment strategies are generally long-term and often personalized for the individual. Unlike the treatment of clinical depression which may involve a trial and error of different antidepressant medications, knee OA treatments are not simply a hit or a miss. They are often carefully planned out based on the specific symptoms and level of disease of the individual. The main treatment modalities include, but are not limited to, weight management, exercise, joint function, bracing, medications and surgery. Non-pharmacologic treatments are often the first step in dealing with knee OA and are considered to be the foundation of the treatment process.
Weight gain over the years, often a result of a more sedentary lifestyle, increases the stress on the knee joints. This can be calculated by comparing an individual’s BMI at different ages to determine whether the weight of the individual has increased disproportionately to the increase in knee pain. Simple weight loss has a dramatic effect in reducing pain and provides the added benefit of decreasing blood pressure and cholesterol. Strengthening the quadriceps and hamstrings can decrease the stress to the knee joint. Studies have shown that a 10% increase in quadriceps strength can decrease the incidence of knee osteoarthritis in women by 50%. Conversely, when an individual becomes stronger there is more weight transmitted across the joint, so it is crucial to maintain muscle strength and lose the proper amount of weight during muscle strengthening. Proper body mechanics and posture are important in reducing the stress on knee joints, particularly during lower extremity activities. The proper alignment of the leg when performing weight bearing activities can decrease the load on the joint surface. In individuals with malaligned knees, physical therapy or the use of a cane to unload the affected side of the joint can reduce pain. In patients with O or X shaped legs, a change in the pattern of walking (gait) can also reduce stress on knee joints. At times, surgery may be necessary to correct severe malalignments and shift loads to undamaged areas of the knee.
It is apparent that weight management is a very effective means of reducing knee pain and disability in overweight individuals. Therefore, it should be a priority in the comprehensive management of knee osteoarthritis. Patients with knee pain related to overweight or obesity should be educated about the importance of weight loss. This is especially relevant given that many people with knee pain may not make an association between their weight and their knee symptoms. Weight loss can be considered a primary therapy for knee osteoarthritis, potentially preventing disease incidence and slowing disease progression. According to the American College of Rheumatology, weight reduction has both short-term and long-term benefits for patients with osteoarthritis. Short-term effects include reduced pain with improved function and reduced disability. Long-term effects are reduction of the development and progression of disease in weight bearing joints, less impact on systemic and structural features of disease and fewer co-morbidities. Weight loss is indeed the best prognosis for overweight patients with knee pain. At the same time, it is recognised that weight loss may be more difficult for older adults because of co-morbidities, low socioeconomic status and difficulties with physical activity. These factors should be taken into consideration in a patient-specific approach to treatment and the assessment of the feasibility and impact of weight loss on overall health.
The findings on weight loss as a therapy for reduction of knee pain in overweight patients are consistent in the literature. For every pound lost, there is a 4-fold reduction in load exerted on the knee for each step taken. A weight loss of 11 lb can decrease the risk of developing symptomatic knee osteoarthritis in overweight women by 50%. Weight loss effects are particularly evident in people with more severe radiographic evidence of disease. Compared to persons in the Framingham Osteoarthritis study who experienced an increase in knee pain, function or stiffness, those who had lost weight had less than half as much progression of disease based on symptomatic or radiographic criteria over the ensuing 8-10 year period. These results are particularly important as it is thought that structural changes in the knee are irreversible. Given that overweight and obesity are modifiable risk factors, interventions specifically targeting weight management are a very relevant public health intervention for prevention of knee osteoarthritis and the reduction of pain and disability in affected individuals.
Weight management is an essential component of knee pain reduction in overweight older patients. The effectiveness of weight loss as a treatment for knee pain and disability in the older patient is conclusive. Observational studies have provided evidence that an increase in body weight is associated with incident knee pain. Weight loss was associated with a decrease in the risk of developing knee pain and a progression of disease in overweight and obese adults. Randomized controlled trials have shown that weight loss can be an effective means of reducing pain and improving function in the osteoarthritic knee. Among older adults with symptomatic osteoarthritis, a combination of diet and exercise resulted in greater improvements in physical function, pain and disability than either diet or exercise alone. Weight loss of as little as 5.1 kg was associated with clinically significant improvements in physical function, bodily pain, social function and vitality.
The purpose of including a strengthening exercise program is to increase the stability of the knee joint. Muscle strength is important in maintaining joint stability, particularly for the knee. In the knee, there are four main ligaments that hold the joint together. The ligaments act as strong ropes to hold the bones together and keep the joint stable. When a ligament is injured, the stability of the joint is compromised. The muscles provide dynamic stability. The quadriceps and the hamstrings are important, and it is important that their strength is maintained throughout life to provide good stability at the knee joint. If the muscles are weak, it will make it hard for the joint to be stable and can cause it to buckle or give way, often leading to further damage or degeneration of the joint. Strengthening the vastus medialis obliquus (VMO) muscle is also important. This is the large muscle on the inner side of the quadriceps. It is thought that strengthening the VMO can improve stability of the patella on the groove at the end of the femur. This can be seen in isolation by straightening the leg with a rolled towel under the knee. If you tense the quadriceps muscle and hold for 5-6 seconds, the inner quadriceps muscle, roughly the area of the VMO, contracts. Gaining strength in the VMO makes it easier to keep the patella in the right position. This can help to relieve pain caused by mal-tracking or clicking of the patella. The right type of strengthening program should not exacerbate the pain in the knee joint. High impact or resistance exercises could potentially put more stress on the joint and cause further damage. Progressing the type of exercises used and resistance can help ensure that the muscles gain maximum benefit. This might mean starting with exercises while seated to avoid too much activation of the gluteal muscles or progressing from light to moderate resistance. Different people will also find that different forms of exercise will better suit them. For instance, swimming can be the best form of exercise for some. It is important to start steadily and gradually increase strength, and it has often been quoted that a good session should not increase knee pain on the following day.
A major part of stress reduction is the utilization of proper body mechanics and posture. The benefits of proper body mechanics and posture are that they decrease the amount of force across the knee joint and reduce the amount of effort the muscles must exert to perform an activity. Less force across the joint means less damage to the joint over time; less muscle effort means less fatigue and more endurance. All of this translates to a decrease in knee pain and an increase in function. Non-concentrated efforts to improve mechanics are usually not very successful in the long term. A physical therapist would be the best resource in providing a comprehensive analysis of body mechanics and specific recommendations for improvement. An easy way to work on posture is to imagine a straight line going from the ear, through the shoulder, hip, knee, to the ankle. When performing activities it is important to avoid placing the joint in extreme positions or maintaining the position for long periods of time. Step stools and reaching devices should be utilized instead of squatting and kneeling. An example of activity modification would be sitting in a chair instead of on the floor to unload the knee joint and decrease muscle effort. During sit to stand activities it is best to lean forward and stand up with a straight back as opposed to sitting up with the back straight and then leaning forward to stand up. This decreases the load on the knee joint. It is important to avoid activities and positions that cause a significant increase in pain or swelling of the knee joint. Lastly, when muscle fatigue is reached the activity should be discontinued to avoid a negative impact on mechanics and an increase in symptoms.
Patients often ask whether a brace can help support the knee and delay the progression of arthritis. A knee brace may be helpful in certain situations. Patients with bow-leg (varus) or knock-knee (valgus) deformities can be shifted into a more normal alignment with a brace. This may take some pressure off a damaged area of joint cartilage and reduce symptoms. Patients with isolated unicompartmental arthritis may be able to unload the damaged side of the joint using a brace with a wedge that shifts the mechanical axis to the healthier side, thus reducing pain and slowing the progression of arthritis on the damaged side. Unfortunately, most braces have not been shown to be superior to medical and physical therapy, and many patients find them uncomfortable and not cost-effective.
After an injury or the onset of arthritis symptoms, doctors usually recommend non-weight-bearing and low-impact cardiovascular exercise that will not further injure the joint. The added bonus of weight loss will further decrease joint stress and pain. The most common low-impact activities are cycling and swimming. These are often successful at maintaining muscle fitness and can have a positive effect on the mental well-being of a patient. The water, in particular, has a soothing effect both physically and mentally and can often aid in patients’ sleep.
Knee pain is a prevalent issue among the elderly, often arising from a combination of age-related changes and underlying medical conditions. The most common causes include osteoarthritis, where the protective cartilage within the knee joint gradually wears away, leading to pain, inflammation, and reduced mobility. Rheumatoid arthritis, an autoimmune disorder, can also affect the knees, causing chronic pain and stiffness. Additionally, meniscus tears, bursitis, tendinitis, and gout contribute to knee discomfort. Fractures resulting from falls or accidents, obesity-related strain on the joints, previous injuries, osteoporosis-related bone weakening, and altered leg alignment due to bowed legs or knock knees are further causes of knee pain in the elderly. Proper diagnosis by a healthcare professional is essential for tailored treatment plans that address the specific cause of knee pain.
Aging plays a significant role in the development of knee pain and discomfort in several ways. As people age, the cartilage within the knee joint tends to degrade naturally, leading to a condition known as osteoarthritis. This deterioration reduces the joint’s ability to absorb shock and provide smooth movement, resulting in pain, stiffness, and limited mobility. Ligaments and tendons may also become less flexible over time, making the knee joint less stable and more susceptible to injury.
There are proactive measures that can help reduce the risk of knee pain as we age. Engaging in regular exercise is crucial, as it helps strengthen the muscles surrounding the knee joint, providing better support and stability. Low-impact activities like swimming, cycling, and walking are particularly beneficial for maintaining joint health without putting excessive stress on the knees.
Maintaining a healthy weight is another key preventive measure. Excess weight places additional strain on the knee joints, accelerating wear and tear. A balanced diet rich in nutrients can contribute to overall joint health by supporting cartilage integrity and reducing inflammation.
Adopting certain lifestyle changes can be highly effective in managing knee pain in the elderly. First and foremost, maintaining a healthy weight is essential. Shedding excess pounds can alleviate the strain on the knee joints, reducing pain and inflammation. Engaging in regular low-impact knee pain exercises for seniors, such as swimming, yoga, and tai chi, can help strengthen muscles around the knees, improve flexibility, and enhance overall joint function.
Incorporating an anti-inflammatory diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help manage knee pain. Certain foods, like fatty fish, turmeric, and berries, are known for their anti-inflammatory properties. Staying well-hydrated also plays a role in joint health by ensuring proper lubrication of the joints.
Non-surgical treatment options offer valuable alternatives for managing elderly knee pain while avoiding the risks and recovery associated with surgery. One prominent approach is physical therapy, where specially designed exercises and stretches are employed to strengthen the muscles around the knee joint, improve flexibility, and enhance overall joint function. Physical therapists can customize treatment plans based on individual needs, ensuring gradual progress and pain relief.
Medications, both over-the-counter and prescription, can also play a role in alleviating knee pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain, offering temporary relief. Topical creams and ointments can provide localized comfort, targeting the source of discomfort directly.
Knee replacement surgery is typically considered when non-surgical treatments have not provided adequate relief, and knee pain has significantly impaired an elderly individual’s quality of life and daily activities. The decision to undergo knee replacement surgery is a collaborative one between the patient, their healthcare provider, and an orthopedic surgeon.
Factors that may indicate the need for knee replacement surgery include persistent and severe knee pain that limits mobility and independence, difficulty walking, climbing stairs, or performing routine tasks. X-rays and other diagnostic tests can reveal the extent of joint damage, helping the healthcare team assess whether surgical intervention is necessary.
Physical therapy and targeted exercises can offer substantial benefits to seniors dealing with knee pain. These interventions play a crucial role in managing pain, improving mobility, and enhancing overall quality of life. A skilled physical therapist can develop a personalized exercise program tailored to the individual’s specific needs and limitations.
Physical therapy focuses on strengthening the muscles surrounding the knee joint, improving flexibility, and promoting better alignment. These exercises help to stabilize the knee, reduce stress on the joint, and enhance joint function. Strengthening the muscles also provides better support to the knee, reducing the risk of further injury and pain.
Maintaining a well-balanced and nutrient-rich diet is essential for supporting knee health in older adults. Incorporating certain foods and nutrients can help manage inflammation, promote joint health, and support overall well-being.
Omega-3 fatty acids found in fatty fish like salmon, walnuts, and flaxseeds have anti-inflammatory properties that can help reduce joint pain and stiffness. Foods rich in antioxidants, such as berries, spinach, and colorful vegetables, can help combat oxidative stress and inflammation in the body.
Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.
He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.
Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.
Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.
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