He also cautions against steroid treatments as patients can become dependent on it. And the problem with total knee replacement is that many of the elderly aren't good candidates for surgery, as they typically suffer from conditions such as high blood pressure, diabetes, high cholesterol and have high risk of stroke.
'Younger patients - those who're in their 40s, for instance - aren't good candidates either, because knee replacements typically last only for 10 years,' he says.
Enter viscosupplementation. 'There's very solid scientific basis to this, and we've seen OA 'reverse' itself,' says Dr Ting, whose first patient 17 years ago still has good knees.
Of course, treating patients with VSP in the early stages of OA sees more result, but even in later stages, VSP can help.
The basis of VSP is to replace the diseased synovial fluid. 'VSP treats the disease at the root thus breaking the vicious circle,' he notes.
The raw material for viscosupplements is hyaluronic acid. Long chains of glucosamine molecules are strung together to form hyaluronic acid, which is the basic building structure of synovial fluid.
Patients typically get diseased synovial fluid drawn out from their knees, and then a replacement viscoelastic fluid is injected in. The injections are given once a week for three weeks, after which the doctor monitors their progress over a six-month period.
In the 17 years he has administered VSP, Dr Ting noticed that patients start to feel less pain (because the root problem of viscosity and elasticity is solved) and the VSP also helps to kickstart the production of healthier and normal synovial fluid.
The damaging process is thus reversed in the synovial membrane, and the cartilage layer is nourished, even to the extent that new cartilage cells might be grown.
'There is an animal model to show this and it is not unreasonable to assume that this can also occur in man,' says Dr Ting.
Pioneering VSP in Singapore
In Singapore, Dr Ting was among the handful of doctors to start using VSP in 1991. 'At this time, VSP was unheard of locally,' he recalls. As it wasn't a standard drug, permission had to be obtained from the Drug Administration Department for every patient he was going to inject.
Hyalgan was brought in by Fidia Research Lab, whose parent company was more known for ice-cream making technology rather than medical technology!
In Europe however, Hyalgan was readily available over the counter, as one of his resourceful patients had sought the help of an airline stewardess to buy it for her.
In the early 90s, Dr Ting had to develop his own protocol, which he managed to do in the mid-90s, after treating about 2,000 knees. This resulted in 'Ting's Score' - a set of criteria with different signs and symptoms. In the late 90s, although the Ministry of Health approved a new product, Synvisc, for use by orthopaedic surgeons only, Dr Ting continued practising VSP as a general practitioner.
He also started introducing VSP to other joints - ankles, hips, shoulders, elbows which have Temporal Mandibular Joint - as his confidence increased, he said. Today, VSP can also be administered to patients with burnt-out rheumatoid arthritis and secondary OA in knees or wrists. He has even started administering single-dose injections of VSP, based on patient need and condition.
The key is diagnosing OA knees correctly, he stresses, as there can be other causes of knee pain such as an infection or a gout attack. Pain is an indicator, classically experienced during weight-bearing activities like walking or climbing stairs.
Also common is patients complaining of pulling pain in the knees at night. X-rays of knees should be taken while standing, to check the distance of the joint space. 'X-ray findings of joint space distance is a powerful predictor of the outcome of VSP,' says Dr Ting.
Compared with painkillers and steroidal injections, VSP is definitely superior, concludes Dr Ting. 'And for most patients, it buys time for a patient to make lifestyle changes and ponder if surgery is totally necessary.'
Dr Ting Choon Meng's clinic is T&T Family Health Clinic & Surgery located at 181 Kitchener Road #01-36/38,
Parkroyal Hotel Shopping Arcade, Tel: 6293-4071
What is osteo-arthritis?
It's due to wear and tear of the knee cartilage
It's characterised by joint pain, tenderness, limitation of movement and variable degrees of local inflammation
It's usually linked to ageing
Essentially affects hip and knee joints