Knee Replacement Surgery Specialist in Singapore

Alternative surgical procedures include:

• Arthroscopy (if the arthritis isn’t too severe) – this is keyhole surgery where the knee surgeon clears out bits of debris inside the knee.
• Microfracture – using keyhole surgery, the knee surgeon makes small holes in the surface layer of the bone to encourage new cartilage to grow.
• Osteotomy (where the leg bones are cut and re-set) – this is sometimes used if the patient is younger, to allow the knee surgeon to delay knee replacement surgery.

The surgical procedure of knee replacement is that the damaged cartilage and bone are removed from the knee joint. Man-made pieces are then placed in the knee. These pieces may be placed in the following places in the knee joint:

• Lower end of the thigh bone. This bone is called the femur. The replacement part is usually made of metal.
• Upper end of the shin bone, which is the large bone in your lower leg. This bone is called the tibia. The replacement part is usually made from metal and a strong plastic.
• Back side of your kneecap. Your kneecap is called the patella. The replacement part is usually made from a strong plastic.

One of these 2 types of anesthesia will be used:

• General anesthesia – This means the patient will be asleep and unable to feel pain.
• Regional (spinal or epidural) anesthesia – Injection in the back to make the patient numb below the waist. The patient will also get medicine to make him/her sleepy.

After administering the anesthesia, the surgeon will make a cut over the knee to open it up. This cut is often 8 to 10 inches long. Then the surgeon will:

• Move the kneecap (patella) out of the way, then cut the ends of the thigh bone and shin (lower leg) bone to fit the replacement part.
• Cut the underside of the kneecap to prepare it for the new pieces that will be attached there.
• Fasten the 2 parts of the prosthesis to the bones. One part will be attached to the end of the thigh bone and the other part will be attached to the shin bone. The pieces can be attached using bone cement or screws.
• Attach the underside of the kneecap. Special bone cement is used to attach this part.
• Repair the muscles and tendons around the new joint and close the surgical cut.

The knee replacement surgery takes about 2 hours.

Most artificial knees have both metal and plastic parts. Some surgeons now use different materials, including metal on metal, ceramic on ceramic, or ceramic on plastic.

The procedure for partial knee replacement surgery is similar to the above. The difference lies in the degree of replacement and repair.

MAKOplasty (Robotic partial knee replacement)

MAKOplasty is a surgical procedure for partial knee arthroplasty or partial knee replacement surgery using a RIO Robotic Arm Interactive Orthopedic System.

It enables orthopaedic surgeons in Singapore to plan partial knee replacement procedures by using three-dimensional computer imaging based on a CT scan. This allows them to determine optimal implant size, position, and alignment for each individual patient, and to map out accurately the areas of bone they want to remove.

During knee replacement surgery, the robotic arm system provides visual, auditory, and tactile control to help assure that knee surgeons cut away only the bone planned to be resected prior to surgery. The procedure is said to take the guesswork out of surgery, resulting in accurate and reproducible results.

Knee Replacement Surgery Recovery

For the recovery of knee replacement surgery, it usually takes around six to 12 weeks to make a full recovery from knee replacement surgery. However, this varies between individuals. The knee will continue to improve for two years after the surgery as scar tissue heals and muscles get stronger through exercise.

Patient may need some kind of pain relief for up to 12 weeks after knee replacement surgery. Some patients have discomfort for up to six months. Patient may be asked to wear compression stockings for several weeks at home. There may be swelling which can last for three to six months.

Build up daily activities gradually. The patient should be able to move around the home and manage stairs carefully. However, some routine daily activities may be difficult for a few weeks. May need to use a walking stick or crutches for up to six weeks.

Physiotherapy exercises are a crucial part of recovery, it’s essential to continue to do them for at least two months. After three months, the patient can try kneeling using a soft cushion. Kneeling isn’t harmful. However, some patients find that kneeling never becomes comfortable after knee replacement surgery.

For working patients, they should be able to return to work after about eight weeks but this will depend on the type of work. If it’s a physically demanding job, it may take up to 12 weeks before the patient is ready. It may help to have a phased return, where the patient gradually build up to his/her usual work activities. Need to ask the knee surgeon in Singapore for recommendations according to specific circumstances.

Most patients can drive after about six weeks following a total knee replacement, and about three weeks after a partial knee replacement surgery. However, need to be sure that the patient can control the vehicle and make an emergency stop – depending on the knee specialist’s assessment.

About Knee Implants

Metal components replace the lower end of the thigh bone (femur) and the upper end of the shinbone (tibia). The metal is typically either titanium or a cobalt/chromium-based alloy. Between the metal components lies a plastic tray, or cushion, made of ultra high-density polyethylene. Some designs of implants don’t have a metal component at the top of the tibia. With these, the surgeon attaches a plastic part directly to the bone. If the surgeon replaces the under surface of the kneecap (patella), he/she will use another plastic component there.

Sometimes the plastic cushion is attached firmly to the metal part underneath – this is called a fixed bearing implant. The metal part at the end of the femur then rolls on this fixed cushion as the patient moves. An alternative design is a mobile bearing implant where the plastic cushion can rotate a little against the metal part lying under it. This allows the patient a small amount of rotation in the new knee joint.

The knee replacement specialist in Singapore will usually fix the knee implant in place using a fast-setting bone cement (polymethylmethacrylate). However, some implants have special textured surfaces which allow new bone to grow into them to hold them in place without the need for cement. These are called cementless implants.

A complete artificial knee weighs about 500–600 grams (18–21 ounces).

What should I do next?

The type of knee implant to use will depend on many factors including age, weight, level of activity and health. Ask your Orthopaedic surgeon in Singapore to explain options and discuss what is best in specific circumstances. To get Dr. HC Chang’s opinion on your condition, contact us today. Visit our FAQ on total knee replacement for more information.