Knee Replacement Surgery in Singapore

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Overview

What is Knee Replacement Surgery?
When is Knee Replacement Surgery Needed?
What Can Knee Replacement Treat?
Types of Knee Replacement Surgery
Total (TKR) vs Unicompartmental Knee Replacement (UKR)
How to Prepare for Knee Replacement Surgery
How is Knee Replacement Performed?
What Happens During the Procedure?
Recovering from Knee Replacement
When Can I Drive, Fly or Return to Work?
Risks of Knee Replacement Surgery
Am I a Suitable Candidate for Knee Replacement Surgery?
Who is Not Suitable for Knee Replacement Surgery?

What is Knee Replacement Surgery?

Knee replacement surgery, also known as knee arthroplasty, is a medical procedure in which a damaged or diseased knee joint is replaced with an artificial implant. This surgery is typically performed to relieve pain and restore function in individuals with severe knee arthritis or other debilitating knee conditions. The procedure involves removing damaged cartilage and bone from the knee joint and replacing them with prosthetic components made of metal, plastic, or ceramic materials.

When is Knee Replacement Surgery Needed?

Knee replacement is typically considered when:

Pain and stiffness in the knee significantly affect daily activities such as walking, climbing stairs, or getting up from a chair
Conservative treatments, including physiotherapy, medications, and injections, no longer provide relief
There is severe joint damage seen on X-rays or MRI scans
The knee is deformed or unstable, making movement difficult
The patient’s quality of life is significantly reduced due to knee pain

To find out if knee replacement may be suitable for you, please reach out to us today for a detailed evaluation and advice.

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What Can Knee Replacement Treat?

Knee replacement surgery is primarily used to treat:

Osteoarthritis: The most common reason for knee replacement, where the cartilage in the knee joint degenerates and wears away over time, leading to knee stiffness and deformity.
Rheumatoid Arthritis: An autoimmune condition that causes inflammation of the lining of the knee joint, resulting in chronic joint inflammation and damage. It may affect many joints and body organs, and may occur in younger patients.
Post-Traumatic Arthritis: This refers to arthritis that develops after an injury, such as a fracture or ligament tear.

Knee Deformities: Conditions like bow-leggedness or knock knees that cause misalignment and pain.
Severe Knee Pain and Stiffness: When conservative treatments fail, surgery can provide relief and improve mobility.

Types of Knee Replacement Surgery

There are several types of knee replacement procedures, each tailored to the patient's condition and needs:

The entire knee joint is replaced with artificial components. This is the most common type of knee replacement surgery and can significantly improve one’s quality of life.

Only the damaged portion of the knee joint is replaced, preserving healthy tissues. This is recommended for patients with localized knee damage or younger patients.

In this procedure, only the kneecap (patella) and the groove it slides in are replaced.

This is performed in cases where a previous knee replacement has failed (e.g. infection) or if the artificial implants have worn off over time.

Types of Knee Replacement Surgery

Total (TKR) vs Unicompartmental Knee Replacement (UKR)

Total (TKR) vs Unicompartmental Knee Replacement (UKR)

The knee joint can be divided into three compartments:

The inside of the knee (medial compartment)
The outside of the knee (lateral compartment)
The space between the kneecap and the thigh bone (patellofemoral joint)

Patients suitable for TKR may have loss of cartilage in all three compartments, have severe deformity, ligamentous injury or inflammatory joint disease.

Patients suitable for UKR, on the other hand, may have localised joint disease in one compartment only.

Both procedures can be performed with an excellent degree of accuracy using a robotic system such as Makoplasty, Navio or Robodoc. Dr Alan Cheung is skilled in performing robotic orthopaedic surgery.

Some of the possible advantages of UKR over TKR include a smaller incision, less tissue damage and postoperative pain, less blood loss, faster recovery and return to work / sport, greater range of postoperative movement.

How to Prepare for Knee Replacement Surgery

How to Prepare for Knee Replacement Surgery

Preparation for knee replacement involves several important steps:

Medical Evaluation – A full assessment, including blood tests and imaging, ensures the patient is fit for surgery.
Weight Management – Overweight patients may be advised to lose weight to reduce strain on the new joint.
Strengthening Exercises – Physiotherapy before surgery can help build muscle strength around the knee.
Medication Review – Some medications may need to be stopped around two weeks before surgery. This usually includes blood thinning medications and TCM herbs.
Home Preparation – Setting up a comfortable recovery space with mobility aids, such as walkers and handrails.
Arranging Assistance – Having a caregiver or family member to help during the initial recovery period.

How is Knee Replacement Performed?

How is Knee Replacement Performed?

Anaesthesia – The patient is given either general anesthesia (where you will be asleep during the procedure) or spinal anesthesia to numb the lower body.
Incision – A surgical cut is made over the knee, exposing the joint.
Bone Preparation – Damaged cartilage and bone are removed from the knee joint.
Implant Placement – Artificial components (prosthetics) are attached to the thigh bone (femur), shin bone (tibia), and kneecap.
Adjustment and Closure – The prosthetics are aligned properly, and the incision is stitched closed.
Recovery – The patient is monitored in the hospital for a few days before starting rehabilitation.

What Happens During the Procedure?

Whenever possible, I perform my joint replacements through a small incision (around 10cm or less). Complex and revision cases may not be suitable for minimally invasive knee surgery. The body tissues are handled very gently during surgery.

During the procedure, I remove the worn joint surfaces from the thigh bone (femur) and shin bone (tibia). I take care to balance the soft tissues so that the knee is stable throughout the range of movement.

Then, I will replace the joint surface with metal implants (usually cobalt chrome alloy) which are cemented onto the bone. Finally, a plastic liner (highly crosslinked polyethylene) is placed between the two metal surfaces to allow a smooth gliding motion and reduce friction.

During the surgery, I use a technique called local infiltration anaesthesia which involves injecting a local anaesthetic into cut tissues. This improves chances for a swift recovery.

I appreciate that pain is the main fear of patients, and I do my utmost to ensure that pain is minimised following surgery. As a result, most patients are able to stand and walk hours after surgery.

Recovering from Knee Replacement

Usually the surgery takes less than an hour. After which, you will be transferred to the recovery area to be monitored for several hours until you are fit for discharge back to the general ward.

Whenever possible, I aim to get my patients standing and walking immediately following the surgery. I work closely with my physiotherapy colleagues to follow an Enhanced Recovery Protocol so that patients start exercising on Day 1 of surgery. The eventual aim is for patients to be discharged from the ward on or before Day 3 of surgery.

The overall recovery process involves:

Hospital Stay – Most patients stay in the hospital for 1-3 days post-surgery.
Pain Management – Medications and ice therapy help control pain and swelling.
Physiotherapy – Rehabilitation starts within 24 hours of surgery, focusing on regaining movement and strength.
Mobility Aids – Walkers or crutches are used initially before transitioning to normal walking.
Wound Care – The wound may take 2 weeks to heal and it is important to keep it clean and dry during this time.
Follow-Up Visits – Regular check-ups with your knee surgeon to ensure proper healing.

When Can I Drive, Fly or Return to Work?

Most patients can drive six weeks following knee replacement. You are advised not to fly long haul for at least six weeks following the operation to reduce risk of blood clot in the legs (deep vein thrombosis) or lungs (pulmonary embolism).

Patients who underwent unicompartmental knee replacement (UKR) can sometimes return to work at six weeks or earlier depending upon their occupation. Patients undergoing total knee replacement (TKR) often need longer to recover – on average between six to twelve weeks in my experience, although there are exceptions.

My aim is to relieve your pain and restore function to your limbs through joint replacement. Although it can take some time and effort to recover, most patients can achieve an excellent result.

Risks of Knee Replacement Surgery

Risks of Knee Replacement Surgery

Even though knee replacement surgeries are some of the most well-established and effective surgical procedures, it still comes with certain risks that the knee replacement surgeon will need to properly manage and watch out for:

Infection – Bacteria can enter the wound and cause complications.
Blood Clots – Clots can form in the legs and may travel to the lungs.
Implant Issues – The prosthetic may loosen, wear out, or cause instability over time.
Nerve Damage – Temporary or permanent nerve injury can cause numbness or weakness.
Persistent Pain or Stiffness – Some patients continue to experience discomfort despite surgery.
Anaesthesia Complications – Risks include allergic reactions or breathing difficulties.

Am I a Suitable Candidate for Knee Replacement Surgery?

If your knee pain is severe and you have difficulty in walking, stair climbing, and have pain at night, you may be a suitable candidate for knee replacement. You may also have a stiff and deformed knee.

If you have tried taking pain killers, physiotherapy exercises and even knee joint injections (e.g. steroid or hyaluronic acid injections) without success then joint replacement may be the next step for you.

At the consultation, a careful history and examination will be taken to assess the severity of your joint disease, and to exclude pain referred from the hip and spine.

A careful discussion will be made with you regarding the risks and benefits of the procedure and what to expect in the long term. You should feel free to ask questions, and express any fears and concerns that you have regarding the surgery.

Please bring a friend or close family member also, as my aim is to ensure that you and your family are well informed and prepared, and have realistic expectations regarding the surgery.

Who is Not Suitable for Knee Replacement Surgery?

Patients with active infection, lack of sensation at the knee joint, poor muscle function in their thigh muscles (quadriceps), as well as severe medical conditions such as blood vessel disease in the leg (arterial blockage and peripheral vascular disease) may not be suitable to undergo a total or unicompartmental knee replacement as they may need to undergo other medical treatment first.

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FAQs About Knee Replacement Surgery

FAQs About Knee Replacement Surgery

I am commonly asked this question by relatives of patients. The answer is no – it depends on your general health and what you can gain from the surgery, rather than your age.

Older people tend to suffer more from a worn out knee joint and therefore are more likely to need a joint replacement. I have replaced the knee joints of patients over 90 years of age, who went on to enjoy their remaining years without knee pain.

With regards to younger patients, I have also treated patients in their 40s who have severely worn out parts of their knees and have benefited from a partial or total knee replacement.

Knee replacement surgery for the right reasons can be suitable for all adult age groups.

For those with two worn out knees, replacing both sides at once (bilateral joint replacement) is an option.

Replacing both knees means a longer operation and anaesthetic time, as well as increased risk of complications. Recovery is slightly longer than having one knee replaced.

However, it does mean that you do not have to worry about having to take more time off in future to have the second knee replaced and also avoid the cost of a second hospitalisation.

The level of pain varies from person to person and is subjective. Nonetheless, you will be given pain relief medications to help manage your pain. Together with physiotherapy, the amount of pain will quickly lessen as you recover.

Most knee replacements last 15-20 years, depending on factors like activity level, body weight, and implant type. Advances in materials and techniques have generally improved implant longevity.

Yes, absolutely. As long as you follow your aftercare instructions and rehabilitation properly, you should be able to return to their normal activities after about six to eight weeks; while full recovery can range from six months to a year.

As a knee replacement is recommended as a last resort, it will generally not be advisable to delay the treatment against your doctor’s recommendation. However, should you have any existing risk factors that may complicate the procedure, your doctor may recommend that you hold off the surgery until the risks have been properly addressed.