Joint Replacement

DO YOU REQUIRE A KNEE REPLACEMENT SURGERY?

If you are severely disabled or in constant pain and your sleep is disturbed, taking the decision would be quite easy for you, even if you have to take certain amount of risk as the potential benefits are worth the risk.

The fact is that your knee arthritis will never get better and it gradually worsens as time passes. The rate of deterioration varies from person to person and you may become severely disabled within few months.

On the other hand, if you are comfortable with conservative treatment and you are able to walk long distances without support, you don’t require a knee replacement.

WHAT ARE THE BENEFITS OF TOTAL KNEE REPLACEMENT?

  • TKR can relieve pain that doesn't respond to other treatment options
  • Pain reduction in 90 to 95% of the patients
  • Reduced stiffness and improved joint movement
  • Increased walking ability
  • Improved alignment of deformed joints

WHY SHOULDN’T YOU WAIT TOO LONG FOR A KNEE REPLACEMENT?

If you do not respond to medical therapy and continue to have severe pain and disability, you may as well get the operation done sooner so that you can enjoy the pain-free life sooner. It is worth noting here that more than 96% patients undergoing knee replacements have no major complications.

If your arthritis has reduced your walking, the sedentary lifestyle will soften your bone and your muscles will become weak. After the operation, you will need a longer time to rehabilitate.

The more you wait, the more your knees will become deformed which means that to straighten your knees, your surgeon has to do more soft tissue release that may increase your post-operative pain.

COMMON POST-OPERATIVE (TKR) COURSE

1. Day 1 : Standing, bending and sitting out in a chair / May take a few steps with help

2. Day 2 : Walking (with aids)

3.Day 4/5 : Stair climbing

4. Day 5-7 : Home (with 2 walking sticks)

5. Week 6 : Walking unaided (or 1 stick) / Driving

6. Week 10-12: Full recovery

CLINICAL OUTCOMES OF TOTAL KNEE REPLACEMENT

1. At 1 year post-op, range of movement 0-120 deg

2. 95-100% survival rate at 10 years

3. 85-95% survival rate at 15 years

4. 80-85% survival rate at 20 years

WHAT ARE THE RECENT ADVANCES IN KNEE REPLACEMENT SURGERY?

1. Objective refinements in surgical techniques e.g. Computer Assisted Surgery or Navigation System

2. Improvement in implant design such as High Flex Knees

3. Post operative pain control – Epidural Analgesia

COMPUTER ASSISTED SURGERY

The small percentage of failure in knee replacement surgery was attributed to:

1. Difficulty in pinpointing anatomical landmarks

2. Appreciating minor variations of angles with naked eye

3. Inability to judge equal soft tissue tension

The introduction of computer assisted navigation techniques improved accuracy and precision of joint replacements.

The navigation unit is a sophisticated surgical tool which consists of –

  • camera
  • touch-screen
  • computer base unit and
  • Increased walking ability
  • sensors placed on patient





The computer guides the surgeon on a dynamic basis to:

  • correct deformity
  • equal soft tissue tension
  • precise placement of the artificial joint

What is ahigh flexion knee?

High flexion in total knee replacement is any flexion beyond 125 degrees. Many Asian patients refuse knee replacement as they can’t squat. With high flexion implants which have a rotating platform, patients are able to kneel and pray.