In individuals with healthy knee joints, the knee serves as a weight-bearing support that moves smoothly due to the presence of cartilage between the bones, which acts as a cushion.
However, the onset of certain conditions, such as arthritis, can lead to the wearing away of cartilage in the knee joint. As a result, the bones in the knee may begin to rub against each other, causing significant discomfort and pain, particularly in the advanced stages of the condition.
One available solution is a surgical procedure called Total Knee Replacement (TKR) surgery (also known as Total Knee Arthroplasty) that aims to alleviate knee pain and restore joint function.
What is total knee replacement surgery?
In a total knee replacement surgery, an orthopaedic surgeon removes the damaged knee joint entirely and replaces it with artificial metal and plastic implants. Specifically, the surgeon will remove the damaged cartilage and a small amount of bone from the end surfaces of the femur (thigh bone) and tibia (shin bone). The implants are then positioned to restore the joint’s function and alignment.
Now, orthopaedic surgeons can carry out the procedure, and some are trained to optimise surgical techniques and patient care to improve outcomes and shorten the recovery period. This approach is known as the Enhanced Recovery After Surgery (ERAS) approach, which takes place before, during, and after surgery.
At Alps Orthopaedic Centre, our experienced surgeon specialises in ERAS Total Knee Replacement to help patients return to their daily activities as soon as possible with optimal outcomes.
Who should get total knee replacement surgery?
Do you need a total knee replacement? Deciding whether you need a total knee replacement involves evaluating several factors, including the severity of your symptoms, daily functionality, and diagnostic imaging results. Below are key indicators that may suggest it’s time to consider this procedure:
1. Chronic Knee Pain That Doesn't Respond to Treatment
- Persistent pain continues despite conservative treatments like physical therapy, medications, injections, or lifestyle modifications.
- Pain that disrupts your daily activities, such as walking, climbing stairs, or sleeping.
2. Reduced Mobility and Functionality
- Stiffness or loss of range of motion in the knee, making it difficult to perform everyday tasks.
- Difficulty bearing weight on the affected knee or requiring a cane or walker for mobility.
3. Knee Deformity
- Visible deformity, such as bowing in or out of the leg, may indicate advanced joint damage.
4. Significant Impact on Quality of Life
- Pain and mobility issues prevent you from enjoying hobbies, social activities, or work.
- The emotional toll due to chronic pain and limitations.
5. Failed Conservative Treatments
- When non-surgical options (e.g., physical therapy, weight loss, corticosteroid injections, or hyaluronic acid injections) no longer provide relief.
6. X-ray or MRI Findings
- Imaging that shows advanced arthritis, such as bone-on-bone contact due to cartilage loss.
- Presence of osteophytes (bone spurs) or joint space narrowing.
Patients who meet the above criteria often suffer from late-stage arthritis. This may include various forms of arthritis, such as osteoarthritis, rheumatoid arthritis, or other related conditions. Given that the risk of these conditions increases with age, most patients undergoing TKR are over 60 years old.
Total knee replacement may not always be the first option; an orthopaedic specialist will explore other treatments before recommending surgery. However, if your symptoms severely affect your quality of life, a total knee replacement can relieve pain and restore mobility.
Benefits
Patients who have undergone a TKR typically experience significant pain relief, enhanced mobility, and an enhanced quality of life. This may include climbing stairs again, enjoying uninterrupted sleep, and more. However, the benefits of a TKR can vary for each individual based on factors such as age, physical health, and other conditions.
While many patients can return to normal activities without discomfort, it is important to note that the surgery does not enable activities beyond what was possible before developing arthritis.
Risks
A TKR surgery is typically a safe procedure with high success rates in Singapore. Most complications, if they occur, tend to be minor and are manageable as part of the patient’s postoperative care.
To ensure optimal results, schedule your surgery with an experienced orthopaedic surgeon. Working with a reliable surgeon can help prevent and effectively manage potential complications, which may include:
- Blood clots that can be managed with anticoagulant medication
- A wound infection that can be minimised with an ERAS approach and treatment with antibiotics when required
- Damage to the surrounding blood vessel, nerve or ligament. This is not a common risk and can be repaired during surgery or will heal on its own during recovery.
- Wear and tear of the implant over time. The majority of implants can withstand 20 years of use.
- A small group of patients may experience continued pain after surgery, but it can be managed with rehabilitation and improvements in knee mobility post-recovery.
How do you prepare for the surgery?
Before a TKR, you must schedule an initial consultation with an orthopaedic surgeon. Your surgeon will thoroughly analyse your current condition based on medical history and present diagnosis to determine if you are a suitable candidate.
Next, you will be informed about what to prepare before the surgery, including stopping certain medications, fasting before admission, and other necessary lifestyle changes. Some clinics, such as Alps Orthopaedic Centre, even offer financial consultations on insurance coverage to help you prepare for the surgery stress-free.
A TKR is frequently performed as a day surgery, and most patients can return home the same day. When required, a patient may stay overnight for further evaluation until deemed fit for discharge.
What happens during surgery?
Total Knee Replacement (TKR), also known as knee arthroplasty, is a surgical procedure to replace the damaged surfaces of the knee joint with artificial components. This procedure is typically performed under anaesthesia and involves the following steps:
Preparation and Anesthesia: You will be given either general anesthesia (which puts you to sleep) or regional anaesthesia (which numbs the lower half of your body). The surgical area is sterilized to minimize the risk of infection.
Incision: To access the joint, the surgeon makes an incision on the front of your knee. The incision size may vary depending on whether it’s a traditional or minimally invasive surgery.
Removing the Damaged Bone and Cartilage:
- The damaged portions of your knee joint, including worn-out cartilage and a small amount of underlying bone, are carefully removed.
- This is done on the femur (thigh bone), tibia (shin bone), and sometimes the patella (kneecap).
Preparing the Joint for Implants
- The bones are reshaped to fit the artificial components exactly.
- Exact alignment, which is crucial for the success of the surgery, may be achieved using a special surgical guide or robotic assistance.
Inserting the Prosthetic Components
- The prosthetic components, typically metal and medical-grade plastic, are fixed to the bones using cemented or cementless techniques.
- These components replicate the natural motion of the knee joint.
Testing the Joint Movement
- The surgeon moves the knee through its range of motion to ensure proper alignment and functionality of the implant.
- Any adjustments needed are made at this stage.
Closing the Incision
- The incision is closed with sutures or staples.
- A sterile dressing is applied, and in some cases, a drain may be placed to remove excess fluid.
Post-Surgery Recovery
- You will be moved to a recovery room where medical staff will monitor your vital signs.
- Pain management, physical therapy, and a customized rehabilitation plan will begin shortly after surgery to help you regain mobility and strength.
If the surgeon employs an ERAS approach, they will actively prepare you pre-operation and implement techniques that minimise patient tissue damage, scarring, and pain.
In general, the surgery may take up to 2 hours to complete. After the surgery, patients are taken to a recovery room, where they are monitored.
Recovery and care
Soon after surgery (i.e., 4–8 hours), patients can start walking with assistive devices (e.g., crutches). Patients are encouraged to begin moving as part of their physical therapy. Several studies, including one in the Australian Journal of General Practice, titled Changes to Rehabilitation After Total Knee Replacement, suggest that this early mobilisation helps reduce complications, shorten hospital stays, and improve functional outcomes.
Before leaving, patients will also receive guidance on recovery and home care. This may include:
- Signing up for rehabilitation sessions
- An optimal diet plan to facilitate faster recovery
- Instructions on wound care and pain management
Patients will also be advised on long-term care to ensure sustained use of their implant for possibly the next 15-20 years. This will include regular light exercises to maintain strength and mobility of the knee, injury prevention and routine follow-ups as needed.
Given that the implant may also face wear and tear over time, your orthopaedic surgeon may also advise against high-impact activities such as running, jogging, and jumping that could shorten the lifespan of your implant after surgery.
Get total knee replacement surgery in Singapore
Opting for a TKR can be a liberating choice for patients who have suffered from chronic pain. If you are considering TKR for pain relief and enhanced mobility in Singapore, schedule an appointment with our Consultant Orthopaedic Surgeon, Dr Jerry Chen, at Alps Orthopaedic Centre for an initial consultation. Dr Chen is an experienced surgeon who advocates for the ERAS approach, which enhances clinical outcomes and recovery speed.
Are you looking for an ankle injury specialist in Singapore? Our team at Alps Orthopaedic Centre is ready to help.
As an experienced senior consultant orthopaedic specialist for ankle injuries, Dr Jerry Chen leads the ALPS orthopaedic team, which is committed to prioritising personalised patient care. With 13 years of experience and over 500 surgeries, Dr Chen has honed his expertise in orthopaedics and sports injuries.
He is also known for adopting comprehensive diagnostic and treatment techniques, such as the Enhanced Recovery After Surgery (ERAS) approach, to optimise patient recovery with minimal downtime and risk. At ALPS Orthopaedic, our team will do our best to help you recover and return to activity as soon as possible.
FAQs
General Questions
Who is a candidate for total knee replacement?
Candidates typically have severe knee arthritis (osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis) that causes chronic pain and limits daily activities. Surgery is considered when conservative treatments, like medications and physical therapy, fail to provide relief.
How do I know if I need a knee replacement?
Despite non-surgical treatments, persistent knee pain, stiffness, reduced mobility, or difficulty performing daily tasks are key signs. Diagnostic imaging (X-rays, MRIs) confirming advanced joint damage may also indicate the need for surgery. This can call for surgery, total knee replacement or partial knee replacement, depending on the orthopaedic surgeon’s diagnosis.
What conditions can a total knee replacement treat?
- Severe osteoarthritis
- Rheumatoid arthritis
- Post-traumatic arthritis
- Bone deformities or severe joint degeneration
- Chronic knee pain not responsive to other treatments
Is knee replacement the only option for severe knee pain?
No. Alternatives include physical therapy, weight loss, corticosteroid injections, hyaluronic acid injections, and bracing. However, when these fail to provide lasting relief, surgery may be the best option.
Before Surgery
What tests are required before a total knee replacement?
- Blood tests to check for infections or underlying health issues.
- Imaging tests (X-rays, MRIs) to assess joint damage.
- Cardiovascular evaluation to ensure safety during surgery.
- Physical examination to measure knee strength and range of motion.
How do I prepare for total knee replacement surgery?
- Stop smoking and manage underlying health conditions like diabetes or hypertension.
- Strengthen leg muscles with preoperative exercises.
- Arrange for post-surgery assistance and recovery support.
- Follow your doctor’s preoperative instructions, including medication adjustments.
Are there alternatives to total knee replacement surgery?
- Yes. Alternatives include:
- Physical therapy and exercise.
- Medications like NSAIDs or analgesics.
- Knee braces or assistive devices.
- Injections (e.g., corticosteroids or platelet-rich plasma).
What are the risks of delaying a needed knee replacement?
Delaying surgery can worsen joint damage, reduce mobility, and lead to muscle weakening. It may also increase the complexity of the surgery and prolong recovery time.
How long do I have to wait for a knee replacement surgery after diagnosis?
The wait time varies depending on your health condition, surgeon availability, and insurance approval. In Singapore, private healthcare offers less waiting time.
During Surgery
What happens during a total knee replacement procedure?
Damaged cartilage and bone are removed from the femur, tibia, and sometimes the patella. The surfaces are reshaped, and prosthetic components are implanted to restore joint function.
How long does a total knee replacement surgery take?
The procedure typically takes 1.5 to 2 hours, depending on the case’s complexity.
What types of implants are used in total knee replacement?
Standard implants are made from metal alloys, ceramics, and high-grade plastics designed to mimic natural joint movement. The choice depends on patient needs and surgeon preference.
Is robotic-assisted knee replacement better than traditional surgery?
Robotic-assisted total knee replacement (TKR) has been shown to offer certain advantages over traditional manual surgery, particularly in terms of precision and implant alignment. Studies indicate that robotic systems can achieve superior post-operative anatomical and mechanical alignment, which is crucial for the longevity and function of the knee implant.
For instance, a meta-analysis published in 2023 found that robotic-assisted TKR resulted in better alignment than conventional methods. However, the same study noted that clinical and functional outcomes and complication rates were similar between the two approaches.
It’s important to note that the success of either surgical approach depends significantly on the surgeon’s expertise and the individual patient’s condition. Therefore, when considering robotic-assisted knee replacement, it’s advisable to consult with an experienced orthopaedic surgeon to determine an appropriate treatment plan tailored to your specific needs.`
Will I need a blood transfusion during surgery?
Blood transfusions are uncommon with modern techniques but may be required if significant blood loss occurs. Surgeons often use blood-conserving measures.
After Surgery and Recovery
How long does it take to recover from a total knee replacement?
Full recovery typically takes 3 to 6 months, though patients can usually walk with assistance within 1–2 days and resume light activities in 4–6 weeks.
When can I walk after knee replacement surgery?
Most patients start walking with a walker or crutches within 24–48 hours post-surgery.
What kind of physical therapy is required after surgery?
Physical therapy focuses on improving strength, flexibility, and range of motion. A structured rehab programme begins immediately after surgery and continues for several weeks.
Can I resume sports or exercise after a knee replacement?
After recovery, low-impact activities like swimming, cycling, or walking are encouraged. To protect the implant, high-impact sports should be avoided.
What should I avoid after a total knee replacement?
- High-impact activities (e.g., running, jumping).
- Twisting motions or heavy lifting.
- Sitting for extended periods without movement.
Pain Management and Risks
How painful is total knee replacement surgery?
Post-surgery pain is common but manageable with medications and physical therapy. Pain typically decreases significantly within the first few weeks.
What are the risks and complications of total knee replacement?
Potential risks include infection, blood clots, implant loosening, nerve damage, or stiffness. These risks are rare.
How do I manage pain after a total knee replacement?
- Take prescribed pain medications.
- Use ice packs to reduce swelling.
- Follow your physical therapy regimen.
What should I do if I experience swelling or stiffness after surgery?
Mild swelling and stiffness are normal, but persistent or worsening symptoms should be reported to your surgeon.
