Procedures

A total knee replacement (TKR) describes a procedure to remove the worn-out parts of the knee and replacing them with implants. Healthy bones and ligaments are left behind to accommodate the metal femur and tibia implants as well as the plaster liner that sits between two metal pieces.

Your surgeon may also replace your patella if there is significant wear, and if your patella bone is large enough. A TKR is done to restore motion and function to the knee, enabling patients to return to an active lifestyle.

Orthopaedic surgeon and medical director Dr Mizan Marican has been performing TKR for more than a decade and is very familiar with the procedure. While TKR is generally done using conventional approaches, Dr Mizan is trained to perform it using navigation as well as robot-arm assisted techniques (Makoplasty®). Navigated and robot-arm assisted techniques are employed to promote better positioning of implants in your knee and facilitate better range of movement and flexibility after surgery.

There is a fine balance between a stable and functional knee and one that is too tight or unstable. Regardless of the technique, TKR can correct both varus (bowing of your knees) or valgus (knock knees) deformities, improve knee extension (straightening) and flexion (bending), as well as significantly improve your pain and daily function.

Dr Mizan uses robot arm-assisted techniques (Makoplasty®) for some of his knee replacement procedures. This technique involves significant pre-operative planning with the use of a CT scan and computer software. The CT scan provides a three-dimensional (3D) image of your knee which helps to determine the appropriate size of implants.

With Makoplasty®, further intra-operative assessments are done to ensure that the CT scans correctly reflect reality. The knee will be appropriately stressed during the surgery as needed, imitating everyday movements, to examine the placement and fit of the implants in the knee.

Another added advantage of a robot arm-assisted knee replacement is the ability to test different implants of varying sizes and only having to make microadjustments where necessary. The computer software advises on an optimal implant position for the patient to achieve good stability and movement. Once satisfied with the implant size and position, the surgeon will then proceed to make the bone cuts to place the implants in the knee.

Makoplasty® is also programmed to enhance the precision of the bone cuts made, as well as to prevent collateral injury to the adjacent soft tissues. Robot arm-assisted procedures have taken the guesswork out of complex operations such as these, resulting in satisfied patients and successful surgeries.

 

 

Total knee replacement generally takes about 90 minutes to complete, depending on the condition and the type of procedure you are going for. Patients are also allowed to walk on the day of the surgery if pain is well controlled.

At Orion Orthopaedic Surgery, patients are given injections around the knee during surgery to help them with post-operative pain. This is to facilitate early mobilization and shorten the length of hospitalization.

It is normal to expect a scar measuring 10 to 15cm on the knee after the surgery. While keyhole surgery may be used in knee preservation techniques, it cannot be used for a formal total knee replacement. Skin incisions that are too small may compromise the surgery as it does not provide adequate visualization of critical areas for implants to be optimally placed.

The surgical scar takes two weeks to heal. During this time, dressings are applied to prevent infection and facilitate good healing. The knee will also be compressed in wool and crepe dressing to reduce knee swelling and prevent bleeding after surgery. This compression will be lightened the next day, and ice packs are used to further reduce the swelling. It can take up to a month or two for the swelling to subside in some patients.

 

Patients are also encouraged to walk and perform aerobic exercises as much as possible. This helps to develop their general muscle strength and flexibility. Squatting is something not everyone is able to achieve after a knee replacement. It depends on how much they were able to flex their knee before the surgery, how large their thighs and calf muscles are and the strength in their legs to perform a squat and stand up.

Dr Mizan has performed multiple bilateral knee replacements in his time, however he is careful to choose his patients for this procedure based on age (less than 65 years old) and their medical condition.

 

Bilateral knee replacements are indicated in patients with severe arthritis in both knees so that they may have a more effective and meaningful rehab journey. Patients who have undergone a bilateral knee replacement are also encouraged to walk after their surgery, but are given a downtime of up to 2 days instead of one (as in single TKR patients). When the pain is well controlled and no dizziness or vertigo is experienced, patients can then begin their physiotherapy programme.

 

Speak to our orthopaedic surgeon if you are having pain and trouble with your knees. We are here to help you on your journey.