What is a total knee replacement?
Total knee replacement surgery, or total knee arthroplasty, is a surgical procedure that replaces the damaged knee joint with prosthetics. This condition can be caused by knee injuries to the cartilage and types of arthritis, such as osteoarthritis or rheumatoid arthritis.
This procedure is one of the most common orthopaedic surgeries, and can significantly improve mobility. The artificial components used in this procedure are designed to mimic the natural movement of the knee, reduce pain, and restore joint function.
When is total knee replacement needed?
When severe arthritis or other knee pain conditions do not improve with nonsurgical treatments, surgical options may be considered. Here is a list of symptoms that indicate the need for this operation.
Severe pain:
Persistent pain in the knee while walking, resting, or performing daily activities.
Reduced range of motion:
Difficulty bending or straightening the injured leg.
Swelling and inflammation:
Chronic swelling and inflammation that does not improve with rest or medication.
Knee deformity:
This condition is characterised by the abnormal bending of the knee.
Failure of non-surgical treatments:
Non-surgical treatments, such as medications or physical therapy, no longer provide relief.
If you are experiencing these symptoms and need a thorough evaluation, request an appointment at Thomson Medical. Our orthopaedic specialists are dedicated to providing you with an accurate diagnosis and a personalised treatment plan, including surgery.
Total knee replacement specialist
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What to expect during the surgical procedure
In the total knee replacement procedure, all cartilage on the inside (medial), outside (lateral) and under the kneecap (patellofemoral) will be removed. In its place is an artificial joint, known as a prosthesis, made of metal or medical-grade plastic.
The primary goal of this surgery is to relieve pain and restore natural range of motion. Here’s a breakdown of the procedure:
Pre-surgery preparation
Before undergoing surgery, an orthopaedic surgeon will do several assessments to determine whether a total knee replacement is the best method to treat your condition.
Preoperative preparation
During this stage, your doctor will examine your medical history, ask about any medications you are currently taking, and discuss your symptoms.
They will also verify that you do not have specific health conditions that could complicate your recovery, such as haemophilia, diabetes, or other autoimmune disorders like lupus.
The doctor will also explain the potential risks and complications of this procedure.
Physical examination:
Your doctor will conduct a thorough examination to determine the location of the pain. They’ll assess the knee's range of motion, stability, strength, and overall leg alignment.
Additionally, to get a better diagnosis, your doctor may perform imaging tests like X-rays, magnetic resonance imaging (MRI), or CT (computed tomography) scans to determine the extent of damage and deformity in the knee.
Anaesthesia
Before the surgery begins, your anaesthesiologist will discuss your anaesthesia options with you.
These options include general anaesthesia, which induces a deep sleep, and regional anaesthesia, where you remain awake while your lower body is numbed.
Surgical steps
On the day of the surgery, patients will be administered anaesthesia, and the procedure will begin. The surgery usually lasts between one or two hours.
Incision:
A vertical incision is made over the knee to access the joint.
Joint preparation:
The surgeon removes damaged cartilage and a small amount of bone from the ends of the femur (thigh bone) and tibia (shin bone).
Implantation:
The implants are positioned onto the prepared bone surfaces, with a plastic spacer inserted in between to replicate the function of cartilage.
Patella (kneecap):
Sometimes, the undersurface of the kneecap is also replaced.
Closing the incision:
The incision is closed with stitches or surgical staples, and the knee is bandaged.
Immediate postoperative care
Following the total knee replacement procedure, you will be moved to a recovery room and closely monitored as you wake up from the anaesthesia. However, you won't be lying down for too long since the risk of blood clots increases after surgery.
To prevent it, the healthcare team may instruct you to:
Sit up and begin walking with crutches.
Wear an elastic compression stocking to prevent blood from pooling in the leg veins.
Take a prescribed blood thinner, either by injection or oral.
You'll also likely be asked to do frequent breathing exercises and gradually increase your activity level. A physical therapist will guide you throughout this phase and recovery stage.
Recovery
After the surgery procedure, your healthcare team will closely monitor your condition. Your hospital stay following this procedure usually lasts 3 to 4 days, and depending on your recovery process, the surgeon will decide when you're ready to leave.
But, with the innovative Enhanced Recovery After Surgery (ERAS) protocol, pioneered by Dr. Jerry Chen, the hospitalisation time postoperation could be reduced to be less than a day.
Following your postoperative care, you can expect the following procedure to help you to a complete recovery.
Early recovery (Weeks 1-4)
During your first month of recovery, you'll focus on:
Physical therapy:
This leg exercise will focus on regaining normal range of motion, strengthening the muscles around the knee joint, and adapting to the prosthetics.
Pain management:
Your doctor may prescribe an anti-inflammatory medication, such as ibuprofen or naproxen, to relieve pain and reduce inflammation.
Assistive devices:
To aid mobility during recovery, your healthcare professional may instruct you on the proper use of assistive devices like crutches to ensure safe usage.
Building strength (Weeks 4-12)
As the surgery heals, you'll progress to:
Increasing activity levels:
As the pain subsides, patients can gradually return to everyday activities within six weeks, although high-impact activities should still be avoided.
Advanced exercises:
At this stage of recovery, the treatment will focus on improving flexibility, building muscle strength, and restoring knee function.
Return to activities (Months 3-6)
During this phase, you can expect to:
Return to low-impact activities like swimming, walking, and cycling within 3 months.
Doing vigorous activities, such as running, within three to six months, depending on individual progress.
Full recovery within 6 to 12 months, depending on the patient's health and adherence to physical therapy.
Recovery tips
To assist with your recovery, your surgeon will develop a personalised recovery plan tailored to your needs.
But in general, the recovery plan that will be given usually includes:
Maintaining an ideal body weight:
An ideal body weight can reduce strain on the new knee joint, ensuring its durability and overall performance.
Eat a balanced diet:
A nutritious diet rich in protein, vitamins, and minerals can significantly enhance the healing process after surgery and promote tissue repair.
Ice pack:
Apply an ice pack to the injured area to reduce swelling and pain post-surgery. Do this for 15-20 minutes at a time, several times a day.
Elevation:
Keep your knee raised above the level of your heart to reduce swelling and promote proper blood flow. You can use pillows or a cushion to prop up your leg while sitting or lying down.
Medications:
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen help reduce pain levels and inflammation.
Keeping the incision clean and covered:
Follow your surgeon's guidelines for incision care, such as when to change the dressing and when it's safe to shower, to ensure faster recovery time.
Follow-up appointments:
Schedule regular check-ups with your orthopaedic surgeon to monitor your health conditions and ensure that the knee implants fit properly to do normal activities.
Cost of total knee replacement in singapore
The cost of total knee replacement surgery can vary depending on factors such as your hospital choice, the surgeon's experience, type of implant used, and whether you qualify for subsidies.
The overall cost of total knee replacement surgery can be divided into several components:
Pre-surgery costs
Specialist consultation: SGD 150-300.
Diagnostic tests (X-rays, MRI): SGD 700-1,200.
Main surgery costs
For non-subsidised patients that perform surgery in private hospitals, the total cost of the procedure ranges from SGD 30,000 to 40,000.
For subsidised patients in public hospitals, the cost can be reduced significantly, sometimes as low as SGD 5,000 and SGD 7,000.
Generally, these expenses already included an initial hospital stay, anaesthesia, and surgical fees.
Post-surgery care
The cost of physiotherapy ranges from SGD 150 to 300 per session, with the total number of sessions needed varying based on each individual's needs.
The daily cost of a hospital stay ranges from SGD 1,500 to 3,000, depending on the class of the ward, with an average treatment duration of 3 to 5 days.
Payment options:
MediSave
Health insurance coverage
MediShield Life
Integrated shield plans
However, there are several important things you should keep in mind:
Actual costs may vary based on individual medical conditions.
Additional charges may apply for complications or extended care.
Pre-surgical consultations and follow-up visits may incur separate fees.
Fees are subject to change.
The information provided above is intended for general reference only. For detailed fee information and payment options, please consult with healthcare providers and insurers directly.
Potential post-surgery complications
Although total knee replacement surgery is generally safe, there is still a risk of potential complications associated with this surgery.
Your orthopaedic surgeon will mitigate this by reviewing these risks with you beforehand and taking proactive measures. Here are potential complications that might happen post-surgery, including:
Infection at the surgery site or around the implant.
Blood clots in the leg veins that can travel to the lungs.
Implant loosening or wearing down too soon.
Nerve or blood vessel damage.
Continued knee pain.
Reduced range of motion and stiffness.
Allergic reactions to the implants.
Scar tissue inside the knee.
FAQ
How long does it take to recover from a total knee replacement?
Recovery time can vary between individuals, but everyday activities can return within six weeks, with an additional three to six months needed for more vigorous activities.
However, you can begin moving and walking with the help of physical therapists within a day or two after the procedure.
What is the difference between partial knee replacement and total knee replacement?
In total knee replacement, the entire joint is replaced, while in partial knee replacement, only the damaged portion of the knee (usually one of the three compartments) is replaced.
Partial knee replacement is a less invasive procedure but may not be suitable for all patients with knee conditions or arthritis.
How is life after a total knee replacement?
After total knee replacement, you can expect to return to daily activities without any pain or difficulty. It’s because recovery focuses on regaining flexibility, building muscle strength, and restoring full knee function.
Why do patients have knee replacement surgery?
This procedure is usually performed when conservative treatments for severe arthritis or other knee pain conditions do not improve with nonsurgical treatments.
How painful is knee replacement surgery?
After knee replacement surgery is performed, you might expect some pain. But with pain management techniques, such as medications and physical therapy, these conditions are going to improve over time.
The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Book an appointment with Thomson Medical today.
For more information, contact us:
Thomson Specialists (Thomson Medical Centre) — Orthopaedic
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