Effective Treatments Towards Recovery
Dr Chua Hwa Sen specialises in Orthopaedic Surgery with a sub-specialty in Anthroplasty, with areas of expertise in adult hip and knee reconstruction and anthroscopic surgery, pelvic and acetabulum trauma and reconstruction, as well as shoulder and knee anthroscopic surgery.
What you need to know:
Total Knee Replacements
Knee replacement surgery was first performed in 1968, and since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacement is one of the most successful procedures in all of medicine. According to the Agency for Healthare Research and Quality, more than 600,000 knee replacements are performed each year in the U.S.
Candidates for Surgery
There is no absolute age or weight restrictions for total knee replacement surgery, recommendations are based on patient’s pain, disability and condition. This treatment is a choice treatment for patients whose knee is severely damaged by arthritis or injury and non-surgical or other less invasive surgical options are no longer helpful in alleviating the pain. It is effective in treating knee arthritis.
This is a joint replacement procedure that is safe and effective in relieving pain, correcting leg deformity and helping patients resume normal daily activities.
In a knee replacement procedure, only the surface of the bones are actually replaced. Metal implants are used to replace the damaged cartilage surfaces and underlying bones that have been removed, recreating the surface of the joint. These metal parts may be cemented or ‘press-fit’ into the bone.
Different types of knee implants are used to meet each patient’s individual needs
X-ray image of a severely arthritic knee, in comparison with an X- ray of a total knee replacement. Note that the plastic spacer inserted between the metal components do not show up in an X-ray
A plastic button may be used to cut and resurface the undersurface of the kneecap
A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
Revisional Knee Replacement
Revision total knee replacement surgery may be required to replace the original components of the primary total knee replacement as there may be problems such as implant wear and loosening over time, infection, weakened or unstable bones, stiffness, and fractures around the primary components.
The procedure for revision total knee replacement is more complex and takes longer to perform than primary total knee replacement, and takes around 2-3 hours.
There are different types of revision surgery, and in some cases, only one implant or component of the prosthesis has to be revised. Other times, all three components – femoral, tibial and patellar – needs to be removed or replaced, and the bone around the knee needs to be rebuilt with metal augments that substitute for the missing bone or bone graft.
Damage to the bone may make it difficult for the doctor to use standard total knee replacement implants for the revision surgery, thus in most cases, specialised implants with longer, thicker stems that fit deeper inside the bone are used for extra support.
In a revision total knee replacement surgery, components with longer stems fit more securely into the bones to provide stability from the unstable, weakened bone from primary total knee replacement surgery.
Ligament reconstruction involves repairing and restoring knee stability by reconstructing the torn ligament, as most anterior cruciate ligament tears cannot be sutured back together. The torn ligament will be replaced with a tissue graft that acts as a scaffolding for a new ligament to grow on.
Candidates for Surgery
Patients who suffer from anterior cruciate ligament injuries and tears may benefit most from this procedure, as ACL tears cannot simply be sutured back together. Yet, elderly patients or those who have a very low activity level may be recommended for non-surgical treatment to allow knee injury to slowly heal.
Grafts as Scaffolding
The torn ligament will be replaced with a tissue graft that can be obtained from several sources, often from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are also a common source of grafts, as well as a quadriceps tendon which runs from the kneecap into the thigh. Sometimes, a cadaver graft (allograft) is also considered. your orthopaedic surgeon will discuss the advantages and disadvantages of each graft source to determine which is best for your condition.
Knee arthroscopy is one of the most commonly performed surgical procedures. A miniature camera is inserted through a small incision (portal), providing a clear view of the inside of the knee. The orthopaedic surgeon then inserts miniature surgical instruments through other portals to trim or repair the knee. It is usually recommended to treat meniscus tears.
This procedure involves trimming away damaged meniscus tissues. Recovery period from meniscectomy takes approximately 3 – 4 weeks.
Close-up of a partial meniscectomy
Some meniscus tears can be repaired by suturing the torn pieces together via meniscus repair. Whether a tear can be successfully treated with this method depends on the type of tear as well as the overall condition of the injured meniscus. Recovery time for a meniscus repair is much longer than from a meniscectomy.
A torn meniscus is repaired with sutures