About Total Knee Replacement

What is Total Knee Replacement (TKR)?

Total Knee Replacement (TKR) surgery is commonly performed to relieve pain and improve movement for patients with wornout and painful knee joints. This is carried out when patients do not respond adequately to conservative treatment (consisting of medication, physiotherapy and activity modification). It is an elective surgery that involves replacement of the worn-out joint surfaces with implants.

Stages of Knee Osteoarthritis

Minimum disruption. There is already 10% cartilage loss.

Joint-space narrowing. The cartilage to begin breaking down. Occurrence of osteophytes.

How will TKR help?

Moderate joint-space reduction. Gaps in the cartilage can expand until they reach the bone.

Joint-space greatly reduced. 60% of the cartilage is already lost. Large osteophytes.

Going through a knee replacement will:

1. Decrease pain

2. Improve mobility

3. Correct deformities of the lower limb

4. Increase overall quality of life

After full recovery, you can enjoy low impact activities such as walking, swimming or cycling. However, sports that involve contact or jumping, as well as high impact activities like jogging or tennis are discouraged. You may not be able to squat after the operation.

Surgery can help to relieve pain and restore your mobility. Set an achievable goal with continued rehabilitation exercise in your journey of recovery.

What are the different types of knee replacement surgery?

TKR, where the whole knee joint is replaced, is the most common type of knee replacement surgery performed.

A unicompartmental knee replacement, or half knee replacement, is performed in selected patients where only one part of the knee is worn out.

In cases of severe alignment problems, or loose or unstable knees, a stemmed implant (or TKR with rod extensions) may be required to improve the stability of the knee.

TKR implants are made of surgical grade metal alloys and plastic components. They are joined to your bone by acrylic cement. Your surgeon will discuss with you the type of implant that best meets your needs.

How long can the implant last?

Typically, an implant can last up to 15 years, depending on the type chosen. However, this also varies from person to person; depending on many factors, such as your physical condition, activity level, body weight and the surgical technique. There is no guarantee that a prosthetic joint will last the rest of your life. All prosthetic knees may need to be replaced at some point.

Possible Complications

• Pain: Pain will gradually ease after the first few months. However, some patients may continue to have moderate to severe pain in the long term.

As with any operation, TKR carries certain risks and benefits. Your surgeon and anaesthetist will answer any questions you may have about the surgery or the anaesthesia aspect.

Surgical risks include:

• Surgical scar: The surgical scar will be in the centre of the knee and can vary based on the individual.

Scar numbness and discolouration is common. The scar can sometimes be raised and thickened if you are prone to keloid formation. The scar usually becomes less prominent over a year.

• Infection of the wound: Superficial skin infections are common and can usually be treated with antibiotics. However, deep infections (bacteria going into the joint and growing on the implant) can also occur. Though these occasions are rare, they require multiple surgeries to clean the joint, and may sometimes involve removal of the implants.

• Blood clots or deep vein thrombosis (DVT): Blood clots may form in the leg veins in the first few weeks after surgery due to reduced movement in the leg. This can be prevented by using special support stockings, walking or exercising soon after surgery, or by using blood thinning medications.

• Unexpected bleeding: This can happen inside or around the joint. Some bruising around the knee after surgery is expected. On rare occasions, the bleeding can become excessive and cause pain.

• Excessive scar tissue forming within the knee and restricting movement: Physiotherapy and exercise after surgery is crucial to recovery and ensuring improved range of movement of the knee. In rare cases, further surgery may be required to remove the scarring and restore movement.

• Damage to surrounding structures (ligaments, arteries or nerves) during surgery: Artery and nerve damage during surgery is an extremely rare but severe complication that can result in loss of the limb if repair cannot be adequately achieved. Ligament damage may result in a knee that feels loose after surgery and may require further corrective surgery.

Anaesthesia risks include:

With any anaesthesia choice - full or half body anaesthesiathere are risks involved. Serious complications include heart attack, stroke, lung infection, blood clots and allergic reactions during surgery. More common side effects include vomiting, giddiness and sore throat.

How much will it cost?

Surgery at Khoo Teck Puat Hospital (KTPH)

The cost will depend on the type of knee replacement chosen, the subsidies you are eligible for, as well as your personal insurance. Financial counselling will be provided prior to surgery.

Post-discharge Care

1. Going Home with Rehabilitation Appointments

After knee surgery, most patients stay at the hospital for 1-3 days to recover, before being discharged.

You will be given appointments to attend rehabilitation sessions to ensure the best outcomes after surgery. You may also be eligible to attend rehabilitation therapy at a Community Rehabilitation Centre near your home. Speak to your Case Manager or Physiotherapist for more information.

2. Intermediate Care

Some patients may be advised to transfer to a community hospital if they require more time to recuperate. At Yishun Health, Yishun Community Hospital (YCH) provides continual care such as rehabilitation services after discharge from an acute hospital. The cost will depend on the ward class and the subsidies you are eligible for.

Visit our website or scan the QR code above https://www.

yishuncommunityhospital.com.

sg/patients-and-visitors/hospitalcharges-schemes-subsidies

The community hospital’s charges include ward charges, daily treatment fees, therapy treatments and ancillary charges such as laboratory, specialised investigations, non-standard medication and consumables. The dietitian service and caregiver training programme are optional, and are in addition to the daily charges. Please inform the nurse if these services are not required.

Patients discharged after 1pm will incur one day’s ward charges and treatment fees.

For subsidised wards, the amount of government subsidy given will be dependent on your Household Means Test Assessment. Please complete the declaration form and submit it to your financial care officer prior to your financial counselling appointment.

Yishun Health reserves the right to change the allocated bed within the requested bed class as and when deemed fit.

You may discuss with your case manager if you wish to transfer to other community hospitals.