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Joint replacement surgery is one of the most effective orthopaedic interventions in providing painless functional range of motion to the joints - principally the hip and knee. With newer materials and designs these implants can typically last 15 to 20 years. After this time these implants do run their course and need to be changed out. The standards of joint replacement have by en large been dictated by Western research and literature that generally predict a specific body type and requirement for anatomical restoration. Modern day Asian surgeons who were trained in the West, however, realise that Asian patients are quite different. There is a tendency for increased femoral and tibial bowing and this results in unusual strains on implants designed for a Western individual. Furthermore, Asian patients tend to have a greater requirement for deep flexion for squatting.
Most times the implants put in are able to last the patients lifetime. Occasionally, however, the joints need to be changed especially if the patient had them put in early in a previous time. Unlike primary joint replacements which should be in the purview of most orthopaedic surgeons, the experience required for such revision arthroplasties are not common. The patients tend to be older and require specific consideration for more medical problems. The implants used may not be compatible with newer designs and need to be revamped if they cannot be retained and adapted. Bone loss as a result of revision can result in the need for bone transplants in addition to specialised joint replacement implants. Most orthopaedic surgeons who have skills in revision arthroplasty would have to be affiliated with a tertiary referal centre, gone on to do fellowships in top centers and then returned to practice in tertiary centers for a number of years. Consequently such a experience skill set is uncommon. Here at Limb Salvage and Revision Arthroplasty Surgery Pte Ltd our surgeons are well skilled in all aspects of revision arthroplasty and are actively involved in research and education on the subject. For more information on other services we provide you can proceed to our central website at www.limbsalvagesurgery.com .
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Figure 1. Knee replacement designs have been fairly standard for the last 20 years (left on a) although newer designs (b) now allow patients better range of motion (e). These newer designs pioneered by our surgeons in Singapore have been used for the last 10 years and show excellent results. The future designs like the ceramic knee (d) also first implemented in Singapore by our surgeons represent the next generation of hypo-allergenic low-wear implants. For revision surgery implants the necessary technological enhancements all necessarily add to the cost of the implants (c).
Figure 2. This review of the author’s own cases shows that from the preoperative state all patients do better using objective scoring systems developed for this.
Figure 3. Ever thought of what's in store in a knee replacement procedure? We present here a comparison of a knee replacement with (left panel) and without (right panel) a tourniquet. We do resort to the latter in the difficult cases of patients with significant vascular risk. On the top panel are the salient steps in MAKOplasty surgery.
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