A small but significant change in surgical technique — switching from a straight midline incision to a curved lateral approach — has dramatically improved functional outcomes in total knee replacement. Approximately 80% of my patients can now kneel comfortably after surgery, and the scar is both functionally and aesthetically superior.
Why I Changed My Approach
When I first began performing total knee replacements, we never truly considered the skin incision or its impact on patient function. The standard approach was a straight vertical incision running down the midline of the knee — it made the surgery easier to perform. About 5 years ago, I switched to a curved lateral incision specifically to improve patients' ability to kneel on their replaced knee.
The results have been transformative. Fast-forward to today, and this change has become one of the most valued aspects of my surgical technique. Not only can significantly more patients kneel comfortably after surgery, but the incision itself is also more aesthetically pleasing because the curved scar blends better with natural skin folds around the knee.
"Small changes in surgical technique can have profound benefits for patient function and cosmetic satisfaction."
— Dr Chien-Wen LiewHow It Works
The curved lateral incision wraps around the side of the knee rather than running straight up and down the midline. While technically the incision can be slightly longer when measured in a straight line, it appears shorter visually because of its curved nature and the way it nestles into natural skin folds and contours around the knee. More importantly, it preserves the anterior knee structures that are critical for kneeling.
Early mobilisation and physiotherapy after surgery help ensure that this advantage is realised. By avoiding damage to the tissues at the front of the knee that are essential for kneeling, we preserve your ability to perform this functionally important movement.
Watch Dr Chien-Wen Liew discuss this topic.
Can I Kneel After My Knee Replacement?
Approximately 80% of my knee replacement patients can now kneel comfortably after their procedure. This is a significant improvement and directly reflects the shift to the lateral curved incision technique. Some factors can decrease the likelihood of being able to kneel, particularly if you have had previous incisions on the front of your knee.
If you have an existing midline incision from a previous surgery or injury, we would typically follow that pre-existing scar rather than add a new one. However, if your previous scar is small — such as from an ACL reconstruction — we can often still perform the lateral curved incision and achieve kneeling capability.
What Your Knee Replacement is Made Of
All knee replacements I perform use Cobalt Chromium metal components with a highly specialised polyethylene bearing. This composition is specifically designed to increase longevity and wear resistance. Under an electron microscope, the surface of the Cobalt Chromium component is extremely smooth, which reduces wear on the plastic bearing.
Importantly, there is no metal-on-metal contact in your replacement knee. The specialised polyethylene plastic sits between the metal components, eliminating any metal-on-metal friction and ensuring the long-term durability of your implant.
Download Knee Replacement Guide
Learn about incision placement, kneeling recovery, and implant materials in total knee replacement.