Total knee replacements are performed when knee arthritis worsens to the point that quality of life is significantly impacted. Dr Liew uses kinematic alignment with patient-specific technology for every knee replacement — aiming for a natural, 'forgotten' knee.
Do I Need a Total Knee Replacement?
Total knee replacements are performed when arthritis in the joint worsens. Arthritis is a condition caused by many factors that result in the destruction or loss of cartilage inside the knee joint. When cartilage is lost, the joint fails to absorb shock and becomes painful due to the release of inflammatory products as bone is exposed.
In general, once pain affects normal activities and is a constant problem, surgery should be considered. An orthopaedic surgeon will ask several questions to determine the right timing, including: How long has the pain been present and where is it located? Do you have night pain? What pain medications are you on? How far can you walk? What treatments have you had so far? Are there any clicking, locking or catching sensations?
Non-Operative Options
A GP will often manage knee arthritis until it is referred to an orthopaedic surgeon, typically including anti-inflammatory medications such as Nurofen. A weight-bearing X-ray of the knee helps assess joint space and alignment.
Physiotherapy is useful for maintaining muscle tone and ligamentous stability, and can help with pain as activity increases. Weight loss is also an important part of both pre-operative and post-operative treatment of knee arthritis.
Dr Liew's Approach — Kinematic Alignment
Dr Liew performs all knee replacements using Patient Specific Technology with a kinematic alignment protocol. This is an extremely important philosophy — aligning a knee to match the native, pre-arthritic alignment rather than forcing all knees to a “straight” position.
This means no ligaments, capsule, or tendons need to be released or cut to balance the knee. The knee is aligned to match the patient's own anatomy, making every single knee cut individually. Few knees are alike. In the normal population, many people are bow-legged or knock-kneed — Dr Liew's approach preserves this individual anatomy rather than “correcting” it artificially.
Patient Specific Instrumentation
Patient specific instruments are made by taking an image of the knee and reproducing it on a computer, similar to how blueprints are made using AutoCAD. This is highly accurate, and can identify what is necessary to obtain optimal alignment. If the blocks do not fit well during surgery, the conventional method is used — this is rare at less than 0.1% in practice.
Single-use instruments are used to improve patient outcomes, ensuring that cutting blocks are brand new each time with no chance of deformity from repeated use or infection from sterilisation failure. This has been standard practice since 2016.
After Surgery
After surgery, patients are often walked the day of or day after surgery. The usual hospital stay for a total knee replacement is 3–4 nights. All dressings should remain dry for the first 14 days. No swimming (including hydrotherapy) is allowed until 1 month post-operatively. TED stockings are worn for the first 14 days.
Driving can commence once off heavier pain medications, typically at 2–3 weeks in 80% of patients. The first 6–8 weeks focuses on swelling reduction and range-of-motion exercises under the guidance of your local physiotherapist.
Patient Information Summary
Download a PDF summary of this article to read later or share with family.