When Is Joint Replacement Needed? Indications for Knee and Hip Surgery

Yes. We first screen and optimise the patient: ruling out uncontrolled medical illness (diabetes, hypertension, coronary artery disease), any potential infection source, checking haemoglobin is adequate, and ruling out autoimmune or systemic disease. After that, you need good imaging where required, trained OT staff, a clean theatre, good ICU and anaesthetic support, a standby cardiologist, and blood bank access since most cases need transfusion.

Yes. We optimise the patient's haemoglobin before surgery with hematinics or iron injections and diet, waiting a couple of weeks for it to improve. If that isn't sufficient, we use autologous transfusion: the patient's own blood is drawn and stored in advance, with no cross-matching needed, and given back to the same patient during surgery.

Templating started as physical templating, then moved to digital templating software. But since we have now shifted to more advanced techniques, we don't rely on templating anymore - intraoperative robotic-assisted guidance gives more accurate implant sizing and positioning directly.

Beyond computer navigation, robotics and AI, there has also been advancement in surgical approach. Older approaches like the posterior and direct lateral approach cut through muscle to enter the hip. The direct anterior approach (also called direct superior approach) avoids any muscle cut or nerve violation, with very minimal blood loss and a minimally invasive incision - patients can often go home after one day, or even as daycare.

In our setup, infection risk is under 0.3%. The two main factors are patient factors (immunocompromise, uncontrolled diabetes, hepatitis B, HIV or other viral disease) and surgeon/facility factors (poor surgical technique, poor OT culture, inadequate medication availability, or poor post-operative care).

Age-related osteoarthritis at stage three or four, an absolute indication for surgery in both the hip and knee.

Difficulty walking or climbing stairs, difficulty getting in and out of a car, resting pain at night, and a clear decline in walking distance from the patient's own prior baseline.