Knee replacement surgery has evolved into a highly customized procedure, catering to the individual needs of each patient — whether a young athlete or an elderly person. Modern approaches now focus more on physiological age rather than just chronological age. Partial knee replacements offer targeted solutions but may later require full replacements. Early rehabilitation, personalized surgical planning, and robotic assistance are transforming recovery and outcomes. However, strong traditional surgical skills remain essential to handle any challenges beyond robotics.

Shahid Akhter, Editor, Healthyouonline, spoke to Dr. Gurpal Singh to understand the latest trends, challenges, and advancements in knee replacement surgery.

Knee Replacement

Knee replacement is essentially an operation that is for end-stage arthritis or wear and tear of the knee where the damaged cartilage and bones, rub against each other, causing severe pain and deformity. We basically remove the diseased bone by introducing an implant which is made of different types of metal like cobalt, chrome ally, and titanium. So it's an artificial joint that is used to replace severely diseased bone.

Knee Replacement: Approach

Knee replacement by itself is not a one size fits all approach. For example, knee replacement for an 80 year old lady is different from a knee replacement for a 55 year old. Someone who's been an ex athlete has burnt out his knees by running, doing triathlons and things like that and is still very active. These are two very different operations. Knee replacement is becoming more and more customized and individualized to the needs of the individual. We are seeing a lot of young arthritic patients, who are still in the prime of their life, very active and have been very active sports people and, still want to be active and want to push the boundaries of knee replacement.

Knee Replacement: Misconceptions

A lot of misconceptions are there, for example, what you can and cannot do after knee replacement. So, you can't sort of jump on the knee. You can't do a very deep squat. But besides these, a lot of activities can be discussed. And it's good if the surgeon knows in advance the needs of the patient, because knee replacement is becoming more of a customised solution to fit the patient's needs. 

Knee Replacement: Ideal Age 

This is a myth that needs to be dispelled and broken. Traditionally, our training has always been that there's a certain age. We must wait until that age.

Now we're moving away from that concept. We are looking more at the physiological age of the patient and the knee rather than the chronological age of the patient. So using that example again, a 55-year-old athlete triathlete who has end-stage arthritis and is having difficulties in terms of his quality of life moving around and has bone-on-bone arthritis is a candidate for knee replacement.  

So is an 80-year-old lady who has end-stage arthritis. But the considerations are very different. So, in summary, there is no real age barrier.

Partial knee replacement

Partial knee replacement is a very good operation, provided patient selection is proper. What do I mean by that?

If the patient has isolated wear and tear in one compartment and has an activity profile that is suitable for partial knee replacement, then it's a good operation. However, one must understand that wear and tear in other compartments will continue, and the patient should be counselled appropriately that if that were to happen, there would be a chance that the partial knee replacement may need to be converted to a total knee replacement at some point.

The subsequent operation of conversion to a total knee replacement is actually a more complex operation than if a knee replacement were what a total knee replacement were to be done from the word go.   

Knee replacement: Pre Operation & Post Operation Core

Rehabilitation is a very important concept that is coming up in terms of joint replacement surgery, sports surgery, sports medicine, and basically the use of targeted physiotherapy even before the surgery. So that muscles are optimised so as not to have such an uphill climb after surgery for the individual or the patient.

This is especially so in the case of the younger arthritic patient who has been a sportsperson in his or her younger days and is faced with the problem of arthritis at a relatively young age.  

Yoga practitioners who want to sit cross-legged after surgery. Is it an impossible task? No, it's not an impossible task. But we have to discuss. We will have to make certain modifications to the surgical technique. And, you know, there's a plan. The rehab plan after surgery is also individualised to meet the needs of the patient.

An avid cyclist who wants to cycle 100km after surgery every week. Is it impossible? Of course we would discourage it, but it's not impossible. I have one such patient myself who does that. But again, knowing what the patient is going to do to that knee replacement after surgery helps because we can incorporate certain techniques during the surgery and certain rehab techniques before and after the surgery that would help the patient to do what he or she wants to do and, at the same time, sort of minimise the adverse effects of wear and tear on the joint.  

We have moved away from the concept of bed rest and encourage very early mobilisation after surgery. And this is only possible with adequate pain management. So, surgically, the techniques we use, including the use of robotic-assisted surgery, which minimises muscle trauma and reduces the cuts that.

And, you know, the type of cuts that we need on the bone, for example, we do not need to use intramedullary instrumentation in the bone when we use robots, so techniques during surgery, in other words, without getting too technical, that minimise tissue trauma,  

Knee replacement: Robotic Surgery 

Robotic surgery is not a fashionable, fancy statement or a tool. It is basically a tool or a way in which we can individualise surgery to meet the patient's needs. When we do a CT scan of the patient's knee or hip before surgery that's fed into the robotic software, and we have an individualised plan that we have for the patient in terms of surgery. 

We show the patient the plan. We discuss the plan with the patient. We execute the plan during the surgery, where the robot basically will make us cut within that very narrow margin. 

Robotic vs Traditional Suregery 

One of the biggest fears I have is that the younger generation of surgeons, that I see training in various parts of the world, being trained on robotic methods. Machines are machines. And if machines have a technical issue, if they fail, one must be able to bail out with traditional methods. We must be very well trained in traditional surgery, conventional surgery. Because as much as we like robotics and as much as we want to advance robotics, we can't depend completely on robotics.