We manage total hip arthroplasty as a critical restoration of the patient’s unique pelvic geometry. Under the clinical direction of Dr. Saminathan Suresh Nathan, our approach utilizes thirty years of surgical data to optimize the triad of stability: femoral offset, acetabular orientation, and leg length restoration. By employing advanced bearing surfaces—such as highly cross-linked polyethylene and ceramic-on-polyethylene—we focus on creating a high-endurance joint designed to withstand the mechanical rigors of an active lifestyle.
The Surgeon’s Origin: Arthroplasty Before Oncology It is often forgotten that before I specialized in the complex reconstruction of bone tumors, I was—and remain—a high-volume Arthroplasty Surgeon. My career began with a dedication to the perfect hip replacement. I did not just "learn" hip surgery; I helped define it for this region. As an International Trainer, I spent years conducting workshops and teaching the current generation of consultants the foundational principles of hip biomechanics and fixation.
The Introduction of the Exeter Hip to Singapore In an era of changing trends, I introduced the Exeter Hip System to Singapore.
Why it matters: The Exeter stem is the most documented, successful cemented stem in orthopaedic history.
The Philosophy: While others experimented with designs that have since failed, I established the use of the "Polished Taper" principle—a design that actually tightens into the bone over time (subsidence) rather than loosening.
The Result: I have patients walking on Exeter hips I implanted over 20 years ago that show no signs of loosening today.
Pioneering Ceramic Bearings: The "Forever" Hip I was among the first in the region to transition young, active patients to Ceramic-on-Ceramic bearings.
The Problem: Standard plastic (polyethylene) liners wear out, creating debris that eats away bone (osteolysis).
The Solution: By using diamond-hard ceramic interfaces, we reduced wear rates to near zero.
The Legacy: Today, this is the "gold standard" advertised by many clinics. I have been using it since its inception because I believe a hip replacement should last a lifetime, not just a decade.
The Direct Anterior Approach (DAA): Anatomical Respect Long before it became a marketing buzzword, I advocated for muscle-sparing approaches. The Direct Anterior Approach allows us to access the hip interval between muscles without cutting them.
Immediate Stability: Because the posterior stabilizing muscles are untouched, the risk of dislocation is significantly lower.
Rapid Recovery: Patients mobilize faster because they are not healing from muscle damage.
Oncological Precision: I apply the same meticulous dissection skills used to separate tumors from major nerves to your hip replacement. This ensures the highest level of safety for the femoral nerve and lateral cutaneous nerve during the DAA procedure.
Why a "Tumor Surgeon" is the Safest Hip Surgeon The global leaders in joint replacement—the very names my former students cite as their idols in London and New York—are almost exclusively Musculoskeletal Oncologists. Why? Because only an oncologist understands the catastrophic cost of failure. The kinds of fractures in metastatic disease are some of the worst seen in medicine.
In Oncology: Failure means amputation.
In Arthroplasty: Failure means a complex, painful revision. Because I routinely treat the "unfixable" revisions sent to me by other surgeons, I perform every primary hip replacement with a singular obsession: It must not fail.
Acetabular Orientation: Utilizing intraoperative landmarks or navigation to achieve the "safe zone" of cup positioning, minimizing the risk of impingement and dislocation.
Leg Length Equalization: Precise intraoperative assessment to ensure pelvic symmetry and eliminate the clinical sensation of discrepancy post-surgery.
Tissue-Sparing Approaches: Utilizing surgical windows that minimize muscle disruption, facilitating rapid biological recovery and immediate weight-bearing.
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 referral centre, gone on to do fellowships in top centers and then returned o 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 .
Do call us for more information:
Office phone: +65 67355 5 76
Fax: +65 67355 7 76
Whatsapp: +65 83854051 (24 hours)
E-mail: info@limbsalvagesurgery.com
Website (primary): www.limbsalvagesurgery.com
Online consults are available for foreign patients at SGD 500 but need to be pre-arranged and bank transfers made beforehand.
Figure 1. In the Asian community the more common causes of hip arthritis is that due to avascular necrosis (a) where cavities form in the head due to bone death (arrowed) and (b) developmental dysplasia where the head becomes uncovered (arrowed) due to a shallow acetabulum.
Figure 2. In younger patients like this, large heads allow the patient extreme stability and range of motion (a) with implants made with hard materials articulating on hard sockets as in the ceramic on ceramic hip replacement inserted through the anterior minimally invasive surgery approach here (b). Whenever the head becomes bigger the socket becomes thinner (arrowed) and more prone to early failure (c).
Figure 3. Hip replacements were originally designed to be put in through the back (posterior approach) and to this day it remains a classic and dependable approach. We continue to use it for older patients and patients with pathologic hip fractures. However in the higher functioning, younger patient our preference is for the anterior or antero-lateral approach featured above.
The clinical protocols and surgical techniques utilized at our practice are the result of over 25 years of pioneering work in Arthroplasty and Limb Salvage. Having served as an International Trainer and Chairman of the Clinical Competency Committee, we have mentored the current generation of surgeons on the very principles of precision and soft-tissue balancing that we apply to your care today.
When you choose our practice for your joint replacement or reconstruction, you are choosing a team that has not only mastered these procedures but has spent decades teaching them to the global orthopaedic community.
Learn more about our Pioneering History & Academic Distinctions.