We manage total knee arthroplasty as a high-precision balancing of soft tissues and mechanical alignment. Under the clinical direction of Dr. Saminathan Suresh Nathan, our practice utilizes thirty years of personal reconstructive experience to move beyond generic "mechanical" alignment toward personalized kinematic restoration. By integrating robotic-assisted navigation and 3D-planned cementless designs, we focus on replicating the patient’s natural joint movement to ensure long-term implant survival and functional stability.
Our Origins: The Trainers of the Region Long before the current trends in robotic surgery emerged, we were established Arthroplasty Surgeons and International Trainers. We spent decades conducting workshops across the Asia-Pacific region, teaching the fundamental principles of knee alignment and soft-tissue balancing to the very surgeons now practicing as consultants. Our transition into Musculoskeletal Oncology was not a departure from these roots but an evolution: mastering the reconstruction of massive bone defects gave us a unique perspective on how to preserve the native knee.
The Philosophy: Resurfacing, Not Just Replacing In many high-volume clinics, a Total Knee Replacement (TKR) is the default solution for knee pain. This approach often sacrifices healthy bone and crucial ligaments (the ACL and PCL) for the sake of surgical speed. We take a different approach. Whenever possible, we advocate for Unicompartmental (Partial) Knee Replacement (UKR).
Ligament Preservation: We preserve the anterior and posterior cruciate ligaments, maintaining the knee’s natural stability and "kinematics."
Bone Sparing: We only resurface the damaged compartment, leaving the healthy bone untouched.
The Result: Because the patient’s own ligaments guide the movement, a partial knee feels more natural and allows for higher-level function than a total replacement.
Makoplasty & Robotic Precision: The Tool, Not the Surgeon We utilize Makoplasty (Robotic-Arm Assisted Technology), but we understand that a robot is only as good as the surgeon guiding it.
Dynamic Balancing: The robot allows us to balance the tension in the ligaments before a single bone cut is made. This is the "art" of knee surgery that we have taught for years—now quantified by data.
Sub-Millimeter Accuracy: We place implants within 0.5mm of the pre-operative plan. This precision reduces wear and is critical for the longevity of the implant.
The Difference: Many surgeons use robots to make the surgery easier for them. We use robotics to make the outcome better for you.
Why an Orthopaedic Oncologist is the Best Knee Surgeon There is a misconception that complex surgeons should only handle complex cases. The reality is that the surgeon who routinely reconstructs massive distal femoral tumors is the most qualified to perform a standard knee replacement.
Anatomical Respect: In oncology, we work around major nerves and vessels daily. We apply this same "micro-precision" to protecting your neurovascular structures during routine arthroplasty.
Fixation Expertise: We understand bone biology at a cellular level. We utilize the same rigorous fixation techniques used in limb salvage to ensure your knee replacement integrates fully and lasts a lifetime.
Our Promise We do not offer "fast food" orthopaedics. We offer a bespoke, surgically precise reconstruction of your knee, backed by the experience of the surgeons who trained the region.
Robotic Precision: Utilizing real-time intraoperative feedback to achieve bone cuts accurate to within 1mm, ensuring optimal implant seating and ligamentous balance.
Cementless Integration: Prioritizing porous-coated implants for younger, active patients to facilitate biological "ingrowth," bypassing the fatigue-life limitations of traditional bone cement.
Soft Tissue Balancing: Dynamic assessment of the "gap" throughout the entire range of motion to eliminate the sensation of joint instability common in manual reconstructions.
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 referal centre, gone on to do fellowships in top centers and then returned to 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. Knee replacement designs have been fairly standard for the last 20 years (left on a) although newer designs (b) now allow patients better range of motion (e). These newer designs pioneered by our surgeons in Singapore have been used for the last 10 years and show excellent results. The future designs like the ceramic knee (d) also first implemented in Singapore by our surgeons represent the next generation of hypo-allergenic low-wear implants. For revision surgery implants the necessary technological enhancements all necessarily add to the cost of the implants (c).
Figure 2. This review of the author’s own cases shows that from the preoperative state all patients do better using objective scoring systems developed for this.
Figure 3. Ever thought of what's in store in a knee replacement procedure? We present here a comparison of a knee replacement with (left panel) and without (right panel) a tourniquet. We do resort to the latter in the difficult cases of patients with significant vascular risk. On the top panel are the salient steps in MAKOplasty surgery.
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.