Knee replacement

Minimally invasive subvastus knee replacement

In the subvastus approach, the quadriceps muscle — the engine of the knee — is lifted rather than cut. Preserving it is associated with earlier straight-leg raising, faster return of walking confidence and less early pain compared with the standard approach. It is technically more demanding for the surgeon, which is why fewer centres offer it routinely.

Complex knee replacement

Beyond routine osteoarthritis, this practice takes on the difficult end of knee reconstruction:

• Advanced osteoarthritis with severe bowing or fixed deformity
• Rheumatoid arthritis with fragile bone and soft-tissue contractures
• Ankylosed (fused or stiff) knees requiring staged soft-tissue release
• Post-fracture knees with old hardware, malunion or bone loss
• Healed tuberculosis of the knee, reconstructed after confirming disease quiescence

When is replacement actually needed?

Surgery is the last step, not the first. If pain is controlled with medication, physiotherapy and lifestyle measures, those are continued. Replacement is advised when arthritis is radiologically advanced and pain restricts daily life despite adequate conservative treatment — a threshold assessed honestly at consultation.