DR. ONG KEE LEONG
Knee Joint Preservation Surgery
Knee joint preservation surgery refers to procedures aimed at preserving the natural knee joint by realigning the knee to redistribute weight-bearing forces. High Tibial Osteotomy (HTO) and Distal Femur Osteotomy (DFO) involve cutting and reshaping either the tibia or femur bone to shift weight away from damaged areas of the knee joint. These surgeries address early to mid-stage knee osteoarthritis affecting only one compartment of the knee, typically in younger, active patients who wish to delay or avoid total knee replacement.
Book AppointmentPotential Risks and Complications
Knee joint preservation surgery carries risks similar to other orthopaedic procedures. Infection may require antibiotics or additional surgery, while delayed union or nonunion can necessitate revision surgery. Hardware-related problems include pain or irritation at plate sites. Loss of correction can occur if fixation fails before complete bone healing. Neurovascular injury to structures around the knee is rare but possible. Persistent pain or incomplete relief may occur in some patients despite technically successful surgery. Knee stiffness may develop, particularly if rehabilitation protocols are not followed.
Indications for Knee Joint Preservation Surgery
The following conditions may indicate that knee joint preservation surgery could be appropriate for certain patients.
- Unicompartmental Osteoarthritis: This procedure applies when arthritis affects only one side of the knee joint, either the medial (inner) or lateral (outer) compartment. The unaffected compartment must have healthy cartilage.
- Knee Malalignment: Patients with abnormal leg alignment, such as bowlegs (varus) or knock-knees (valgus), that places excess pressure on one side of the knee joint may benefit from realignment surgery.
- Young to Middle-Aged Patients: These procedures suit patients typically between 40 and 60 years old who are too young for knee replacement but require intervention beyond conservative treatments.
- Post-Traumatic Deformity: Previous injuries to the knee that have resulted in malalignment and subsequent arthritis may be corrected through osteotomy procedures.
- Failed Conservative Treatment: Patients who have tried non-surgical treatments, including medications, physical therapy, injections, and activity modifications, without adequate relief.
- High Activity Requirements: Individuals who wish to maintain higher levels of physical activity than what would be recommended after a total knee replacement.
Surgical Techniques
- High Tibial Osteotomy (HTO): Corrects varus (bowleg) deformity by cutting the upper tibia. The medial opening wedge creates a gap which may need to be filled with bone graft and secured with hardware. The lateral closing wedge removes bone laterally, closes the gap, and fixes it in place. HTO typically redirects weight from the damaged medial compartment to the healthier lateral side.
- Distal Femur Osteotomy (DFO): Addresses valgus (knock-knee) deformity by cutting the lower femur. Using lateral opening or medial closing wedge techniques, DFO shifts weight-bearing from the damaged lateral compartment to the healthier medial side. Less common than HTO but follows similar load redistribution principles.
- Minimally Invasive Techniques: Uses smaller incisions and specialised instruments to reduce soft tissue damage, potentially decreasing post-operative pain and recovery time. Typically employs fluoroscopic guidance but may not be suitable for all cases.
Benefits of Knee Joint Preservation Surgery
Joint Preservation
The procedure maintains the natural knee joint and avoids removing bone and cartilage as required in knee replacement surgery. This preserves proprioception and normal knee biomechanics.
Delayed Need for Knee Replacement
Successful osteotomy surgery can postpone the need for total knee replacement by 10-15 years in many cases. This timing can be particularly valuable for younger patients.
Return to Higher Activity Levels
Patients can typically return to more demanding physical activities compared to what would be advised following knee replacement, including running and impact sports.
Pain Relief
Realignment of the knee reduces pressure on the damaged compartment, which often results in significant reduction of pain during daily activities and exercise.
Correction of Deformity
The surgery addresses the underlying mechanical problem causing the knee pain rather than simply treating symptoms, correcting angular deformities that lead to uneven joint wear.
Tissue Preservation
Unlike knee replacement, no removal of existing joint structures occurs, leaving all future surgical options available if needed.
Medisave & Insurance Shield Plan Approved
For Singaporeans & Singapore Permanent Residents
Preparing for Surgery
- Medical Evaluation: A comprehensive assessment includes physical examination, imaging studies, and laboratory tests. X-rays, MRI, and sometimes CT scans help evaluate the extent of arthritis, alignment issues, and overall knee condition. The evaluation may include a gait analysis and assessment of other joints, as problems in the hip or ankle can affect knee alignment.
- Medication Adjustments: Certain medications need to be paused before surgery to reduce bleeding risk. Blood thinners such as aspirin, warfarin, or clopidogrel typically require adjustment or temporary discontinuation. Anti-inflammatory medications may need to be stopped 7-10 days before surgery.
- Lifestyle Modifications: Weight management can affect surgical outcomes and recovery. Smoking cessation is recommended at least 4-6 weeks before surgery to support healing potential. A nutritionally balanced diet supports tissue healing and recovery. These modifications can significantly impact the success of your surgery and rehabilitation.
Post-Surgical Care and Recovery
- Immediate Post-operative Care: Hospital stays typically last 2-3 days with pain management through medications and nerve blocks. Physical therapy begins the day after surgery, with drainage tubes removed within 48 hours and X-rays confirming proper alignment.
- Weight-bearing Restrictions: Patients use crutches or walkers for 4-8 weeks, with partial weight-bearing around week 6 if healing progresses well. Full weight-bearing typically resumes between 8-12 weeks, allowing the bone to heal in the corrected position.
- Return to Activities: Daily activities gradually resume within 6-12 weeks, with driving permitted after 6-8 weeks and return to work at 4-6 weeks for sedentary jobs. Sports and high-impact activities typically resume between 6-12 months, often achieving higher activity levels than would be recommended after knee replacement.
Step-by-Step Procedure
Anaesthesia Administration
The procedure typically uses spinal or general anaesthesia based on patient factors. The anaesthetist discusses options during pre-operative consultation, considering medical history and procedure duration. Nerve blocks may be used as adjuncts to provide post-operative pain control.
Surgical Approach and Exposure
The surgeon makes an incision on the side of the knee corresponding to the planned osteotomy. For HTO, the incision is typically on the inner side of the upper tibia, while DFO requires an incision on the appropriate side of the distal femur. The surgeon carefully dissects through the tissue layers to expose the bone while protecting surrounding structures.
Osteotomy Planning and Execution
Guide wires are placed to mark the planned bone cut under fluoroscopic guidance. The surgeon uses specialised saws and osteotomes to create a precise cut in the bone according to pre-operative measurements. For opening wedge techniques, the cut bone is carefully opened to the predetermined angle. The surgeon verifies the correction by checking alignment with fluoroscopy or navigation tools.
Fixation of the Osteotomy
Once the correct alignment is achieved, the surgeon stabilises the bone. In opening wedge techniques, bone graft material fills the wedge-shaped gap. A metal plate is positioned across the osteotomy site and secured with screws. The hardware selection depends on bone quality, patient factors, and the specific technique used.
Closure and Dressing Application
The surgeon checks for bleeding and irrigates the wound before closure. The deeper tissue layers are closed with absorbable sutures to restore the anatomical structure. Skin closure uses stitches, staples, or adhesive depending on surgeon preference. A sterile dressing covers the wound, and sometimes a knee brace or splint provides additional protection.
Why Do Patients Choose Dr Ong Kee Leong?
- Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
- Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
- Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
- Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
- Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
- Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
- Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
- Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park Hospital
- Minimal Waiting Time For Initial Consultation
- Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)
About Dr. Ong Kee Leong
Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)
Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.
He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.
- MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
- Member of the Royal College of Surgeons of Edinburgh 2007
- Master of Medicine in Orthopaedic Surgery (NUS) 2007
- Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
- Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
- Sports Surgery and Arthroscopy in Germany (Hannover)
- Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
- Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
- Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
- He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
- Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
- He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.
Frequently Asked Questions
How long will the results last?
Results vary based on individual factors including age, activity level, and extent of pre-existing arthritis. Most patients maintain good function for at least 10 years after surgery. Younger patients with minimal arthritis typically experience longer-lasting results than older patients with more advanced joint damage.
Will I need a knee replacement eventually?
Many patients will eventually require knee replacement, but osteotomy surgery can delay this need significantly. The surgery provides valuable time, particularly beneficial for younger patients who may otherwise face multiple knee replacements in their lifetime.
What happens if the surgery does not provide adequate pain relief?
If pain relief is inadequate after proper healing and rehabilitation, your surgeon may recommend additional treatments such as injections, bracing, physical therapy modifications, or activity adjustments. Conversion to partial or total knee replacement remains an option if conservative measures fail to provide relief.
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Prefer to talk? Call our clinic directly to make an enquiry at (65) 6884 6788
(Please ask for Dr Ong Kee Leong)
our clinics
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Mt Elizabeth Novena
- 38 Irrawaddy Road #06-59/60/61 Mt Elizabeth Novena Specialist Centre Singapore 329563
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
other practice locations
Farrer Park Hospital
- 1 Farrer Park Station Road #14-06 Connexion Singapore 217562
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
Mt Alvernia Medical Centre
- 820 Thomson Road #07-53 Mt Alvernia Medical Centre D Singapore 574623
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."
Billing & Payment
Consultation fees are charged based on length of consultation, and start from SGD$200 (within 30 minutes).
Modes of Payment
We accept the following modes of payment:
- Cash
- PayNow & PayLah
- All major Credit Cards
If you are insured and would like to use a Letter of Guarantee (LOG) from the major insurers in Singapore, please contact us and our friendly clinic staff will assist you and provide more information if required.
Can I Claim Through My Medisave Account? (For Singaporeans and PR)
Yes, you can. Our Clinic is an accredited day surgery clinic by the Ministry of Health. Singaporeans and Permanent Residents may use their Medisave for eligible orthopaedic inpatient procedures and hospitalizations.
The exact amount would depend on the complexity of the procedure. If you have any enquiries, feel free to speak to our friendly clinic staff about using your Medisave account.
Integrated Shield Plans (Singaporeans and PRs)
Yes, patients who have purchased Integrated Shield plans with riders for co-insurance and deductibles will be able to use them in our clinic for eligible procedures. For more information, contact us to find out if your procedure is claimable.
The 5 Approved Integrated Shield Insurers are:
- NTUC Income’s IncomeShield and Enhanced IncomeShield
- American International Assurance International Co’s (AIA) HealthShield Gold
- Great Eastern Life Assurance Co’s SupremeHealth and SupremeHealth Plus
- Prudential Assurance Co’s PRUShield
- AXA Shield