Total Knee Arthroplasty (Total Knee Replacement)

Overview

Total knee arthroplasty may be used to replace damaged knee joint surfaces with artificial components to reduce pain and improve function. The procedure typically involves resurfacing the end of the femur and top of the tibia, and the patella may also be resurfaced in some cases.

Indications

This procedure may be considered when:

• •Severe knee pain and functional limitation that may be related to osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis
• •Knee stiffness or deformity that can limit walking, stairs, or daily activities despite non-surgical management
• •Persistent symptoms that may continue despite medications, activity modification, assistive devices, injections, or physical therapy

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation may include a history and physical examination, imaging such as X-rays, and assessment of overall health and surgical risk
• •Anesthesia can be general or regional, and antibiotics may be given around the time of surgery to reduce infection risk
• •An incision is typically made at the front of the knee to access the joint
• •Damaged cartilage and a small amount of underlying bone are typically removed from the femur and tibia to create surfaces for the implant
• •Metal components are positioned on the femur and tibia, often with bone cement or press-fit fixation depending on implant design and bone quality
• •A plastic spacer is typically placed between the metal components to allow smooth motion
• •The patella may be resurfaced with a plastic component in some cases, depending on cartilage condition and surgical approach
• •The surgeon typically checks knee alignment, stability, and range of motion before closing the incision

Risks

As with any surgical procedure, potential risks include:

• •Infection of the surgical site or prosthesis
• •Blood clots in the legs or lungs
• •Bleeding, wound healing problems, or hematoma
• •Stiffness or limited range of motion
• •Persistent pain or dissatisfaction despite technically successful surgery
• •Implant loosening, wear, or mechanical failure over time
• •Nerve or blood vessel injury (uncommon but possible)
• •Allergic or inflammatory reaction to implant materials (uncommon)
• •Need for revision surgery, which may occur if complications develop or the implant wears out

Recovery Expectations

Recovery follows a gradual progression:

• •Hospital stay may be same-day or may last 1 to several days, depending on overall health, mobility, and postoperative needs
• •Walking with assistance (such as a walker or crutches) can often begin soon after surgery, depending on pain control and stability
• •Swelling and discomfort may be common for weeks, and pain control plans often include multiple medication types and non-drug strategies
• •Physical therapy typically begins early and may continue for weeks to months to support strength, range of motion, and gait
• •Many people may resume some daily activities within several weeks, although recovery timelines can vary
• •Improvement in function can continue for several months, and full recovery may require up to a year in some individuals

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification and weight management strategies that may reduce knee load
• •Physical therapy and exercise programs that can improve strength and function
• •Medications such as acetaminophen or anti-inflammatory drugs that may reduce pain (when medically appropriate)
• •Injections (for example, corticosteroid injections) that may provide temporary symptom relief
• •Assistive devices (cane, brace) that can improve stability or reduce pain with walking
• •Knee osteotomy for selected patients with alignment-related arthritis
• •Unicompartmental (partial) knee arthroplasty for arthritis limited to a single compartment

Sources

• American Academy of Orthopaedic Surgeons (AAOS) – Total Knee Replacement
• Mayo Clinic – Knee Replacement
• Cleveland Clinic – Knee Replacement Surgery