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Specialties: Total Knee Arthroplasty Procedure Overview

Total knee replacement is a surgical procedure which involves the end of the femur (thigh bone) and the top of the tibia (shin bone) being resurfaced. The artificial knee implant is composed of metal and polyethylene — a durable plastic. The femoral and tibial components glide together to replicate the knee joint.

Steps to the Procedure

View Animation of Knee Replacement »

Step 1: Knee Incision
To begin the surgery, the surgeon will make an incision on the front of your knee, cutting through the tissue surrounding the muscles and bone. The kneecap, or patella, is rotated to the outside of the knee, to help your doctor see the area where the implant will be placed.

Step 2: Prepare the Femur
The surgeon will use special cutting instruments to measure and make precise cuts of the bone. The end of the femur (thigh bone) is cut into a shape that matches the corresponding surface of the metal femoral component.

Step 3: Implant the Femoral Component
The femoral component is then placed on the end of the femur.

Step 4: Prepare the Tibia
The tibia (shin bone) is prepared with a flat cut on the top. The exposed end of the bone is sized to fit the metal and plastic tibial components.

Step 5: Implant the Tibial Component
The metal tibial component is inserted into the bone. Then a plastic insert is snapped into the tibial component. The femoral component will slide on this plastic as you bend your knee.

Step 6: Implant Patella
If needed, the patella (kneecap) is also cut flat, and fitted with a plastic patellar component. The surgeon may choose to use cement to help fix the implants onto your bone.

Step 7: Final Implants
Your surgeon will conduct several tests during the surgery to ensure the correct sized components are used to help you regain good balance and motion in your knee. Your surgeon will then close the wound in layers with stitches and/or staples.

Reasons for the Procedure

Knee replacement surgery is a treatment for pain and disability in the knee. The most common condition that results in the need for knee replacement surgery is osteoarthritis.

Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees. Damage to the cartilage and bones limits movement and may cause pain. Persons with severe degenerative joint disease may be unable to do normal activities that involve bending at the knee, such as walking or climbing stairs, because they are painful. The knee may swell or "give-way" because the joint is not stable.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, may also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the knee joint.

If medical treatments are not satisfactory, knee replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:

There may be other reasons for your physician to recommend a knee replacement surgery.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

The replacement knee joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by surgery.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

In addition to a complete medical history, your primary physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

Notify your surgeon if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

Notify your surgeon of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

Notify your surgeon if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Knee replacement requires a stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Knee replacement surgery may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your physician will discuss this with you in advance.

Generally, knee replacement surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will be positioned on the operating table.
  4. A urinary catheter may be inserted.
  5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  6. The skin over the surgical site will be cleansed with an antiseptic solution.
  7. The physician will make an incision in the knee area.
  8. The physician will remove the damaged parts of the knee joint and replace them with the prosthesis. The knee prosthesis is made up of metal and plastic. The two most common types of artificial knee prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a fine mesh into which the bone grows to attach to the prosthesis. Sometimes, a combination of the two types is used to replace a knee. The prosthesis is generally comprised of three components: the tibial component (to replace the top of the tibia, or shin bone); the femoral component (to replace the two femoral [thighbone] condyles and the patella groove); and the patellar component (to replace the bottom surface of the kneecap that rubs against the thighbone).
  9. The incision will be closed with stitches or surgical staples.
  10. A drain may be placed in the incision site to remove fluid.
  11. A sterile bandage/dressing will be applied.

After the Procedure

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Knee replacement surgery usually requires an in-hospital stay of several days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. A continuous passive motion (CPM) machine may be used to begin the physical therapy. This machine moves your new knee joint through its range of motion while you are resting in bed. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your physician will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

To help reduce swelling, you may be asked to elevate your leg, apply ice, or wear support hose or special compression boots.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Contact your physician to report any of the following:

You may resume your normal diet unless your physician advises you differently. You should not drive until your physician tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.

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Last Modified: June 24, 2014