Table of ContentsView AllTable of ContentsPurposeHow to PrepareWhat to ExpectRecoveryLong-Term Care
Table of ContentsView All
View All
Table of Contents
Purpose
How to Prepare
What to Expect
Recovery
Long-Term Care
Knee replacement surgery (knee arthroplasty) involves removing a patient’s damaged joint surface and replacing it with a metal and plastic implant. This surgery is performed on patients with severe knee arthritis (most commonly,osteoarthritis) to decrease pain and improve mobility, and it tends to have a high success rate.
While knee replacement surgery is considered a safe and effective operation, it’s important to gain knowledge about the potential risks involved, as well as the recovery process, which may take up to a year in some patients.
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What Is Knee Replacement Surgery?
During a total knee replacement (TKR), the bone and cartilage at the end of the thigh bone and shinbone are removed. An implant is then placed on the knee to create a new joint surface. This implant functions similarly to a normal knee.
Those who have disease limited to one area of their knee (for example, only the medial or inside compartment of their knee) may be candidates forpartial knee replacementinstead of TKR.However, most patients require the latter, which is focused on here.
Your surgical team will help you decidewhat type of anesthesiais best for you:
What Is a Custom Knee Replacement?
Various Surgical Techniques
There are two main surgical techniques used in total knee replacement surgery: the traditional technique and the minimally invasive technique.
Thetraditional techniqueinvolves making an 8- to 12-inch incision in the knee to expose the joint. Once this is done, damaged tissues are removed and the knee implant is placed.
Theminimally invasive techniqueinvolves making a smaller incision (3 to 5 inches) and using long, thin surgical instruments to remove the tissue and position the implant.
Over the years, the minimally invasive technique has evolved to include three main approaches:
Minimally invasive approaches are associated with less blood loss, reduced postoperative pain, and a shorter hospital stay. Additionally, because there is less tissue trauma during surgery, patients may be able to reach milestones—like walking with a cane—sooner than with traditional surgery.
Computer-Assisted Total Knee ReplacementSome surgeons utilize a sophisticated computer imaging system when performing total knee replacements. While this surgical approach involves a longer operation time and is more costly, it may allow for a more precise implant alignment. Talk with your surgeon if you are interested in this investigational technology.
Computer-Assisted Total Knee Replacement
Some surgeons utilize a sophisticated computer imaging system when performing total knee replacements. While this surgical approach involves a longer operation time and is more costly, it may allow for a more precise implant alignment. Talk with your surgeon if you are interested in this investigational technology.
Implant Types
A knee implant is usually made of metal (e.g., cobalt chrome or titanium) and plastic (polyethylene). Each prosthesis typically replaces up to three bone surfaces:
There are a variety of knee joint implants out there. Your implant will be selected during a pre-operative visit with your surgeon. The specific implant used for your knee replacement will depend on various factors, such as:
Do not hesitate to ask your surgeon questions about why a particular implant is being recommended for you.
There are also different ways in which the implant is placed during the surgery. Traditionally, the implant is fixed into the bone with cement. Now, though, a novel cement-less technique may be used. This means that the implant is press-fit onto the bone, allowing the bone to grow and permanently bond to the implant without any adhesive.
There is still debate within the medical community about whether a cemented or cement-less fixation is better. Early research has found that in young patients, cement-less fixation may provide better outcomes in terms of pain relief and restoring knee function.
Contraindications
Absolute contraindications to undergoing knee replacement surgery include:
Relative contraindications include:
Knee Replacement and Metal Allergies
Potential Risks
Knee replacement surgery has become quite common. Fortunately, well over 90% of patients who undergo knee replacement surgery have good results, but there are still risks that must be considered.
Besides general surgical risks likeblood clots, pneumonia, and bleeding, other potential complications that may occur after a knee replacement surgery include:
The Seriousness of Infections After Knee Replacement
Purpose of Knee Replacement Surgery
The joint inflammation that characterizes arthritis can lead to cartilage loss and exposed bone over time. With the normal, smooth joint surface compromised, pain and disability can occur.
The purpose of knee replacement surgery is to restore knee function, alleviate symptoms like knee pain and stiffness, and improve mobility and overall quality of life.
Knee replacement surgery is indicated for patients who:
While the vast majority of knee replacement surgeries are performed in older individuals with osteoarthritis, surgery may also be performed in people with one or more damaged knee joints from post-traumatic arthritis, or in people with inflammatory arthritis likerheumatoid arthritisorpsoriatic arthritis.
Rarely, children with juvenile idiopathic arthritis may undergo knee replacement surgery.
Knee Replacement Surgery: Overview
After scheduling your knee replacement surgery, you will be provided with instructions on how to prepare for the operation.
In addition to standard directions, all surgical patients are given—like stopping certain medications for a period of time, stopping smoking for at least two weeks prior to surgery, and avoiding food after midnight on the eve of your surgery—your healthcare provider may suggest:
What to Expect on the Day of Surgery
On the day of surgery, you will first go to a pre-operative room where you will change into a hospital gown. A nurse will then record your vital signs and place a peripheral IV in your hand or arm.
After briefly meeting with members of the surgical and anesthesia teams, you will be taken into the operating room.
If undergoing general anesthesia, you will be given medications to put you to sleep and anendotracheal tubeconnected to a breathing machine (ventilator) will be placed. If you are undergoing regional anesthesia, you will be given a sedative to relax you while the anesthesiologist performs a nerve block (usually in your lower back).
Knee replacement surgery will then typically proceed with the following steps:
Knee Replacement Surgery: What to Expect on the Day of Surgery
You can expect to stay in the hospital for approximately one to four days after your operation.While many patients experience significant pain relief and a rapid improvement in knee functioning within weeks of the surgery, full recovery can take anywhere from six months to a year.
As you recover in the hospital, you can expect the following:
Once discharged home, it’s important to follow your surgeon’s post-operative instructions, which may include:
The success of knee replacement surgery depends partially on the rehabilitation period that follows the operation.
With rehabilitation, you can generally expect the following after surgery:
Can You Kneel After a Knee Replacement?
Besides attending physical therapy appointments and engaging in various exercises at home, it’s important to follow-up with your surgeon as advised. Your surgeon will want to ensure that your knee is maintaining good strength, stability, and mobility.
Will I Ever Need Revision Surgery?Even though over 80% of knee implants last 25 years or longer, revision surgery may be indicated for various complications—the main one beingloosening or wearing out of your knee implant. Younger patients are more likely to experience implant loosening because they live longer and tend to be more active.
Will I Ever Need Revision Surgery?
Even though over 80% of knee implants last 25 years or longer, revision surgery may be indicated for various complications—the main one beingloosening or wearing out of your knee implant. Younger patients are more likely to experience implant loosening because they live longer and tend to be more active.
A Word From Verywell
No doubt, many people have knee arthritis, but it can be difficult to know when the right time is to have knee replacement surgery. To make the best decision, be sure to meet with and engage in thoughtful discussions with your healthcare provider, rheumatologist, and/or orthopedic surgeon. Do not hesitate to ask questions, voice your concerns, and seek out second opinions.
Reasons to Delay or Decline Knee Replacment
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Knee Replacement.Foran J.Unicompartmental Knee Replacement. American Academy of Orthopedic Surgeons.Edwards PK, Milles JL, Stambough JB, Barnes CL, Mears SC.Inpatient versus Outpatient Total Knee Arthroplasty.J Knee Surg. 2019 Aug;32(8):730-735. doi:10.1055/s-0039-1683935Tzatzairis T, Fiska A, Ververidis A, Tilkeridis K, Kazakos K, Drosos GI.Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature.J Orthop. 2018 Jun;15(2):459-66. doi:10.1016/j.jor.2018.03.026Masjudin T.A Comparison Between Subvastus and Midvastus Approaches for Staged Bilateral Total Knee Arthroplasty: A Prospective, Randomised Study.Malays Orthop J.2012 Nov; 6(3): 31–36. doi:10.5704/MOJ.1207.018Dabboussi N, Sakr M, Girard J, Fakih R.Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach.N Am J Med Sci.2012 Feb; 4(2): 81–85. doi:10.4103/1947-2714.93381Haritinian EG, Pimpalnerkar AL.Computer Assisted Total Knee Arthroplasty: Does it Make a Difference?Maedica (Bucur); 8(2):176-81.Aprato A, Risitano S, Sabatinu L, Giachino M, Agati G, Massè A.Cementless total knee arthroplasty.Ann Transl Med.2016 Apr; 4(7): 129. doi:10.21037/atm.2016.01.34Wang K, Sun H, Zhang K et al.Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials.Medicine (Baltimore).2020 Jan;99(3):e18750. doi:10.1097/MD.0000000000018750Hsu H, Siwiec RM.Knee Arthroplasty.In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing.Nam D, Nunley RM, Barrack RL.Patient dissatisfaction following total knee replacement: a growing concern?Bone Joint J. 2014;96-B(11 Supple A):96-100. doi:10.1302/0301-620X.96B11.34152Yohe N, Funk A, Ciminero M, Erez O, Saleh A.Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians.Geriatr Orthop Surg Rehabil. 2018; 9: 2151459318804113. doi:10.1177/2151459318804113Van Manen MD, Nace J, Mont MA.Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners.Review J Am Osteopath Assoc; 112(11):709-15.University of California San Francisco Health.Preparing for Knee Replacement Surgery.Johns Hopkins Medicine.Knee Replacement Surgery Procedure.Heyse TJ, Ries MD, Bellemans J et al.Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis.Clin Orthop Relat Res.2014 Jan; 472(1): 147–154. doi:10.1007/s11999-013-3095-3University of Michigan.Preparing and Recovering from Knee Replacement Surgery.Foran J.Activities After Knee Replacement Surgery. American Academy of Orthopaedic Surgeons.American Academy of Orthopaedic Surgeons.Total Knee Replacement.Forster R, Stewart M.Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair.Cochrane Database Syst Rev.2016 Mar 30;3:CD004179. doi:10.1002/14651858.CD004179.pub2Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR.How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019 Feb 16;393(10172):655-63. doi:10.1016/S0140-6736(18)32531-5
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic.Knee Replacement.Foran J.Unicompartmental Knee Replacement. American Academy of Orthopedic Surgeons.Edwards PK, Milles JL, Stambough JB, Barnes CL, Mears SC.Inpatient versus Outpatient Total Knee Arthroplasty.J Knee Surg. 2019 Aug;32(8):730-735. doi:10.1055/s-0039-1683935Tzatzairis T, Fiska A, Ververidis A, Tilkeridis K, Kazakos K, Drosos GI.Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature.J Orthop. 2018 Jun;15(2):459-66. doi:10.1016/j.jor.2018.03.026Masjudin T.A Comparison Between Subvastus and Midvastus Approaches for Staged Bilateral Total Knee Arthroplasty: A Prospective, Randomised Study.Malays Orthop J.2012 Nov; 6(3): 31–36. doi:10.5704/MOJ.1207.018Dabboussi N, Sakr M, Girard J, Fakih R.Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach.N Am J Med Sci.2012 Feb; 4(2): 81–85. doi:10.4103/1947-2714.93381Haritinian EG, Pimpalnerkar AL.Computer Assisted Total Knee Arthroplasty: Does it Make a Difference?Maedica (Bucur); 8(2):176-81.Aprato A, Risitano S, Sabatinu L, Giachino M, Agati G, Massè A.Cementless total knee arthroplasty.Ann Transl Med.2016 Apr; 4(7): 129. doi:10.21037/atm.2016.01.34Wang K, Sun H, Zhang K et al.Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials.Medicine (Baltimore).2020 Jan;99(3):e18750. doi:10.1097/MD.0000000000018750Hsu H, Siwiec RM.Knee Arthroplasty.In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing.Nam D, Nunley RM, Barrack RL.Patient dissatisfaction following total knee replacement: a growing concern?Bone Joint J. 2014;96-B(11 Supple A):96-100. doi:10.1302/0301-620X.96B11.34152Yohe N, Funk A, Ciminero M, Erez O, Saleh A.Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians.Geriatr Orthop Surg Rehabil. 2018; 9: 2151459318804113. doi:10.1177/2151459318804113Van Manen MD, Nace J, Mont MA.Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners.Review J Am Osteopath Assoc; 112(11):709-15.University of California San Francisco Health.Preparing for Knee Replacement Surgery.Johns Hopkins Medicine.Knee Replacement Surgery Procedure.Heyse TJ, Ries MD, Bellemans J et al.Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis.Clin Orthop Relat Res.2014 Jan; 472(1): 147–154. doi:10.1007/s11999-013-3095-3University of Michigan.Preparing and Recovering from Knee Replacement Surgery.Foran J.Activities After Knee Replacement Surgery. American Academy of Orthopaedic Surgeons.American Academy of Orthopaedic Surgeons.Total Knee Replacement.Forster R, Stewart M.Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair.Cochrane Database Syst Rev.2016 Mar 30;3:CD004179. doi:10.1002/14651858.CD004179.pub2Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR.How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019 Feb 16;393(10172):655-63. doi:10.1016/S0140-6736(18)32531-5
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cleveland Clinic.Knee Replacement.Foran J.Unicompartmental Knee Replacement. American Academy of Orthopedic Surgeons.Edwards PK, Milles JL, Stambough JB, Barnes CL, Mears SC.Inpatient versus Outpatient Total Knee Arthroplasty.J Knee Surg. 2019 Aug;32(8):730-735. doi:10.1055/s-0039-1683935Tzatzairis T, Fiska A, Ververidis A, Tilkeridis K, Kazakos K, Drosos GI.Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature.J Orthop. 2018 Jun;15(2):459-66. doi:10.1016/j.jor.2018.03.026Masjudin T.A Comparison Between Subvastus and Midvastus Approaches for Staged Bilateral Total Knee Arthroplasty: A Prospective, Randomised Study.Malays Orthop J.2012 Nov; 6(3): 31–36. doi:10.5704/MOJ.1207.018Dabboussi N, Sakr M, Girard J, Fakih R.Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach.N Am J Med Sci.2012 Feb; 4(2): 81–85. doi:10.4103/1947-2714.93381Haritinian EG, Pimpalnerkar AL.Computer Assisted Total Knee Arthroplasty: Does it Make a Difference?Maedica (Bucur); 8(2):176-81.Aprato A, Risitano S, Sabatinu L, Giachino M, Agati G, Massè A.Cementless total knee arthroplasty.Ann Transl Med.2016 Apr; 4(7): 129. doi:10.21037/atm.2016.01.34Wang K, Sun H, Zhang K et al.Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials.Medicine (Baltimore).2020 Jan;99(3):e18750. doi:10.1097/MD.0000000000018750Hsu H, Siwiec RM.Knee Arthroplasty.In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing.Nam D, Nunley RM, Barrack RL.Patient dissatisfaction following total knee replacement: a growing concern?Bone Joint J. 2014;96-B(11 Supple A):96-100. doi:10.1302/0301-620X.96B11.34152Yohe N, Funk A, Ciminero M, Erez O, Saleh A.Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians.Geriatr Orthop Surg Rehabil. 2018; 9: 2151459318804113. doi:10.1177/2151459318804113Van Manen MD, Nace J, Mont MA.Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners.Review J Am Osteopath Assoc; 112(11):709-15.University of California San Francisco Health.Preparing for Knee Replacement Surgery.Johns Hopkins Medicine.Knee Replacement Surgery Procedure.Heyse TJ, Ries MD, Bellemans J et al.Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis.Clin Orthop Relat Res.2014 Jan; 472(1): 147–154. doi:10.1007/s11999-013-3095-3University of Michigan.Preparing and Recovering from Knee Replacement Surgery.Foran J.Activities After Knee Replacement Surgery. American Academy of Orthopaedic Surgeons.American Academy of Orthopaedic Surgeons.Total Knee Replacement.Forster R, Stewart M.Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair.Cochrane Database Syst Rev.2016 Mar 30;3:CD004179. doi:10.1002/14651858.CD004179.pub2Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR.How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019 Feb 16;393(10172):655-63. doi:10.1016/S0140-6736(18)32531-5
Cleveland Clinic.Knee Replacement.
Foran J.Unicompartmental Knee Replacement. American Academy of Orthopedic Surgeons.
Edwards PK, Milles JL, Stambough JB, Barnes CL, Mears SC.Inpatient versus Outpatient Total Knee Arthroplasty.J Knee Surg. 2019 Aug;32(8):730-735. doi:10.1055/s-0039-1683935
Tzatzairis T, Fiska A, Ververidis A, Tilkeridis K, Kazakos K, Drosos GI.Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature.J Orthop. 2018 Jun;15(2):459-66. doi:10.1016/j.jor.2018.03.026
Masjudin T.A Comparison Between Subvastus and Midvastus Approaches for Staged Bilateral Total Knee Arthroplasty: A Prospective, Randomised Study.
Malays Orthop J.2012 Nov; 6(3): 31–36. doi:10.5704/MOJ.1207.018
Dabboussi N, Sakr M, Girard J, Fakih R.Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach.N Am J Med Sci.2012 Feb; 4(2): 81–85. doi:10.4103/1947-2714.93381
Haritinian EG, Pimpalnerkar AL.Computer Assisted Total Knee Arthroplasty: Does it Make a Difference?Maedica (Bucur); 8(2):176-81.
Aprato A, Risitano S, Sabatinu L, Giachino M, Agati G, Massè A.Cementless total knee arthroplasty.Ann Transl Med.2016 Apr; 4(7): 129. doi:10.21037/atm.2016.01.34
Wang K, Sun H, Zhang K et al.Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials.Medicine (Baltimore).2020 Jan;99(3):e18750. doi:10.1097/MD.0000000000018750
Hsu H, Siwiec RM.Knee Arthroplasty.In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing.
Nam D, Nunley RM, Barrack RL.Patient dissatisfaction following total knee replacement: a growing concern?Bone Joint J. 2014;96-B(11 Supple A):96-100. doi:10.1302/0301-620X.96B11.34152
Yohe N, Funk A, Ciminero M, Erez O, Saleh A.Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians.Geriatr Orthop Surg Rehabil. 2018; 9: 2151459318804113. doi:10.1177/2151459318804113
Van Manen MD, Nace J, Mont MA.Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners.Review J Am Osteopath Assoc; 112(11):709-15.
University of California San Francisco Health.Preparing for Knee Replacement Surgery.
Johns Hopkins Medicine.Knee Replacement Surgery Procedure.
Heyse TJ, Ries MD, Bellemans J et al.Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis.Clin Orthop Relat Res.2014 Jan; 472(1): 147–154. doi:10.1007/s11999-013-3095-3
University of Michigan.Preparing and Recovering from Knee Replacement Surgery.
Foran J.Activities After Knee Replacement Surgery. American Academy of Orthopaedic Surgeons.
American Academy of Orthopaedic Surgeons.Total Knee Replacement.
Forster R, Stewart M.Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair.Cochrane Database Syst Rev.2016 Mar 30;3:CD004179. doi:10.1002/14651858.CD004179.pub2
Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR.How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019 Feb 16;393(10172):655-63. doi:10.1016/S0140-6736(18)32531-5
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