Total Knee Replacement

The knee is the largest joint in the human body and provides motion where the thigh meets the lower leg. Having two healthy knees is essential for performing almost every daily activity. When people begin experiencing pain and immobility that interferes with their daily life, a total knee replacement may be necessary.


A total knee replacement is a surgery in which a diseased knee joint gets replaced with an artificial implant. The joint may be damaged by arthritis or injury, making it difficult to participate in your daily activities.

Causes of a Total Knee Replacement

The most common reason people need a total knee replacement is arthritis. There are many types of arthritis that could cause problems, but osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis are the most common.

  • Osteoarthritis is often equated to a “wear and tear” kind of arthritis. It typically occurs in people over the age of 50, but isn’t exclusive to this age group. In this type of arthritis, the cartilage cushioning the bones in the knee wears away, causing the bones to rub against each other.
  • In rheumatoid arthritis, the synovial membrane around the knee joint becomes inflamed and thickened. The chronic inflammation can damage the knee’s cartilage and eventually lead to the loss of cartilage, pain, and stiffness.
  • Post-traumatic arthritis typically follows a serious knee injury. A fracture of the bones around the knee or ligament tears can lead to damage to the articular cartilage over time. Eventually this can cause knee pain and limit the function of the knee.

Symptoms of a Total Knee Replacement

Candidates who experience the following symptoms may be good candidates for a total knee replacement:

  • Severe knee pain or stiffness when walking, climbing stairs, or getting in and out of chairs
  • Difficulty walking more than a few blocks at a time
  • Moderate or severe pain in the knee even when at rest
  • Chronic inflammation and swelling that doesn’t respond to rest and/or medications
  • Knee deformity like a bowing in or out of the knee
  • Problems that do not improve with the use of nonsurgical treatments like medication, injections, physical therapy, or even other surgeries

The Procedure

Preparing the Bone

First, the surgeon will make an incision in the knee and move the patella to the side to create a better view. Sometimes with osteoarthritis bone spurs will be present. If they are, these will be removed.

Next, the surgeon will remove damaged cartilage at the ends of the femur and tibia. A small amount of the underlying bone on the upper part of the tibia and the lower sections of the femur is also removed.

Placing the Implants

Then, the tibia and femur can be capped with metal implants, which create new surfaces for the knee joint. Bone cement may be applied to ensure the implants stay in place. The metal implants are shaped so that they mimic the original bones. In some cases, the kneecap will also be degraded. If that is the case, the surface on its underside is also cut and replaced with an implant.

Inserting a Spacer

A plastic spacer will then be placed onto the tibial component so that both parts of the implant have a smooth gliding surface. 

End of Procedure

When everything is in place, the surgeon will test the knee to make sure it can perform a range of movements like flexing and extending. Finally, the incision can be closed with sutures or surgical staples. Bandages will be applied to protect the incision.

After the Procedure

Physical therapy will be an important part of recovery after a total knee replacement. Often, exercising the knee begins just hours after surgery. A physical therapist will be able to recommend specific exercises that will help strengthen your knee and restore knee functioning. 

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