How Is Total Knee Replacement Surgery Performed?

A Surgical Option for Advanced Knee Arthritis

Total knee replacement (TKR) is an effective surgical procedure performed in cases of advanced knee osteoarthritis, rheumatic diseases, or traumatic joint damage where the knee has lost its function. In this procedure, the damaged joint surfaces are replaced with an artificial prosthesis, with the aim of helping the patient walk with less pain, climb stairs and return to daily activities more comfortably.

So, how is a total knee replacement done? What are the stages? And what does the recovery process involve? Here’s a comprehensive guide.

What Is Total Knee Replacement?

The knee is a complex joint formed between the femur (thigh bone) and tibia (shin bone). As the cartilage that covers the joint surfaces wears away, friction and pain increase.

During TKR:

• Damaged cartilage and bone surfaces are removed from the femur and tibia
• These surfaces are replaced with metal and plastic components
• The underside of the kneecap (patella) may also be resurfaced if needed
• The goal is to create a smooth, stable joint with less pain

Preoperative Preparation

• Detailed physical examination and medical history review
• X-rays and possibly MRI for joint assessment
• Anesthesia evaluation
• Blood tests, ECG, chest X-ray
• Review of current medications; some may be paused
• Full explanation of the procedure and consent obtained

Steps of Total Knee Replacement Surgery

1. Anesthesia

   • Performed under spinal or general anesthesia

2. Surgical Incision

   • A 10–15 cm incision is made on the front of the knee

3. Removal of Damaged Tissue

   • The worn cartilage and bone are carefully trimmed

4. Placement of Prosthetic Components

   • Metal components are placed on the femur and tibia

   • A plastic insert ensures smooth gliding

   • The back of the patella may also be resurfaced

5. Stability Check and Closure

   • Joint balance and range of motion are tested

   • Layers are closed and the incision is dressed

6. Total Duration

   • Typically takes 1.5 to 2 hours

Postoperative Recovery

• Hospital stay: 3–5 days
• Walking: Begins as early as day one with assistance
• Physical therapy: Essential, especially in the first 6 weeks
• Full recovery: Usually within 6 weeks to 3 months
• Returning to daily activities (e.g., driving): After 6 weeks
• Prosthesis lifespan: 15–20 years on average

Benefits of Total Knee Replacement

• Significant pain relief in most patients
• Improved mobility and knee function
• Easier daily activities: walking, sitting, standing
• Return to independent and active lifestyle
• Long-term satisfaction and quality of life improvement

Postoperative Considerations

• Minimize infection risk during the first few weeks
• Avoid sudden or excessive loads on the knee
• Be cautious on slippery or uneven surfaces
• Follow physical therapy instructions strictly
• Avoid extreme joint positions or high-impact activities