If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones are replaced.

There are four basic steps to a knee replacement procedure:

• Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
• Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
• Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
• Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Is Total Knee Replacement for You?

The decision to have total knee replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopaedic surgeon. Your doctor may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

• Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
• Moderate or severe knee pain while resting, either day or night
• Chronic knee inflammation and swelling that does not improve with rest or medications
• Knee deformity — a bowing in or out of the knee
• Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

During the procedure

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

Knee replacement surgery is most often performed while you are asleep under general anesthesia. Your anesthesiologist will discuss this with you in advance.

After the procedure

In the hospital

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 doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

At home

Once you are home, it is important to keep the surgical area clean and dry. Your doctor 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 or apply ice to the knee.

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

Notify your doctor to report any of the following:

• Fever
• Redness, swelling, bleeding, or other drainage from the incision site
• Increased pain around the incision site

You may resume your normal diet unless your doctor advises you differently.

You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.