Total Knee Replacement

What is a total knee replacement?

A total knee replacement is the surgical removal of the entire knee joint and replacement with an artificial joint called a prosthesis. Your knee joint is formed where your thigh bone (femur) and your shin bone (tibia) meet. It is the largest joint in your body and also contains ligaments, tendons, cartilage, the kneecap (patella), and lubricating fluid. Total knee replacement can help restore pain-free range of motion and full function in a diseased knee joint.

A total knee replacement is a common but major surgery with significant risks and potential complications. Less invasive treatment options may be available to you depending on your condition and specific circumstance, so you should consider getting a second opinion about your treatment options before having a total knee replacement.

Why is a total knee replacement performed?

A total knee replacement is a major surgical procedure that may be recommended to treat a variety of diseases, disorders and conditions of the knee. For many of these conditions, a total knee replacement may only be considered if other treatment options that involve less risk and fewer complications have been ineffective in treating your condition. Talk with your doctor about all of your treatment options and consider getting a second opinion.

A total knee replacement may be recommended for severe knee joint damage caused by:

• Knee joint infections, also called septic arthritis
• Knee joint injuries, including fractures, torn ligaments, and torn cartilage, which may lead to irreversible joint damage
• Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones within the joint, resulting in pain, stiffness and swelling. It is the most common reason for a total knee replacement.
• Osteonecrosis, or death of bone. Osteonecrosis is a rare condition.
• Rheumatoid arthritis, which is an autoimmune disease characterized by joint inflammation, and other inflammatory causes of arthritis

How is a total knee replacement performed?        

Your total knee replacement will be performed in a hospital by a surgical team led by an orthopedic surgeon. An orthopedic surgeon is specialized in conditions of the bones and connective tissues. Your orthopedic surgeon will perform the procedure by making an incision in the knee to remove damaged cartilage and bone and replace it with plastic or metal surfaces.

Surgical approaches to a total knee replacement

A total knee replacement may be performed using one of the following approaches:

• Minimally invasive surgery is performed by inserting special instruments and an arthroscope through a three to four inch incision in the knee. The arthroscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your doctor sees the inside of your knee on the video screen as he or she performs the surgery. Minimally invasive surgery generally results in a quicker recovery with less pain than open surgical procedures. This is because it causes less trauma to tissues. Your doctor will make a smaller incision than the incision used in open knee surgery. He or she can then thread surgical tools around structures, such as muscle and tendons, instead of cutting through or displacing them as in open surgery.
• Open surgery is performed by making an eight to ten incision in the knee. An open surgery incision allows your doctor to directly view and access the surgical area. Open surgery generally has a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

In some cases, minimally invasive techniques may be combined with an open procedure or your doctor may decide after beginning a minimally invasive technique that you require an open surgery to safely and most effectively complete your surgery. Your doctor will determine which type and method of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different total knee replacement procedures and ask why your doctor will use a particular type of procedure for you.