Total Knee Replacement


Sarah Lewis, PharmD

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. Another name for it is total knee arthroplasty.

A total knee replacement is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a total knee replacement. 

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Why is a total knee replacement performed? 

Your doctor may recommend a total knee replacement to treat a variety of diseases, disorders and conditions of the knee. Your doctor may only consider a total knee replacement if other treatment options that involve less risk of complications have not worked. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on total knee replacement surgery.

Your doctor may recommend total knee arthroplasty to treat 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

Who performs a total knee replacement?

An orthopedic surgeon performs total knee replacement. An orthopedic surgeon specializes in surgical treatment of diseases and conditions of the bones and connective tissues. 

How is a total knee replacement performed?

Your total knee replacement will be performed in a hospital or surgical center. 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 involves inserting special instruments and an arthroscope through a 3- to 4-inch incision in your 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 surgeon sees the inside of your knee on the video screen while performing surgery. Minimally invasive total knee replacement generally results in a quicker recovery with less pain than open surgical procedures. This is because it causes less trauma to tissues. Your surgeon will make a smaller incision than the incision used in open knee surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery involves making an 8- to 10-inch incision in the knee. 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. 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.

  • Sensor-assisted surgery uses a device during surgery to help your surgeon properly balance the soft tissues in the knee. This includes ligaments, tendons and muscles. The sensor helps avoid making the new joint too tight, which limits the range of motion, or too loose, which makes the knee unstable. Sensor-assisted surgery may also shorten your recovery time. However, using the sensor does not change the type of implant or the surgical method your doctor can choose.

Minimally invasive techniques may be combined with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you require an open surgery to safely and most effectively complete your surgery. 
Your surgeon will advise you on which procedure 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 procedures and ask why your surgeon will use a particular type of procedure for you.

Types of anesthesia for knee replacement