Total knee replacement

Total knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint. The most common reasons for knee replacement surgery are to relieve pain and replace joint cartilage damaged by osteoarthritis, rheumatoid arthritis and a variety of other conditions that lead to arthritis of the knee.During total knee replacement, the surgeon removes damaged cartilage surfaces at the ends of the femur (thighbone) and tibia (shinbone) and replaces them with an implant called a prosthesis. A plastic spacer is attached to the prosthesis to create a cushioning effect much like the original cartilage in your knee.

Today, most knee replacement surgeries are minimally invasive, with numerous benefits to the patient. These include smaller incisions, less tissue trauma, bleeding and post-operative pain, shorter hospital stays, faster recovery, and earlier return to work and activities

One of the most innovative techniques is muscle-sparing knee replacement, which combines the latest minimally invasive methods with a surgical approach that leaves key muscles and tendons intact. Instead of cutting the major knee tendons, the surgeon makes a three- to five-inch incision on the knee and splits or dissects under the quadriceps muscle and tendon. Because the incision is very small and the quadriceps extensor mechanism is intact, patients are able to lift and bend their leg within the first hours after surgery. This technique also results in much less knee pain and blood loss.


The knee is the largest joint in the body and one of the most complex. It is made up of the femur, tibia and patella (kneecap). Articular cartilage covers the ends of the bones and allows them to glide smoothly over one another. Osteoarthritis and rheumatoid arthritis cause the surface layer of cartilage to wear away. Without this cushioning effect, the bones of the knee joint rub together. The knee can’t move easily and becomes stiff, swollen and painful.

When is surgery recommended?

If you have knee pain that limits your everyday activities, secondary to arthritis, and all non-surgical methods of treatment have failed – including weight loss, anti-inflammatory medications, cortisone injections, lubricating injections and physical therapy – then you should consider surgery.

Knee replacement surgery is now much less invasive, with less tendon and muscle trauma, less bleeding, less pain and less life interruption. Patients recover much more quickly and return to work and activities within weeks rather than months.

Most patients with advanced knee arthritis are considered good candidates for minimally invasive total knee replacement surgery. However, each patient should be carefully screened to determine the most appropriate type of procedure.

What is the recovery time?

Minimally invasive approaches, improved implant material and design, and refined surgical techniques have dramatically reduced recovery time. For these patients, the typical recovery period is now weeks rather than months. Most patients are up and walking immediately following surgery and regain range of motion, strength and flexibility after several weeks of physical therapy. Many surgeries can be performed in an outpatient setting where you go home the same day. If you are in the hospital, it is usually a one-night stay and the vast majority of patients can go directly home without having to use a rehabilitation center.


How do I know it is time for a knee replacement?

If all non-surgical methods of treatment fail, a diagnosis of arthritis is confirmed, other medical problems are developing as a result of arthritis, requirements for pain medications are increasing and significant lifestyle changes have occurred as a result, then you should consider knee replacement surgery.

Am I too young for a knee replacement?

Years ago, knee replacement surgery was reserved for elderly patients due to a high complication rate and lack of implant durability. Modern techniques have allowed orthopedic surgeons to base surgical decisions on a patient’s pain and disability, and not necessarily chronological age. Most patients who undergo knee replacement are between the ages of 50 and 80, but surgeons evaluate patients individually and primarily on their physiologic age and demands.

How long will a knee replacement last?

Thanks to improvements in materials and design, the vast majority of knee implants will last 20 years or more based on current scientific studies. It is likely that current techniques and materials will prove to last even longer.

How long is my recovery?

Recovery varies by patient and demand. The typical recovery period involves one to two days in the hospital, and four to six weeks in an organized physical therapy rehabilitation program.

How much work will I miss?

It depends on your profession and location of your job. If your work is sedentary and local, you may return as early as two to four weeks after your surgery. If your job is more rigorous and involves travel, your time off from work may be longer.

Do you use minimally invasive surgery?

Yes, most knee replacement surgeries are minimally invasive, with numerous benefits to the patient, including smaller incisions, less tissue trauma, bleeding and post-operative pain, shorter hospital stays, faster recovery, and earlier return to work and activities — in weeks rather than months.

How long will my scar be?

The typical scar is approximately three to five inches long. It is dictated by many factors, mostly patient size.

Can I have both knees replaced at the same time?

Double knee surgeries may be right for some patients. OrthoVirginia’s total joint replacement surgeons carefully assess each patient to determine the best course of action that minimizes the inherent complications of joint replacement surgery such as infection, blood clots and blood loss.

My mother had a long recovery after her knee replacement. Will mine be like that?

The standard of care for total knee replacement has improved dramatically in recent years with the development of new minimally invasive approaches, improved implant materials and designs, and refined surgical techniques. Patients are up and active sooner and function returns much more quickly. Today, almost all total knee patients walk into their hospital room with assistance hours after their surgery. Long hospitals stays, long incisions and severe longstanding pain as experienced by prior generations of knee replacement patients are no longer part of today’s modern procedures.

Will I be able to run afterwards?

Moderate running and other high-impact sports are allowed after knee replacement. Lower-impact exercises, such as walking, biking, swimming or using an elliptical trainer, are encouraged. Patients are reminded that continuous high-impact activities can lead to premature wear and premature failure of the implant.

Will I be able to kneel afterwards?

Yes, although it may be uncomfortable at first. Many patients use a kneeling pad.

What happens when I go through airport security?

Because knee implants contain metal, there’s a chance they could set off an airport metal detector. If this happens, the TSA agent may use a wand or a pat-down to ensure that the metal is inside your body.

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