What is the procedure for total knee replacement surgery?

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The procedure for total knee replacement surgery is as follows:

  • An incision is made on the front of the knee. The doctor may use a minimally invasive technique with the assistance of computer navigation to perfectly align the knee.
  • Approximately one-eighth to one-fourth inch of arthritic/worn out cartilage and bone is removed from the end of the thigh bone, undersurface of the knee cap and the top of the shin bone.
  • After appropriate sizing of the implant, the doctor places the brand new knee components and attaches them to the bone. In the majority of people that have healthy bone, doctors may use cement-free/press-fit knee replacement. This means that the bone will grow permanently into the implant. In situations where the bone is not strong enough, the knee may be cemented in place.
  • Once the metal implants are attached, a new polyethylene bearing surface is implanted between the thigh bone and shin bone. This resembles new cartilage.
  • The knee is then washed with an antibiotic solution and closed up with layers of suture. The skin is usually closed with glue.
Dr. Erik N. Zeegen, MD
Orthopedic Surgeon

The procedure for total knee replacement surgery involves resurfacing the diseased articular surfaces of the femur, tibia and patella. A metal covering is placed on the end of the femur and the top of the tibia. A plastic liner is inserted in between the metal components and a plastic covering is placed on the surface of the patella.

Dr. Scott D. Martin, MD
Orthopedic Surgeon
During total knee replacement surgery, the surgeon first cuts away thin slices of bone with damaged cartilage from the end of the femur and the top of the tibia, making sure that the bones are cut to precisely fit the shape of the replacement pieces. The metal prosthesis is applied to the cut ends of the bone using cement, with plastic in between. The artificial joint is attached to the bones with cement or screws. A small plastic piece goes on the back of the kneecap (patella) to ride smoothly over the other parts of the artificial joint when you bend your knee.
Knee replacement surgery involves resurfacing, cement and bearings, says Joseph Dobner, MD, from Frankfort Regional Medical Center. Find out what that means and watch him demonstrate exactly what happens during the procedure in this short video.
A knee replacement surgery is a resurfacing of the three major bones in the knee, says Joseph Turk, MD, from Los Robles Hospital & Medical Center. Learn what those bones do, and how surgery helps, by watching this informational video.
Discovery Health
Administration Specialist

You and your orthopedic surgeon have prepared for this day—the day of your total knee replacement surgery. You've had a physical. You're blood has been analyzed. Your surgeon has pinpointed the location of damage in your knee thanks to X-rays. And you've chosen the type of anesthesia you wish to use—general, spinal or epidermal. Whether you are conscious or not during the procedure you will be hooked up to heart leads and monitors will register your heart rate and your oxygen level. Here is what happens now.

During the surgery the knee will be stabilized in a bent position enabling the surgeon to see the joint in as much detail as possible. The region will be scrubbed with an antiseptic and a tourniquet may be placed strategically above the knee to reduce blood loss. An incision from 6 to 12 inches (15 to 30 centimeters) in length will be made.

Once the kneecap is delicately placed to the side, the surgeon will focus on the removal of damaged bone tissue, all the while paying particular attention to leaving a sufficient amount of bone in place so that the implant may be attached. If this is the first total knee replacement, the surgeon will ensure enough bone remains intact should another surgery be required when this implant deteriorates in a decade or so.

Typically, to allow the implant to fit properly, bone is cut away at the end of the femur, in addition to the front and back sides of the bone end. Bone is slashed at the tip of the tibia, flattening the end. Damaged bone tissue on the back of the patella is also cut away. Measurements of the bones are taken and the artificial implant is put in place when everything is ready for fitting.

The implant is attached and to maximize function of the prosthesis, the surgeon may adjust the alignment of the ligaments. The surgeon will now repair tissue that was moved during the procedure and sews it back into place. Before closing the incision, a tube may be inserted to drain excess fluid from the knee. The final stitches are complete and the entire procedure took about two hours.

Simple physical therapy exercises will be next to help your leg heal.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.