Total Knee Replacement

Total knee replacement is one of the most successful orthopedic procedures performed today.  It is done primarily for osteoarthritis.  Osteoarthritis is the progressive degeneration of the surfaces of the knee joint.  I like to think of the knee joint surfaces like tires on your car.  They have tread on them.   As osteoarthritis progresses, the tire tread wears down.   When the tread is worn out – it’s time to consider a ‘re-tread’.  This is the objective of a ‘total knee’.

Why is it called a ‘Total Knee’ ?

There are three major surface areas of the knee.  The kneecap and its matching surface on the femur bone called the patellofemoral compartment, the medial area of the knee – or the medial compartment, and the lateral area of the knee – the lateral compartment.  A partial knee replacement resurfaces ONE of these three areas, a ‘total’ knee resurfaces all of these.  In this way, the entire knee joint is resurfaced in one step.

What is a total knee replacement made of ?

The new femoral surface is all metal – usually a cobalt chrome alloy.   The tibial side is a titanium tray in which a plastic liner snaps in.  It is this metal femur that rubs against the plastic tibial liner.  The kneecap, or patellar piece, is made of plastic alone.  Specifically, it is a highly crosslinked polyethylene plastic.  These parts have been designed and refined over the last 40 years to perform for a long time – usually your entire life – or at lease several decades.

What happens in a knee replacement surgery ?

A total knee replacement surgery takes about an hour to an hour and a half.  During this time, the worn surfaces of the knee are removed and resurfaced with these new parts.  There is no ‘chopping out the entire knee’ as many patients think.  In fact, this has never been done – its always been a resurfacing surgery.  The parts are either pressed tightly into place or cemented into place.  Before committing to any particular parts for your knee, we test them out using ‘trial’ parts that act like the final parts.  Once we are happy with our selection of sizes and shapes, the final pieces are placed.

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What is a robotic knee replacement surgery ?

Robotic surgery has become the latest major change in joint replacement. There may be some benefit in terms of a more reliable procedure using this technique. This works by feeding a CT scan of your knee into a computer system. With this, we can carefully place the new joint surfaces accurately within the joint. The robotic system helps us trim the bones in exactly the way we plan with computer control. I have been doing this procedure for years. Ask me if this is right for you.

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What happens after total knee replacement surgery ?

After a total knee, we get you up and walking within an hour of the surgery.  The final parts are ready for you to walk on them right away.  Later that same day, most patients go home.  For me this is mostly an outpatient procedure.  If you live far away, I may keep you overnight just to be safe.  You can use pain medications as needed for pain.  Physical therapy starts right away to ensure you get the best outcome possible.  You will take a strong blood thinner for two weeks to help reduce the risk of blood clots.

We will go into all this in more detail in later posts.  I hope this gives you a good overview of total knee replacement surgery.  Please ask me your questions below !

I held a webinar on knee pain Spring of 2021 and posted it on You Tube. In this, I go over everything about treatment options for knee pain, from simple oral treatments and exercise to advanced joint replacement. You can find it by clicking: KNEE PAIN WEBINAR