What to Expect With a Total Knee Replacement

Medically Reviewed By Daniel Wiznia, MD
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A total knee replacement, also known as total knee arthroplasty, is the surgical removal of the damaged surfaces of the knee bones. Doctors resurface the bones with artificial components. A total knee replacement can help improve the range of motion and function of an injured, infected, or diseased knee. Your knee joint is where your thigh bone, shin bone, and kneecap join together. It is the largest joint in your body and contains ligaments, tendons, cartilage, and lubricating fluid. Total knee replacement surgery can be traditional or minimally invasive.

Read on to learn more about why doctors perform a total knee replacement, how they perform it, and what recovery from the procedure looks like.

Why do people need a total knee replacement? 

A person with a knee brace
Holly Clark/Stocksy United

Doctors may recommend a total knee replacement to treat various knee conditions. They may only consider this procedure if other treatment options have not worked.

Your doctor may recommend a total knee replacement to treat severe knee joint damage caused by:

  • Knee joint injuries: Fractures, torn ligaments, and torn cartilage can lead to severe joint damage.
  • Osteoarthritis: This degenerative joint disease causes 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: This is a rare condition where blood flow to the bones is restricted, resulting in bone tissue death and collapse of the joint.
  • Rheumatoid arthritis: This is an autoimmune disease that causes severe inflammation and damage, mainly in the joints.

Total knee replacement is a common procedure. Researchers estimate that doctors worldwide will perform 3.48 million procedures annually by 2030.

How do doctors perform a total knee replacement?

Orthopedic surgeons are doctors specializing in the surgical treatment of diseases and conditions of the bones and connective tissues. These doctors perform total knee replacements. You will undergo either general or regional anesthesia for the procedure. 

Total knee replacement surgery involves four general steps:

  1. Surgeons remove the damaged cartilage and surface of the bones.
  2. Surgeons put the implants that are replacing the damaged joint surfaces into place. Knee implants consist of metal, ceramic, and plastic components.
  3. Surgeons may resurface the underside of the kneecap with a plastic button.
  4. Surgeons implant a plastic spacer between the metal parts to ensure the components glide smoothly. 

Types of knee replacement surgery

There are two general approaches to total knee replacement surgery: traditional and minimally invasive.

For traditional knee replacement surgery, the surgeon makes an 8–10-inch incision in the knee, revealing the joint. Open surgery requires a larger incision and more displacement of muscle and other tissues than minimally invasive surgery.

Minimally invasive surgery involves making a 4–6-inch incision in your knee and using special surgical instruments. This method generally results in a quicker recovery with less pain because it is less disruptive to the tissues in your knee. However, it can increase the risk for complications, such as tissue breakdown or joint instability.

There are a few different subtypes of minimally invasive total knee replacements. The quadriceps sparing technique avoids damaging the quadriceps, which cover the front and sides of the thigh. The midvastus and subvastus approaches require small muscle incisions. However, they are still not as invasive as traditional surgery.

Your surgeon will advise you on which procedure is best for you and how long you will need to stay in the hospital or surgical center. They will base this recommendation on your diagnosis, age, medical history, and general health.

What are some potential complications of a total knee replacement?

While most total knee replacements are successful, complications can occur during the surgery or recovery. Potential complications of a total knee replacement include:

  • dislocation or loosening of the new joint
  • nerve, muscle, or blood vessel damage
  • wear and tear of the new joint, requiring another replacement
  • instability
  • infection
  • pain and stiffness
  • blood clots
  • heart attack
  • stroke
  • death

Reducing your risk of complications

You can reduce the risk of complications by following your doctor’s postsurgery recommendations. You may need to make changes to your daily activities and diet before and after the procedure. It is also important to stick to any physical therapy or rehabilitation plans.

What can I expect after a total knee replacement?

Knowing what to expect can help make your road to recovery after a total knee replacement as smooth as possible.

A total knee replacement may require a hospital stay, or you may be able to go home the same day. Some people may need to stay in a rehabilitation center after discharge from the hospital to improve mobility and joint function.

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for the pain, or they may prescribe opioids. You may also need to take blood thinners to reduce your risk of developing a blood clot.

Recovery after surgery is a gradual process that depends on the procedure, type of anesthesia, general health, age, and other factors. According to the American Association of Hip and Knee Surgeons (AAHKS), recovery can take anywhere from 3 months to a year.

The AAHKS also mentions that most people who get a total knee replacement usually require physical therapy for around 3 months.

How will a total knee replacement affect my everyday life?

A total knee replacement can significantly reduce your symptoms so you can resume many of your usual activities. The procedure may help relieve pain and allow you to move around more easily. 

However, total knee replacements do not typically result in complete restoration of motion. You will probably need to adjust your lifestyle to avoid strenuous activities, including:

  • contact sports
  • high impact activities, such as running
  • joint overloading activities, such as heavy lifting
  • sports requiring lateral movements, such as skiing
  • vigorous walking, hiking, or stair climbing

Other frequently asked questions

Here are a few other commonly asked questions about total knee replacement. Dr. Daniel Wiznia has medically reviewed the answers.

How long does total knee replacement surgery take?

Total knee replacement surgery typically takes 1–2 hours. You may need to stay in the hospital afterward, or you may be able to go home the same day.

What is the most commonly reported problem after total knee replacement surgery?

One of the most common issues that people who have had a knee replacement report is knee stiffness. Other postsurgery complications can include pain and instability.

How soon can I walk after a total knee replacement?

Most doctors encourage walking soon after a total knee replacement. Many people can walk with assistance the day after surgery and unassisted within a few weeks.

Summary

Total knee replacement is a procedure where doctors remove damaged bone surfaces and put in artificial replacements. It can treat injuries like fractures and diseases like osteoarthritis.

The surgery can be traditional or minimally invasive and typically takes a few hours. You may experience some pain and stiffness after a total knee replacement. You will probably require a few months of physical therapy.

Talk with your doctor about total knee replacement. They can help you determine the best approach and plan your recovery process.

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Medical Reviewer: Daniel Wiznia, MD
Last Review Date: 2022 Jun 5
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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