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Total Knee Replacement Surgery: A Step-by-Step Guide

May 23rd, 2024 | 3 min. read

By Rob S Williams, MD

Total Knee Replacement

Chronic, debilitating knee pain can be a major obstacle to your everyday life. If your knees are constantly aching, stiff, or unstable, simple tasks become strenuous, and quality of life diminishes. When conservative treatment options like medication, physical therapy, and injections no longer provide relief, total knee replacement (TKR) surgery may be the best solution to regain your mobility and a pain-free life.

Understanding Total Knee Replacement

Total knee replacement, also known as total knee arthroplasty, is a surgical procedure designed to eliminate damaged portions of your knee joint and replace them with artificial components, known as prostheses. These prostheses are typically made from metal alloys and medical-grade plastics, designed to mimic the natural function of a healthy knee.

Why Opt for Total Knee Replacement?

TKR surgery is most often recommended for individuals suffering from severe osteoarthritis, rheumatoid arthritis, or the debilitating effects of a past knee injury. This surgery alleviates knee pain, improves mobility and range of motion, and can significantly enhance overall quality of life.

Are You a Candidate?

Your orthopedic surgeon will conduct a thorough evaluation to determine if a total knee replacement is the right course of action for you. This evaluation often includes:

  • Medical history and physical examination: Discuss your pain levels, functional limits, and any prior medical conditions.

  • X-rays and imaging scans provide a detailed picture of the damage within your knee joint.

  • Considering other treatments: Exploring whether conservative therapies may still be effective.

Do you need your knee replaced?

If your knee pain is constant, interferes with your sleep, and prevents you from enjoying the activities you love, it's definitely time to talk with your doctor about treatment options, which may include knee replacement.

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The Total Knee Replacement Procedure: A Step-by-Step Guide

    1. Preparation: Before your scheduled surgery, there are steps for a smooth procedure and recovery. Pre-surgical steps can include:

      • Medical evaluation: Discuss any underlying conditions in detail (diabetes, heart disease, etc.) and how these may impact surgery and recovery. Mention pre-operative tests like bloodwork and possibly an EKG.

      • Medications: Emphasize the importance of informing your surgeon of all medications, including supplements and over-the-counter drugs. Some may need to be temporarily discontinued.

      • Preparing your home: Give specific examples like installing handrails in the bathroom, arranging necessary items in easy-to-reach locations, and potentially renting assistive devices (walker, raised toilet seat).

      • Pre-habilitation: Expand on physical therapy before surgery, noting that it can improve strength and flexibility, potentially aiding post-op recovery.

    2. Anesthesia: You'll be administered anesthesia before the procedure. Options include general anesthesia (making you unconscious) or a spinal block (numbing you from the waist down). Your surgical team will discuss the best option for you.

    3. The Incision: Your surgeon will make an incision over the front of the knee. Length varies depending on individual needs and surgical technique.

    4. Reshaping the Bones: The damaged surfaces of your knee joint, including the ends of the femur (thighbone) and tibia (shinbone), are carefully removed. The patella (kneecap) may also be reshaped.

    5. Implant Positioning: The metal implants are precisely positioned to replicate the surfaces of your natural knee joint. These can be secured with bone cement or designed to promote bone ingrowth.

    6. The Spacer: A medical-grade plastic component is placed between the metal implants, creating a smooth, low-friction gliding surface.

    7. Closure: The incision is carefully closed with sutures or staples. A bandage and possibly a drain to manage fluid will be put in place.

    The Road to Recovery

    Recovery from total knee replacement is a process. Immediately after surgery, you'll spend time in a recovery room where you'll be closely monitored. Most patients can expect a hospital stay of 1-3 days.

    • Pain Management: Managing post-operative pain is crucial. Your care team will utilize various methods, including medication, to comfort you. Other techniques, such as ice therapy or a continuous passive motion (CPM) machine, could be recommended to control pain and swelling.

    • Physical Therapy: PT will begin quickly, often on the day of your surgery. It is essential for regaining strength, flexibility, and range of motion. This can include in-hospital sessions and continued outpatient PT afterwards.  

      You may be provided with types of exercises you might perform early on. These may include bed exercises, ankle pumps, heel slides, and straight leg raises. Gradually progress to walking and more complex movements to help you work on regaining balance and stability.

    • Home Modifications: As you recover at home, following your surgeon's instructions is of utmost importance. Attend follow-up appointments, maintain the physical therapy regimen, and practice at-home exercises as directed.  

      Ensure that your home is safe during recovery. This could include temporarily removing area rugs, using non-slip bathmats, and ensuring good lighting.

    • Timeline: Initial recovery often takes several weeks; full recovery can take months. Note that everyone recovers at a different pace; this is just an approximation.

    • Potential Complications: While relatively rare, complications include infection, blood clots, stiffness, and implant wear. Be sure to report any concerns to your doctor immediately.

    Remember:  It can take several weeks to months to fully recover, but many people experience significant pain reduction and improved knee function within weeks of surgery.

We understand that the decision to undergo surgery is a major one. Our Coastal Orthopedics team is here to guide you through every step, from your initial evaluation to your complete recovery.  Our goal is to empower you to make informed choices about your health and achieve the best possible outcome.


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Rob S Williams, MD

Dr. Williams has been practicing orthopedic surgery in Corpus Christi since 1998. After graduating from Texas Tech hereceived his medical degree from the University of Texas at San Antonio. At the prestigious Campbell Clinic located at the University of Tennessee, Dr. Williams completed not only an Orthopedic Surgery Residency, but an additional year of Fellowship Training in Spine Surgery. Dr. Williams is dedicated to creating an excellent patient experience in the office or in the surgery suite.