Total Knee Replacement

What is knee replacement surgery? 

Arthritis or injury often causes excessive knee pain and limited function. Knee pain that is uncontrolled by medications, injections, physical therapy, or other conservative means may require knee replacement to restore knee function and relieve pain.

Knee replacement surgery (knee arthroplasty) involves cutting away damaged bone and cartilage and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics, and polymers. Arthritic damage to one side of the knee is common. Partial knee replacement surgery or total knee replacement are options that your orthopedic surgeon will discuss with you.

Anatomy of the knee 

The knee joint is one of the most intricate areas in the body. The knee connects to the thigh, shin, and smaller bones of the knee and kneecap with tendons and ligaments, which help move the knee and leg, support our weight, and provide stability.  

The knee consists of the following:

  • Tibia (knee bone)
  • Femur (thigh bone)
  • Patella (small bone located in front of the knee joint)
  • Cartilage (flexible connective tissue)
  • Synovial membrane (the connective tissue that produces synovial fluid for lubrication of the joint)
  • Ligament (connects bone to bone and supports joints)
  • Tendon (attaches muscle to bone)
  • Meniscus (c-shaped cartilage, acts as a shock absorber)


Knee Replacement Surgery and Recovery Time 

Total knee replacements are generally cemented into place, making them secure and stable. Depending on the patient’s overall health, many individuals walk with assistance the day after surgery. Physical therapy is provided after surgery and is specific to each patient, but people will need physical therapy for a few weeks to a few months post-op.  

Physical therapy exercises are designed to improve range of motion, mobility, and stability and restore a normal gait. Knee joint prosthetics are made from ultra-strong materials such as polyethylene and metals and are made to last and withstand pressure.  

When is Surgery Recommended? 

The two notable indicators for knee replacement are unrelenting pain and decreased mobility. We can slow the progression of wear and tear through conservative treatment options and try to limit the degenerative effects, but over time, it will continue to worsen. The cartilage in the knee has no blood supply. Synovial fluid nourishes the cells that make cartilage, but once the cartilage is damaged and worn down, the progression cannot be reversed, and knee replacement is often necessary.  

If you think of your knee joint cartilage as treads on a tire, once those are worn down, you must replace the tire. With each step, we put approximately 500 lbs. of pressure on the knees. Over time, this, along with other degenerative issues, can cause extreme wear and tear and pain.

Preparing for Surgery 

For the patient, giving yourself time to prepare for the physical, emotional, social, and daily activity aspects of joint replacement surgery is essential. Any post-op surgery creates challenges for the patient. Having a plan in place for getting around, stocking up on essentials, asking friends and family members to help out, and having rehabilitative training schedules are essential to ensure optimal outcomes and healing.  

For the medical team, certain tests and evaluations are determined, requested, and needed before your surgery. These may include all or some of the following:

  • Medical Evaluation

A primary care medical evaluation will be needed before your surgery is scheduled

  • Tests 

Imaging, blood work, urinalysis, and other tests will be required before surgery.

  • Medications 

Pre and post-op medications will need to be prescribed and picked up before your surgery. Antibiotics are prescribed before your surgery and after.

  • Social Planning

You will be able to walk with a cane or walker, but you will need help bathing, preparing meals, shopping, etc. Having a dedicated person or professional to help you is essential.

  • Home Planning

Occupational therapy helps you learn to navigate in your post-op state within your home to better maneuver yourself around and complete daily living tasks. You may need to set up your living quarters on the first floor of your home, use toilet seat risers, utilize shower handrails, and remove anything that is a tripping hazard such as electrical cords or area rugs, to name a few.

  • Dedicated Assistance

A dedicated family or friend who will bring you to your appointments, drive you to and from the surgical center/hospital and help you remember instructions is critical.

  • Driving

You will not be able to drive for 6 to 8 weeks. Preplanning any shopping, appointments, or having an emergency standby driver is imperative

  • Preparing Your Space

You will be fairly confined to one area of your home. Placing everyday items in an easy-to-reach location will be helpful after your surgery.

  • Elective Procedures and Dental Work

It’s best not to have any dental or elective procedures several weeks before or after your surgery due to the risk of infection.

Total Knee Replacement Surgery

The surgical procedure usually takes 1 to 2 hours and can be performed via a robotic-assisted system. The goals of total knee replacement are to relieve pain, improve function, correct deformity, improve gait, and increase range of motion. 

Removing the involved arthritic surfaces, which can include the femur, tibia, and patella, and fitting them with metal and plastic components is essentially what total knee replacement involves. The knee replacement prosthetics are cemented or glued in place to allow for stability in weight-bearing and return to knee function and mobility. 

Total knee replacement surgery may leave a small scar. With today’s advanced techniques, the scars are minimal and smaller than surgery of decades before.

Avoiding Problems After Surgery 

Complications are uncommon, but below highlights blood clots and other symptoms that patients should be aware of after surgery:

Preventing Blood Clots 

Blood clots in the leg are serious complications that can be life-threatening. We take great precautions to prevent these in patients after total knee replacement. Along with gentle exercises to increase circulation, support stockings can be worn, and other inflatable pumping garments can be applied.  Dr. Charles E. Stewart employs a strategy called Risk Stratification, to determine the correct blood thinner to use to help prevent blood clots.

Warning signs of blood clots:

  • Increasing pain in your calf
  • New or increasing swelling in your calf, ankle, and foot
  • Tenderness
  • Redness of the skin


Blood clots can break loose and travel to the lungs, heart, or brain. These symptoms are as follows:

  • Shortness of breath
  • Chest pain
  • Coughing with Pain
  • Tightness in chest
  • Faster than normal or irregular heartbeat
  • Coughing up blood
  • Dizzy/lightheaded
  • Abdominal pain
  • Nausea
  • Slurred speech
  • Asymmetrical mouth (droop)
  • Confusion
  • Loss of sensation on one side of the body


Preventing Infection

A small percentage of patients may develop an infection after total knee replacement surgery. To avoid infection, antibiotics are prescribed before and after surgery. Bacteria can enter the bloodstream through the skin, during dental or elective procedures, and through wounds.

Warning signs of infection

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills, and night sweats
  • Fatigue

Avoiding Falls after total knee replacement surgery is critical. You will be able to walk with assistance but removing anything from your home that can cause you to trip and fall is imperative. You will also need help when showering, and we recommend a shower chair to help you stabilize yourself or at least have handrails installed. Because your knee takes time to heal, if you fall, you can severely damage your knee and leg and may require additional surgery.

Total Knee Replacement Exercise Guide 

To prevent a blood clot, exercises will be provided to the patient to increase circulation. These are gentle exercises, not to be confused with strenuous activity, which should be avoided until you are accurately healed. Early postoperative exercises will reduce pain and increase healing. These can be done as early as in the recovery room after surgery. Three examples of primary early postoperative exercises are below:

Quadriceps Sets

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise approximately 10 times during a two-minute period, rest one minute, and then repeat. Continue until your thigh feels fatigued.

Straight Leg Raises

While sitting up or lying on the bed, tighten your thigh muscle with your knee fully straightened. Lift your leg several inches. Hold for 5 to 10 seconds. Slowly lower. Repeat until your thigh feels fatigued. 

Bed-Supported Knee Bends

Slide your foot toward your buttocks, bending your knee and keeping your heel on the bed. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.

Repeat several times until your leg feels fatigued or until you can completely bend your knee.

Why choose Sforzo Dillingham for the Total Knee Replacement Surgery? 

Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine are experts in knee replacement surgery.  They are experts in orthopedic diagnosis, treatment, and they deliver the best outcomes for their patients. Why? The training and expertise they have is unparalleled. Along with their elite expertise, they put their patient’s needs first above all else.

Charles E. Stewart M.D. is a board certified, Johns Hopkins fellowship-trained orthopedic surgeon specializing in adult complex reconstruction of the lower extremity. His specialties include, lower extremity sports injuries, meniscal injuries, partial knee replacement, total hip and knee arthroplasty (replacement), as well as, the reconstruction of failed hip and knee arthroplasties, and complete fracture care. Dr. Stewart’s focus is performing complex reconstruction using state-of-the-art procedures to maximize short and long-term function. In addition to traditional total hip replacement (arthroplasty), he has the training and expertise to perform the technically demanding anterior approach for primary total hip replacement. Dr. Stewart is the knee surgeon who is the foremost expert in Robotic Knee Replacement in the region.  

You Have a Choice

Any physicians you choose to see are always your personal decision. It should never be mandated by policy or selected for you without regard to your needs and best interest. When you choose Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, you can rest assured that you will be treated with respect, given the opportunity to ask questions, your options will be explained in detail, and you will be in the hands of experienced surgeons with the utmost integrity, receiving optimal care.

With decades of experience, at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine all of our surgeons are board certified, and fellowship trained. We offer you the best treatment options and care.

We provide excellent medical care in a warm, caring, comfortable environment, where patients are treated efficiently, effectively, and as if they were the only patient. Let us get you back in your game.