ORTHOPEDICS + SPORTS MEDICINE
Total Knee Replacement
Replacing worn knee surfaces to relieve arthritis pain and return you to walking, stairs, and daily life.
Advanced knee arthritis affects more than the joint surface. As pain increases, people often shorten their stride, avoid stairs, stop exercising, and rely more heavily on the opposite leg. Total knee replacement is designed to address this broader loss of mobility by resurfacing the damaged areas of the knee and correcting alignment that has been altered by arthritis.
Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine considers knee replacement when symptoms have become persistent and nonsurgical treatment is no longer providing enough support. Surgical planning accounts for the pattern of cartilage loss, leg alignment, ligament stability, bone quality, and the patient’s expectations for life after recovery.
The Knee’s Weight-Bearing Surfaces
The knee is formed by the lower end of the femur, the upper end of the tibia, and the patella, or kneecap. Articular cartilage covers the areas where these bones meet, creating smooth surfaces for bending and straightening the leg.
Two menisci sit between the femur and tibia and help absorb force. Ligaments stabilize the joint, while the muscles of the thigh and lower leg provide strength and control.
Arthritis damages the cartilage that protects the bone. As that surface wears away, the joint can become painful, swollen, and stiff. Uneven cartilage loss may also cause the leg to bow inward or outward, placing additional stress across the knee.
Why a Knee May Need Replacement
Osteoarthritis is the most common condition leading to total knee replacement. Other causes of severe joint damage include rheumatoid arthritis, post-traumatic arthritis, and deformity following an injury.
Symptoms may develop slowly and become more limiting over time. Patients often report:
- Pain during walking or stair use
- Difficulty rising from a chair
- Stiffness after sitting or resting
- Swelling that repeatedly returns
- Pain at night or while resting
- Reduced knee motion
- Increasing bowing of the leg
- Reliance on a cane or other walking support
An X-ray can show how much joint space has been lost, but the decision to have surgery is not based on imaging alone. The effect of the knee on mobility and quality of life is equally important.
When Is Total Knee Replacement Considered?
Treatment usually begins with options such as activity modification, medication, injections, physical therapy, weight management, or an assistive device. These measures may reduce symptoms and help patients remain active without surgery.
Replacement becomes a consideration when knee pain continues despite appropriate care and begins limiting necessary or meaningful activities. It may also be recommended when stiffness, inflammation, or deformity has become severe.
The orthopedic evaluation includes knee motion, strength, stability, and overall leg alignment. X-rays help identify whether damage involves one area of the knee or several compartments. This distinction is important because isolated damage may be treated with a partial knee replacement, while widespread arthritis is more likely to require total replacement.
Total Knee Replacement Is a Resurfacing Procedure
Although the procedure is called a replacement, the entire knee is not removed. The surgeon removes the damaged cartilage and a measured amount of bone from the femur and tibia.
Metal components are positioned over the prepared surfaces, and a medical-grade plastic spacer is placed between them. This spacer creates the new gliding surface of the knee. The underside of the kneecap may also be resurfaced when its condition indicates that doing so would be beneficial.
The components may be secured with bone cement or through another method chosen for the patient’s bone and surgical plan. The surgeon also evaluates ligament balance and alignment so the reconstructed knee remains stable as it bends and straightens.
Surgical planning may incorporate advanced imaging, computer navigation, or robotic assistance. These tools can provide additional information during bone preparation and component positioning, but the surgeon remains responsible for every decision and step of the operation.
Preparing for the Procedure
A medical evaluation may be needed before surgery to make sure existing health conditions are appropriately managed. Patients should provide a complete list of medications and supplements because some may need to be stopped or adjusted.
Preparation may also involve blood tests, heart testing, skin care, and attention to active dental or urinary infections. Any cut, rash, or infection near the surgical leg should be reported before the procedure.
At home, patients can reduce fall risks by removing loose rugs and cords, arranging frequently used items within easy reach, and creating a clear path for a walker. Help with meals, transportation, and household tasks may be needed during early recovery.
The First Stage of Recovery
Patients begin moving the knee and standing with assistance shortly after surgery. Some return home the same day, while others remain in the hospital based on their health, mobility, and available support.
A walker, crutches, or a cane may be used while strength and balance return. Pain medication, compression devices, ankle exercises, and blood-thinning medication may also be part of the early plan.
Patients receive instructions for caring for the incision and watching for signs of infection or a blood clot. Swelling and discomfort are expected, particularly after exercise or prolonged time on the feet. Elevation and cold therapy may be recommended to help manage these symptoms.
Physical Therapy and Restoring Knee Motion
Physical therapy begins early because the knee can quickly become stiff after surgery. Rehabilitation works toward two immediate goals: fully straightening the knee and gradually improving the ability to bend it.
Therapy also addresses:
- Quadriceps and leg strength
- Safe walking with an assistive device
- Balance and control
- Getting into and out of chairs
- Stair navigation
- Returning to household and community activities
Many patients resume basic daily activities within several weeks, but rebuilding strength and endurance takes longer. The amount of motion achieved after surgery is influenced in part by how well the knee moved beforehand.
Walking, cycling, swimming, and other low-impact activities are generally appropriate after recovery. Running, jumping, and repetitive high-impact exercise may place unnecessary stress on the components and are commonly discouraged.
When to See a Knee Specialist
A knee replacement evaluation may be appropriate when pain regularly limits walking, stairs, sleep, or personal care. Chronic swelling, increasing deformity, reduced motion, and diminishing relief from injections or medication are additional reasons to seek an assessment.
Not every painful knee requires total replacement. Symptoms may originate from a meniscus, ligament, tendon, kneecap, or a single area of cartilage loss. A complete evaluation helps determine whether the joint needs total replacement or whether a more limited treatment remains appropriate.
Summary
Total knee replacement creates new weight-bearing surfaces, but recovery depends on restoring the strength and movement needed to use them well. Surgery, physical therapy, home exercise, and gradual activity progression each contribute to the final function of the knee.
Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine helps patients consider the full course of treatment, from deciding whether replacement is appropriate to protecting the reconstructed joint over time.