Total Knee Replacement

Total knee replacement (total knee arthroplasty) is a surgical procedure in which the damaged surfaces of the knee joint are replaced with metal and plastic components. Over 790,000 knee replacements are performed annually in the US, making it one of the most successful orthopedic procedures.

Knee replacement is recommended for severe osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis that causes significant pain, stiffness, and limited mobility that has not responded to conservative treatments such as medications, physical therapy, and injections.

Preparation includes pre-surgical testing (blood work, EKG, X-rays), medical clearance, stopping blood thinners, and dental clearance. Many programs include pre-operative education classes. Home modifications (grab bars, raised toilet seat) should be arranged before surgery.

Under general or spinal anesthesia, the surgeon makes an 8-10 inch incision over the knee, removes damaged cartilage and bone, and fits precision-shaped metal and plastic implant components. The procedure takes 1-2 hours. Robotic-assisted surgery is increasingly available.

Hospital stay is typically 1-3 days. Physical therapy begins the day of or after surgery. A walker or cane is needed for 2-6 weeks. Most patients can drive at 4-6 weeks, return to desk work at 6-8 weeks, and achieve maximum recovery at 3-6 months.

Risks include blood clots (DVT/PE), infection (1-2%), implant loosening, stiffness, nerve or blood vessel injury, fracture, and continued pain. Blood clot prevention with medications and early mobilization is critical.

Alternatives include weight management, physical therapy, anti-inflammatory medications, corticosteroid injections, hyaluronic acid injections, bracing, and partial knee replacement for patients with damage limited to one compartment.

Covered by Medicare and most insurance plans when conservative treatments have failed. Prior authorization is often required. Documentation of at least 3-6 months of non-surgical treatment is typically needed.