Knee Replacement Surgery Procedure (2024)

What is a knee replacement surgery?

Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.

The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.

Anatomy of the knee

Joints are the areas where 2 or more bones meet. Most joints aremobile, allowing the bones to move. Basically, the knee is 2 long legbones held together by muscles, ligaments, and tendons. Each bone endis covered with a layer of cartilage that absorbs shock and protectsthe knee.

There are 2 groups of muscles involved in the knee, including thequadriceps muscles (located on the front of the thighs), whichstraighten the legs, and the hamstring muscles (located on the back ofthe thighs), which bend the leg at the knee.

Tendons are tough cords of connective tissue that connect muscles tobones. Ligaments are elastic bands of tissue that connect bone to bone.Some ligaments of the knee provide stability and protection of thejoints, while other ligaments limit forward and backward movement ofthe tibia (shin bone).

The knee consists of the following:

Tibia. This is the shin bone or larger bone of the lower leg.
Femur. This is the thighbone or upper leg bone.
Patella. This is the kneecap.
Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber, increases contact area, and deepens the knee joint.

Reasons for the procedure

Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.

Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or"give-way" because the joint is not stable.

Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.

If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:

Anti-inflammatory medications
Glucosamine and chondroitin sulfate
Pain medications
See Also
Arthroplasty Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee – Medical Policy Article (A52369)Presence of unspecified artificial hip joint Coding for Arthroscopic Knee Surgery
Limiting painful activities
Assistive devices for walking (such as a cane)
Physical therapy
Cortisone injections into the knee joint
Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful)
Weight loss (for obese persons)

There may be other reasons for your doctor to recommend a knee replacementsurgery.

Seminar Management of Knee Arthritis

Have you been diagnosed with arthritis of your knees? Watch this webinar with Dr. Vishal Hegde, hip and knee surgeon and Assistant Professor of Orthopaedic Surgery at Johns Hopkins as he discusses the diagnosis and management of knee osteoarthritis and treatment options to improve your function to get you back to the activities you enjoy.

Watch this webinar

Risks of the procedure

As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:

Bleeding
Infection
Blood clots in the legs or lungs
Loosening or wearing out of the prosthesis
Fracture
Continued pain or stiffness

The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.

Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
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Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your doctor.
You will be asked to fast for eight hours before the procedure, generally after midnight.
You may receive a sedative prior to the procedure to help you relax.
You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
Based on your medical condition, your doctor may request other specific preparation.

Pre-Operative Education

Johns Hopkins offers educational sessions to help you prepare for knee replacement surgery. During your class, we'll review important aspects of your care and what to expect before and after surgery. You will be able to ask questions and meet many of the staff who will be caring for you in the hospital.

Learn more and register

During the procedure

Knee replacement requires a stay in a hospital. Procedures may varydepending on your condition and your doctor's practices.

Knee replacement surgery is most often performed while you are asleepunder general anesthesia. Your anesthesiologist will discuss this withyou in advance.

Generally, knee replacement surgery follows this process:

You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on the operating table.
A urinary catheter may be inserted.
If there is excessive hair at the surgical site, it may be clipped off.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The doctor will make an incision in the knee area.
The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis. Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a knee.
The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone).
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to remove fluid.
A sterile bandage or dressing will be applied.

After the procedure

In the hospital

After the surgery you will be taken to the recovery room forobservation. Once your blood pressure, pulse, and breathing are stableand you are alert, you will be taken to your hospital room. Kneereplacement surgery usually requires an in-hospital stay of severaldays.

It is important to begin moving the new joint after surgery. A physicaltherapist will meet with you soon after your surgery and plan anexercise program for you. A continuous passive motion (CPM) machine maybe used to begin the physical therapy. This machine moves your new kneejoint through its range of motion while you are resting in bed. Yourpain will be controlled with medication so that you can participate inthe exercise. You will be given an exercise plan to follow both in thehospital and after discharge.

You will be discharged home or to a rehabilitation center. In eithercase, your doctor will arrange for continuation of physical therapyuntil you regain muscle strength and good range of motion.

At home

Once you are home, it is important to keep the surgical area clean anddry. Your doctor will give you specific bathing instructions. Thestitches or surgical staples will be removed during a follow-up officevisit.

To help reduce swelling, you may be asked to elevate your leg or applyice to the knee.

Take a pain reliever for soreness as recommended by your doctor.Aspirin or certain other pain medications may increase the chance ofbleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

Fever
Redness, swelling, bleeding, or other drainage from the incision site
Increased pain around the incision site

You may resume your normal diet unless your doctor advises youdifferently.

You should not drive until your doctor tells you to. Other activityrestrictions may apply. Full recovery from the surgery may take severalmonths.

It is important that you avoid falls after your knee replacementsurgery, because a fall can result in damage to the new joint. Yourtherapist may recommend an assistive device (cane or walker) to helpyou walk until your strength and balance improve.

Making certain modifications to your home may help you during yourrecovery. These modifications include, but are not limited to, thefollowing:

Proper handrails along all stairs
Safety handrails in the shower or bath
Shower bench or chair
Raised toilet seat
Long-handled sponge and shower hose
Dressing stick
Sock aid
Long-handled shoe horn
Reaching stick to grab objects
Removing loose carpets and electrical cords that may cause you to trip
Avoiding stair-climbing until recommended by your doctor

Your doctor may give you additional or alternate instructions after theprocedure, depending on your particular situation.