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Introduction: Total knee arthroplasty—also called total knee replacement—is one of the most commonly performed joint replacement procedures. Even in knees that are severely damaged, it is often highly successful and can bring significant improvement to quality of life.

Function: Total knee arthroplasty can relieve pain and restore function and range of motion of the knee.

History of Injury: Total knee replacement is rarely performed after an injury, but it is often needed due to the wear and tear caused by arthritis. 

Diagnosis: Your orthopedic surgeon will discuss your health history and perform a physical exam. He or she may also take X-rays, typically while you are standing up so that the way your knee joint functions while bearing weight can be viewed. This provides important information that your surgeon will use to determine the best treatment for you, whether it be a total knee replacement or something else. 

Treatment: Total Knee Arthroplasty

  • Initial: If you have mild knee pain, instead of recommending surgery right away, your orthopedic surgeon may suggest anti-inflammatory medications or analgesics such as acetaminophen. Other non-surgical options include steroid knee injections or using walking support, such as a cane, or doing exercises. If you are obese or overweight, your surgeon will likely suggest healthy weight loss to see if that reduces your pain and inflammation. 
  • Long Term: Long-term results of total knee arthroplasty are generally considered excellent.
  • Indications for Surgery: Total knee arthroplasty is usually an elective surgery. Your orthopedic surgeon will assess your pain and movement levels. If your knee hurts when you are using it for simple tasks, such as climbing the stairs, and when you are not using it, such as when you are sitting or lying down, it is an indication that surgery is a good option for you. Total knee arthroplasty is best for people who are over 40 years old who have arthritis in more than one area of their knee. 

Surgery: Total knee arthroplasty is performed while you are under general anesthesia. First, the orthopedic surgeon makes an incision in the front of your knee and removes the damaged cartilage of your joint from the surface of your bones. Next, he or she shapes these surfaces so they can hold a metal or plastic artificial joint. (A knee replacement is sometimes called a knee "resurfacing" because only the surface of the bones is actually replaced.) Then, an artificial knee is inserted into the area and attached to the thighbone, shin, and kneecap using a special material. The undersurface of the kneecap may also be cut and resurfaced, and finally, a plastic spacer is placed between the components so they can move and glide easily.

Post-Operation: You will go to a recovery room while your anesthesia wears off, and you will be monitored. If your total knee arthroplasty is performed on an outpatient basis, you will be released the day of your procedure to recover from home after you are cleared by your surgeon.

Rehabilitation: You should be able to stand and move around one day after surgery. Typically, patients begin recovery by using parallel bars to practice walking. Next, you will transition to a walking device, such as crutches or a walker. After six to eight weeks, when your knee can support your body weight and after your body has built muscle strength, you should be able to perform most normal and low-impact activities. 

Risks and Complications: As with any surgery, there is a risk of infection or blood clots. Sometimes, the range of motion may be more limited than was expected, and knee scarring can occur. Additionally, over time, implant surfaces become worn and the artificial joint may loosen from use. Typically around 10 years after surgery, a revision total knee arthroplasty may be needed. 

Summary: You should seek out an experienced orthopedic surgeon to perform your total knee arthroplasty. This clinician should not only be skilled at performing the surgery, but should also be knowledgeable about choosing patients who are appropriate for the procedure. While many patients are candidates for the technique, only an experienced, skilled surgeon knows for sure who will benefit most from the procedure.