Knee Surgery, Orthopedic Surgery

February 7, 2022

What Happens During a Total Knee Replacement Surgery?


Total knee replacement surgery, sometimes called total knee arthroplasty, is an intricate surgical procedure for patients who have severe knee joint pain and mobility issues. The surgeon removes or files down damaged bones in the joint, replacing or capping them with plastic and metal implants. These implants or prostheses help to restore function without pain.

When is a Total Knee Replacement Needed?

Osteoarthritis is the most common reason for knee arthroplasty. Less common causes of irreversible knee joint damage include rheumatoid arthritis, breaks, and torn cartilage or ligaments.

Osteoarthritis refers to damage caused by aging, repetitive movements, and general wear and tear on the bones in the knee. This leads to damaged cartilage between the joints, causing grinding and instability. Bending the knee, going up and down stairs, walking, and other activities become painful. The knee may either lock up or collapse because it is unstable.

What Happens During a Total Knee Replacement?

A total knee replacement is a complex procedure that allows an entire hospital team made up of your surgeon, nurses, and other medical personnel to provide complete care before, during, and after the operation.

Starting the Procedure

Your surgeon will make an incision on the front of your knee that gives them access to your kneecap, or patella. The incision can be anywhere from 4 to 10 inches long, depending on whether you have a traditional procedure or a minimally invasive surgery. Your doctor will discuss with you which option is best for your needs. The surgeon will gently rotate the patella away so they can clearly see the underlying area, where most of the surgery will take place.

Femoral Resurfacing & Implant

With a total knee replacement, multiple bones have to be resurfaced. Then, the various components of the artificial knee are implanted. Typically, the first bone to be resurfaced is the femur (thigh bone). Damaged cartilage and bone are cut away and resurfaced to prepare it for the addition of the femoral component of the artificial knee. Bone cement is used to attach a femoral implant that’s been precisely engineered for your knee joint.

Tibia Resurfacing & Implant

The tibia (shin bone) is next to be resurfaced. The surgeon trims away damaged cartilage and bone, then carefully smooths and shapes the bone to fit cleanly with the tibia components. These are usually made of both plastic and metal. The metal section, or tibia tray, is attached to the tibia using bone cement. A rigid plastic insert is snapped onto the tray to provide a smooth, cushioned space between the tibia and femoral implants. This buffers the joint when you flex your knee and provides shock absorption when walking or running.

Patella Adjustment

The kneecap is then put back into place. If there was severe damage to the knee joint, the patella may have to be reshaped with a plastic cap to ensure it will fit appropriately with the other components. As with the other components, bone cement will ensure it stays in place.

Finishing the Procedure

Once all the parts are in place and the knee joint is aligned correctly, your surgeon will flex the joint to make sure it bends correctly and that the positioning, size, and alignment of all the implants are all correct. The incision is then closed with staples or stitches and bandaged. In some cases, a continuous passive motion (CPM) machine will be placed on your leg. The CPM will slowly bend your knee for you while you heal.

What Happens After a Total Knee Replacement Surgery?

A total knee replacement procedure is a major surgery that will take extensive time to heal. Your surgical team will work with you to determine a recovery regimen that works for you.


After your total knee replacement surgery, you might remain in the hospital for a few days. You’ll start physical therapy while you’re still in the hospital to ensure your knee doesn’t stiffen up. You will be prescribed pain management medications when you return home, where you’ll continue physical therapy. Following the suggested protocols for exercise and movement is critical for maintaining strength and range of motion in the knee.


In the first three months following your surgery, painkillers and anti-inflammatory medications may be prescribed to help you maintain your mobility. Within three months, you should be back to your normal activities without the need for drugs. After six months to a year, your knee replacement should be strong and functioning at peak levels.


Most total knee replacements last 15 to 20 years. According to the American Academy of Orthopedic Surgeons, 90% of patients who receive a total knee replacement have improved mobility, increased range of motion, and significant pain reduction. While you can resume your daily activities, it’s important to avoid high-impact sports like skiing or jogging. Moderate movement and exercise are best to promote movement and prevent stiffening of the joint.

Get Help for Your Knee Pain Today

The orthopedic surgeons at Arkansas Surgical Hospital are experienced in performing total knee replacements, as well as many other procedures designed to address knee pain. If you are living with chronic knee pain, it may be time to consider a total knee joint replacement. Contact us here or call (877) 918-7020 for help scheduling a consultation with one of our joint specialists.

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