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Total Knee Replacement

Alternative name: Knee Arthroplasty

What is a total knee replacement?

Total knee replacement (TKR) is a procedure in which orthopaedic surgeons replace a painful, dysfunctional joint with a highly functional, long-lasting artificial joint. In the past few decades, there have been many advances in the use of artificial joints, resulting in a high percentage of successful long-term outcomes. Total knee replacement has brought increased mobility and less pain to hundreds of thousands of people.

Why would a doctor recommend a total knee replacement?

Knee joint replacement may be recommended for:

  • Knee pain that has failed to respond to conservative therapy (including medication, injections, and physical therapy for 6 months or more)
  • Knee pain that limits or prevents activities of importance to the patient
  • Arthritis of the knee
  • Decreased knee function caused by arthritis
  • Inability to sleep through the night because of knee pain
  • Some tumors involving the knee

Knee joint replacement is usually not recommended for a patient with:

  • Current knee infection
  • Poor skin coverage around the knee
  • Paralysis of the quadriceps muscles
  • Severe peripheral vascular disease or neuropathy affecting the knee
  • Severe limiting mental dysfunction
  • Terminal disease (metastatic disease)
  • Morbid obesity (over 300 lbs.)

What does total knee replacement surgery involve?

Before your surgery you will have some pre-operation appointments. On the day of your surgery, after admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia, in which you are asleep throughout the procedure, and spinal or epidural anesthesia, in which you are awake but your legs are anesthetized. The anesthesia team with your input will determine which type of anesthesia will be best for you.

The procedure itself takes about two hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee.

Many different types of designs and materials are currently used in total knee replacement surgery. Nearly all of them consist of three components: the femoral component (made of a highly polished strong metal), the tibial component (made of a durable plastic often held in a metal tray), and the patellar component (also plastic).

For more information view an example of the guidebook given to patients at Dartmouth-Hitchcock Medical Center in Lebanon, NH.

How long is the recovery after total knee replacement surgery?

In the majority of total knee arthroplasties, patients are allowed weight-bearing as tolerated (WBAT) with an assistive device. Follow the instructions of your individual surgeon. Your specific weight bearing precautions are in effect until your first post-operative appointment in four to six weeks.

The results of a total knee replacement are often excellent. The operation relieves pain in over 90% of patients, and most need no assistance walking after recovery. Most prostheses last 10 to 15 years, some as long as 20 years, before loosening and requiring revision surgery.

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