Total knee replacement surgery, also known as total knee arthroplasty (TKA) is a surgical procedure that involves replacing damaged or worn-out knee cartilage with an artificial joint called a prosthesis. 

Over time, conditions such as osteoarthritis, rheumatoid arthritis, injuries, congenital issues or other factors can damage your knee joint, resulting in pain, stiffness and reduced function. Your doctor may recommend a total knee replacement when knee pain and loss of function become severe, and medications and other treatments no longer relieve pain. 

Total knee replacement surgery is not recommended for people who:

  • Have poor general health and may not tolerate anesthesia and surgery well
  • Have an active infection or are at risk for infection
  • Have severe weakness of the quadriceps muscles at the front of the thigh
  • Have a knee that appears to bend backward when fully extended (genu recurvatum), if this condition is due to muscle weakness or paralysis
  • Are severely overweight (replacement joints may be more likely to fail in people who are very overweight)

Total knee replacements are generally most suitable for individuals who are in their later years or those engaged in less physically demanding activities. However, due to advances in medical technology, surgical techniques and improved materials, implants continue to become more durable.  

If you are a younger patient, you may be a candidate for partial knee resurfacing.

What Happens During Total Knee Replacement Surgery?

During total knee replacement surgery, your orthopaedic surgeon replaces damaged bone and cartilage in a step-by-step process:

  • Knee replacement surgeons often replace the entire surface at the ends of the thigh and lower leg bones.
  • Surgeons cap the end of these damaged bones, as well as the kneecap, with artificial surfaces lined with metal and plastic.
  • Surgeons remove the damaged cartilage and replace it with new joint surfaces.

Most patients are under regional anesthesia for joint replacement surgeries. Regional anesthesia numbs the area being operated on so that you do not feel pain during the surgery. This does not affect your brain or breathing. You will be given medications to help you relax and fall asleep. In most cases, this eliminates the need for a breathing tube. Based on past experience with anesthesia and current health conditions, general anesthesia, or a combination of general and regional anesthesia, is sometimes the best option.  

Recovery Process

You will often go home (be discharged) on the day of surgery, as long as you have met physical therapy goals and are medically ready. Your doctor will monitor your progress following knee replacement at regularly scheduled visits.  

Rehabilitation (rehab) after a total knee replacement is intensive. You will work with a physical therapist during your hospital stay and continue with an exercise program after you return home. 

Some patients may need home health physical therapy, but most will attend outpatient physical therapy. Full recovery after joint replacement usually takes several months. 

Most people start to walk on the day of surgery with the use of a walker, and progress to a cane later. After you go home, your doctor may recommend: 

  • Taking a short walk several times each day
  • Riding a stationary bike to strengthen your leg muscles and improve your knee bending
  • Swimming once your incision is completely healed, usually 6 weeks after surgery (talk to your surgeon about when you can start swimming)

Living With a Total Knee Replacement

Most people experience significantly less pain after total knee replacement surgery and can perform many of their daily activities more easily. Here’s what you can expect:

  • The knee will not bend as far as it did before you developed knee problems, but the surgery will allow you to stand and walk for longer periods without pain. 
  • You may be allowed to resume activities such as golfing, riding a bike, swimming, walking for exercise, dancing, or cross-country skiing (if you did these activities before surgery). 
  • Your doctor may suggest avoiding high-imapct activities like running, jumping, and airborne or contact sports. These activities can put extra strain on your joints and may cause them to wear out faster.

Joint Replacement Program

At Atrium Health Wake Forest Baptist, we’re proud to offer an award-winning joint replacement program, which is also one of the most comprehensive in the region. We are the first in NC to receive Advanced Total Hip and Total Knee Replacement Certification from The Joint Commission with multiple hospitals awarded Joint Commision certifications. From minimally invasive to bone-sparing procedures, our full menu of surgical options fits patients of all ages and activity levels. 

Our orthopaedic teams include surgeons who are highly trained and specialized in their fields. That means they focus on diagnosing and treating problems in only one region of the body, such as the knees, hips or shoulders.