Knee Replacement Surgery - Types, Procedure, Indications, Preparation, Risks, and Recovery

What is Knee Replacement Surgery?

Knee replacement surgery, also known as knee arthroplasty, is a medical procedure where a damaged or worn-out knee joint is replaced with an artificial implant. This procedure is typically recommended for individuals suffering from severe knee pain and reduced mobility due to conditions like osteoarthritis, rheumatoid arthritis, or traumatic injury.

The goal of knee replacement is to relieve pain, improve joint function, and enhance quality of life. During the procedure, the surgeon removes the damaged surfaces of the knee joint and replaces them with metal and plastic components that replicate the natural movement of the knee. The surgery can be partial or total, depending on the extent of the joint damage.

Knee replacement surgery is considered when non-surgical treatments such as medications, injections, physical therapy, or lifestyle modifications fail to provide relief. It is a highly effective solution that has helped millions of people regain mobility and live more active lives.

Why is Knee Replacement Surgery Done?

Knee replacement surgery is performed to relieve chronic knee pain, improve joint function, and restore your ability to perform everyday tasks like walking, climbing stairs, or getting out of a chair. It’s typically recommended when knee damage becomes severe and no longer responds to non-surgical treatments such as medications, steroid injections, physiotherapy, or lifestyle changes.

This surgery is not only about reducing pain—it's about restoring independence, mobility, and overall quality of life. For many patients, it provides the opportunity to return to hobbies, work, or family activities that had become too difficult due to joint issues.

Common Conditions That Lead to Knee Replacement Surgery

Several underlying conditions can damage the knee joint to a point where surgery becomes necessary:

• Osteoarthritis:
   This is the most common reason for knee replacement. Osteoarthritis is a degenerative joint condition in which the protective cartilage wears down over time. As the cartilage erodes, bones begin to rub against each other, causing pain, swelling, stiffness, and reduced mobility. It’s most common in older adults but may also affect younger individuals due to obesity or joint trauma.
• Rheumatoid Arthritis:
   An autoimmune disorder where the immune system mistakenly attacks the synovial lining of the knee joint. The resulting chronic inflammation can destroy cartilage and bone, causing pain, deformity, and joint instability. If medications fail to manage symptoms, surgery may be needed to restore function.
• Post-Traumatic Arthritis:
   This develops after significant knee injuries such as fractures, ligament tears, or meniscus damage. These injuries can alter joint mechanics and cause early wear and tear of cartilage, leading to chronic pain and stiffness.
• Knee Deformities:
   Conditions like bow legs (varus deformity) or knock knees (valgus deformity) place abnormal stress on the knee joint, accelerating joint damage. Knee replacement can correct alignment issues and relieve associated symptoms.
• Severe and Persistent Pain:
   Constant pain, especially one that persists even while resting or sleeping, is a strong indication for surgery—especially when it impacts your ability to perform simple tasks like walking or standing for extended periods.
• Loss of Joint Mobility or Function:
   If your knee becomes so stiff, weak, or unstable that it limits movement or requires a walking aid, knee replacement may restore stability and improve your ability to perform routine activities independently.
• Reduced Quality of Life:
   Many people seek surgery when knee problems interfere with their personal and social life—whether that’s playing with grandchildren, gardening, working, or travelling. When joint issues limit your lifestyle and well-being, surgery can be a life-changing option.
   

When is Knee Replacement Surgery Recommended? 

Doctors typically recommend knee replacement surgery when:

• You have severe knee pain that limits daily activities such as walking, climbing stairs, or even getting out of bed.
• You experience persistent swelling or stiffness that doesn't improve with conservative treatments.
• Your knee has visible deformity or misalignment that affects how you walk or stand.
• Non-surgical treatments—including physical therapy, medications, steroid injections, or weight loss—have failed to provide lasting relief.
• Your sleep or mental well-being is affected by chronic pain or limited mobility.

Timely surgical intervention can help prevent further joint deterioration and significantly improve your mobility and quality of life.
 

When is Knee Replacement Surgery Not Recommended?

While knee replacement is safe and effective for many patients, certain conditions may make surgery unsuitable or riskier. Contraindications include:

• Active infections:
  Any infection in the body, especially around the knee joint, must be fully treated before considering surgery. Implanting a prosthetic in an infected area can lead to serious complications.
   
• Uncontrolled chronic illnesses:
  Poorly managed diabetes, advanced heart disease, or severe lung conditions can increase surgical and recovery risks.
   
• Morbid obesity:
  Excessive body weight puts additional strain on the knee joint and prosthetic, increasing the risk of implant failure, delayed wound healing, or infections.
   
• Severe peripheral vascular disease:
  Poor blood circulation in the legs can impair wound healing and raise the risk of complications after surgery.
   
• Neurological disorders:
  Conditions like Parkinson’s disease, stroke, or multiple sclerosis can affect coordination, muscle control, or rehabilitation outcomes, reducing the effectiveness of the surgery.
   
• Allergies to implant materials:
  Rarely, patients may have hypersensitivity to materials like nickel, cobalt, or chromium used in prosthetic components. Allergy testing may be advised before surgery in suspected cases.
   
• Inability to comply with rehabilitation:
  Successful recovery requires physical therapy and active participation. Patients with cognitive issues, lack of motivation, or inability to follow instructions may not achieve desired results.
   
• Limited life expectancy or terminal illness:
  In cases where overall health is poor and the benefit of surgery is unlikely to outweigh the risks, knee replacement may not be appropriate.
   

Types of Knee Replacement Surgery

Knee replacement surgery is not a one-size-fits-all procedure. Depending on the extent of joint damage, patient age, activity level, and overall health, different types of knee replacement surgeries are available. Each type aims to restore knee function and relieve pain while preserving as much healthy tissue as possible.

1. Total Knee Replacement (TKR)

This is the most common and widely performed type of knee replacement surgery. In a total knee replacement, the surgeon removes the entire damaged knee joint and replaces it with artificial components made of metal and durable plastic. This procedure is usually recommended when arthritis or injury has severely damaged the entire knee joint, causing significant pain and mobility issues.

• Suitable for patients with severe osteoarthritis or rheumatoid arthritis.
• Improves overall knee alignment and stability.
• Typically offers long-lasting relief and improved function.

2. Partial Knee Replacement (PKR)

Also called unicompartmental knee replacement, this surgery targets only the part of the knee that is damaged. Instead of replacing the whole joint, only the affected compartment—either the inner (medial), outer (lateral), or kneecap (patellofemoral)—is resurfaced with an implant. This procedure preserves healthy bone, cartilage, and ligaments, leading to a more natural knee movement.

• Best for patients with early-stage arthritis limited to one compartment.
• Smaller incision, faster recovery, and less pain compared to total knee replacement.
• Not suitable for patients with widespread joint damage.

3. Bilateral Knee Replacement

This option involves replacing both knees either during the same surgery (simultaneous bilateral replacement) or in two separate surgeries spaced weeks or months apart (staged bilateral replacement). It is usually chosen by patients with severe arthritis affecting both knees and who want to reduce overall recovery time.

• Can improve mobility in both knees quickly.
• Requires a more intensive rehabilitation plan.
• Slightly higher surgical risk, so thorough preoperative assessment is essential.

4. Revision Knee Replacement

Sometimes, the initial knee replacement implant may wear out, loosen, or become infected years after surgery. In such cases, a revision knee replacement is performed to remove the old prosthesis and replace it with a new one. This surgery is more complex because of scar tissue, bone loss, and the need for specialized implants.

• Typically needed 15 to 20 years after the original replacement.
• Longer surgery and recovery time compared to primary knee replacement.
• Success depends on bone quality and overall health.

How to Prepare for Knee Replacement Surgery

Proper preparation before knee replacement surgery can make a significant difference in your surgical outcome and speed of recovery. Here’s a comprehensive guide to help you get ready:

1. Medical Evaluation and Tests

Your surgeon and healthcare team will conduct a full medical assessment to ensure you are fit for surgery. This typically includes:

• Blood tests to check for anemia, infections, and overall health status.
• Electrocardiogram (ECG) to evaluate heart health.
• Chest X-rays to check lung condition.
• Knee X-rays or MRI to assess the extent of joint damage.
• Review of your medical history, including chronic illnesses like diabetes or hypertension.

Any underlying conditions will be managed before scheduling surgery to reduce complications.

2. Medications Review

Inform your surgeon about all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements you take regularly. Certain medications, especially blood thinners (like aspirin, warfarin) and some anti-inflammatory drugs, may need to be stopped several days before surgery to reduce bleeding risk. Always follow your doctor’s instructions carefully.

3. Pre-Surgery Exercises

Building strength before surgery helps your muscles support the new joint and speeds up rehabilitation. Focus on:

• Quadriceps strengthening exercises (e.g., straight leg raises).
• Hamstring stretches and strengthening.
• Low-impact activities like walking or swimming if advised.

Physical therapy may be recommended preoperatively to maximize your knee function.

4. Home Preparation and Safety Modifications

Create a safe, comfortable environment at home to support your recovery:

• Arrange for assistive devices like a raised toilet seat, shower chair, and handrails on stairs or in the bathroom
• Place chairs with firm cushions and armrests for easy sitting and standing.
• Remove loose rugs, clutter, and cords that can cause falls.
• Set up your living space so essential items are easily reachable without excessive bending or stretching.

Having help arranged from family or friends during the first few weeks is also beneficial.

5. Lifestyle Adjustments

Certain habits can affect surgery outcomes:

• Quit smoking at least several weeks before surgery to improve blood flow and healing.
• Limit or avoid alcohol consumption, as it can interfere with anesthesia and recovery.
• Maintain a balanced diet to support your immune system and tissue repair.

6. Mental and Emotional Preparation

Understand what to expect during and after surgery to reduce anxiety:

• Discuss the surgical procedure, risks, benefits, and recovery timeline with your surgeon.
• Learn about postoperative pain management and rehabilitation plans.
• Join support groups or talk to patients who have undergone knee replacement.
• Prepare yourself for temporary limitations in mobility and activities.

Being mentally prepared helps with motivation and adherence to your recovery program.

 

Knee Replacement Surgery: Step-by-Step Procedure

Before the Surgery: Preparation

• Hospital Admission: You’ll be admitted to the hospital on the day of surgery or earlier, depending on your condition.
• Fasting: You will be instructed not to eat or drink for several hours before surgery to reduce the risk of complications during anesthesia.
• Anesthesia: The anesthesiologist will administer anesthesia—usually either general anesthesia (where you are fully asleep) or spinal anesthesia (numbing the lower half of your body).
• Sterilization: The surgical area around your knee will be thoroughly cleaned and sterilized to prevent infection.

During the Surgery: The Procedure

• Incision: The surgeon makes an incision, typically about 6 to 10 inches long, over the front of your knee to access the joint.
• Removing Damaged Tissue: The damaged cartilage and bone surfaces from the femur (thigh bone), tibia (shin bone), and sometimes the patella (kneecap) are carefully removed.
• Bone Preparation: The ends of the femur and tibia are shaped precisely to fit the new artificial components.
• Implant Placement: Artificial components made of metal and durable plastic are implanted to replace the damaged joint surfaces.
• Alignment and Movement Testing: The surgeon moves your knee through its range of motion to ensure the implant fits correctly and functions smoothly.
• Closing the Incision: The incision is closed with stitches or surgical staples, and a sterile dressing is applied.

After the Surgery: Recovery Begins

• Recovery Room: You will be transferred to a recovery room where vital signs are monitored closely.
• Medications: Pain relief medications, antibiotics to prevent infection, and blood thinners to reduce the risk of clots are administered.
• Physical Therapy: Rehabilitation usually starts within 24 hours, focusing on gentle exercises to improve knee movement and strength.
• Hospital Stay: The entire surgery typically takes 1 to 2 hours. Most patients stay in the hospital for 2 to 4 days to ensure stable recovery before discharge.

Risks and Complications of Knee Replacement Surgery

While knee replacement surgery is highly effective for relieving pain and restoring function in patients with severe joint damage, like any major surgical procedure, it comes with potential risks and complications. Understanding these can help patients make informed decisions and take proactive steps for a smooth recovery.

Common Risks (Typically Temporary and Manageable)

1. Swelling, Bruising, and Pain Around the Knee
   These symptoms are common immediately after surgery and are part of the normal healing process. Pain is typically managed with prescribed medications, and swelling can be minimized with elevation, ice packs, and compression stockings.
2. Blood Clots (Deep Vein Thrombosis - DVT)
   Clots may form in the deep veins of the leg after surgery, especially in the early recovery period. To reduce this risk, doctors often prescribe blood thinners and encourage early movement or use of pneumatic compression devices.
3. Infection at the Incision Site
   Infections can occur externally (superficial) or internally (deep infections near the joint). Superficial infections are treated with antibiotics, while deep infections may require surgical intervention to clean or replace the implant.
4. Temporary Stiffness or Difficulty Moving the Knee
   Post-surgical stiffness is common, especially if rehabilitation exercises are delayed. Adhering to a structured physiotherapy program is essential to regain flexibility and joint mobility.
    

Rare but Serious Risks

1. Implant Loosening or Wear Over Time
   Although modern implants are built to last 15–20 years or more, they can gradually loosen or wear out, especially in highly active individuals. This may require revision surgery.
2. Nerve or Blood Vessel Damage
   In rare cases, surrounding nerves or blood vessels may be injured during surgery, leading to numbness, tingling, or weakness. Most cases resolve over time, but severe damage may need further treatment.
3. Allergic Reaction to Metal Components
   Some patients may have a hypersensitivity to metals like nickel, cobalt, or chromium used in implants. Those with known metal allergies should inform their surgeon in advance, as hypoallergenic implants are available.
4. Persistent Pain or Joint Instability
   Despite successful surgery, a small percentage of patients may continue to experience pain or a feeling of instability in the joint. This could be due to implant malalignment, soft tissue issues, or unresolved arthritis in surrounding joints.

Other Possible Complications

• Scarring and Skin Discoloration
  Post-surgical scars are normal, but some may become raised or darkened. Proper wound care and scar management techniques can help improve their appearance.
• Joint Stiffness Due to Scar Tissue (Arthrofibrosis)
  Excess scar tissue can limit movement. In some cases, a procedure called "manipulation under anesthesia" may be required to improve range of motion.
• Anesthesia-related Reactions
   Reactions to general or spinal anesthesia, though rare, may include nausea, breathing difficulties, or changes in heart rate or blood pressure.

How to Reduce the Risks

• Choose a skilled and experienced orthopedic surgeon.
• Follow all pre-operative instructions, including stopping certain medications.
• Use assistive devices and walk with support to avoid falls.
• Maintain a healthy diet and hydration level to promote healing.
• Attend all post-surgery follow-ups and stick to your rehabilitation plan.

Early detection and immediate medical intervention can greatly improve outcomes and reduce the likelihood of long-term complications. Always report any unusual symptoms—like redness, warmth, increased pain, or fever—to your healthcare provider right away.

Recovery After Knee Replacement Surgery

Recovery time for knee replacement varies by individual but generally follows this timeline:

Week 1–2:

• Start with assisted walking using a walker.
• Gentle knee bending and stretching exercises.
• Pain and swelling are common but manageable with medications.

Week 3–6:

• Walking longer distances with less support.
• Resuming some household activities.
• Continued physiotherapy to regain range of motion.

Week 6–12:

• Most patients resume driving and light activities.
• Best sitting positions include straight-back chairs with feet flat on the floor.
• Avoid kneeling, running, or high-impact exercises.

After 3–6 Months:

• Major improvements in strength and mobility.
• Some patients may still feel occasional stiffness.
• Full recovery can take up to 12 months.

Recovery time for elderly patients may be slightly longer, and personalized rehabilitation programs are often recommended.

Benefits of Knee Replacement Surgery

Knee replacement surgery can be life-changing, especially for individuals struggling with severe knee pain or limited mobility. The procedure offers several important benefits that significantly improve both physical function and overall quality of life:

Pain Relief

One of the most immediate and noticeable benefits is relief from chronic knee pain. Most patients experience a significant reduction in pain, and in many cases, the discomfort disappears entirely. This allows for a more comfortable and active lifestyle, free from the constant reliance on pain medications.

Improved Mobility and Function

After recovery, patients are usually able to walk more comfortably, climb stairs with less difficulty, and engage in day-to-day activities that were once painful or impossible. Tasks like standing for extended periods, getting up from a chair, or even taking a leisurely stroll become easier and less tiring.

Enhanced Quality of Life

Living without pain and with better mobility means patients can return to hobbies, social events, and even light sports or fitness routines. Many report feeling more independent and confident in their movements, which greatly contributes to mental well-being and emotional health.

Correction of Joint Deformities

In cases where the knee joint is misaligned—such as in bow-legged or knock-kneed conditions—knee replacement surgery can help straighten the leg and restore proper alignment. This not only improves function but also helps prevent further joint wear or back and hip problems caused by poor posture.

Long-Lasting Results

Modern knee implants are made of durable materials like titanium or cobalt-chromium and are designed to withstand years of daily use. With proper care and activity modification, these implants can last 15 to 20 years or longer, reducing the likelihood of needing another surgery in the near future.

Improved Sleep

Many patients with chronic knee pain experience difficulty sleeping due to discomfort. After knee replacement surgery, as pain diminishes, sleep quality often improves, contributing to better overall health and faster recovery.

Knee Replacement Surgery vs. Arthroscopy

Both knee replacement surgery and arthroscopy are used to address knee joint issues, but they differ significantly in purpose, invasiveness, and effectiveness. The table below highlights the key differences:

 

Cost of Knee Replacement Surgery in India

The cost of knee replacement in India depends on the city, hospital, and type of implant used. On average:

• Single Knee Replacement: ₹2,00,000 to ₹3,50,000
• Bilateral Knee Replacement: ₹4,00,000 to ₹7,00,000

This usually includes hospital stay, surgery, anesthesia, and physiotherapy.

To know the exact cost, contact your nearest Apollo Hospitals.

 

Frequently Asked Questions

1. Is knee replacement surgery painful?
   You may experience some pain after surgery, but it is managed with medications. Long-term, the surgery significantly reduces chronic knee pain.
    
2. How long does it take to walk after knee replacement?
   Most patients start walking with assistance within 24–48 hours. Independent walking typically resumes within 4 to 6 weeks.
    
3. How long will my knee implant last?
   Modern implants can last 15 to 20 years or more, depending on activity levels, weight, and implant type.
    
4. How do you know if you need a knee replacement?
   If you experience chronic knee pain that doesn't improve with medication or therapy, difficulty walking, or visible joint deformity, you might be a candidate. Consult an orthopedic surgeon for a complete evaluation.
    
5. How long does knee replacement surgery take?
   The surgery itself usually takes between 1 and 2 hours. However, pre-operative preparation and post-operative monitoring can extend the overall time in the hospital.
    
6. How long does it take to recover from knee replacement?
   Most patients resume light activities in 6–8 weeks. Full recovery may take 3 to 6 months or longer, depending on age, health status, and adherence to rehabilitation exercises.
    
7. What are the disadvantages of knee replacement surgery?
   Possible downsides include surgical risks, temporary pain, limited range of motion, and the potential need for revision surgery after 15–20 years. Some patients also report difficulty kneeling or stiffness.
    
8. Can you kneel after knee replacement?
   Many patients find kneeling uncomfortable even after recovery. While it's not medically harmful, it's best to avoid prolonged kneeling, especially on hard surfaces.
    
9. Can you run or jog after knee replacement?
   Running or jogging is not typically recommended after surgery due to the risk of implant wear and joint damage. Low-impact activities like walking, swimming, or cycling are better options.
    
10. How long does a titanium knee replacement last?
     Titanium implants are designed to last 15–20 years, and in many cases, they last longer with proper care and activity modification.
     
11. How long after knee replacement can you drive?
    Most people can resume driving 6–8 weeks post-surgery, once they regain sufficient strength and control in their leg. Always check with your doctor before driving.
     
12. What exercises should be avoided after knee replacement?
    Avoid high-impact exercises such as running, jumping, or heavy lifting. Also, avoid deep squats and twisting motions that can strain the joint.
     
13. How should you sleep after knee replacement?
    Sleep on your back with a pillow under your operated leg to keep it straight. Avoid placing pillows directly under the knee joint. Side sleeping is fine after the initial recovery period.
     
14. Can both knees be replaced at once?
    Yes, bilateral knee replacement is possible if you're healthy enough. It shortens overall recovery time but has a slightly higher risk of complications.
     
15. What are the restrictions after surgery?
    Avoid running, jumping, squatting, or sitting cross-legged. Stick to low-impact activities like walking or swimming.
     
16. When can I return to work?
    Desk jobs may be resumed in 4–6 weeks. Physically demanding jobs may require 2–3 months or more of recovery.
     
17. Will I need physiotherapy after the surgery?
    Yes, physiotherapy is essential for regaining strength, flexibility, and function. It starts within a day after surgery and continues for several weeks.
     
18. Are there alternatives to knee replacement?
    Yes, alternatives like medications, injections, or arthroscopy are available for early-stage joint issues but may not be effective for severe arthritis.
     
19. Is the surgery safe for elderly patients?
    Yes, with proper pre-surgical evaluation and post-operative care, knee replacement is safe and effective even for elderly patients.
     
20. Can I climb stairs after knee replacement?
     Yes, with proper rehabilitation, most patients can climb stairs with minimal discomfort after recovery.

Conclusion

Knee replacement surgery is a transformative solution for individuals suffering from chronic knee pain and joint damage. With the right preparation, care, and rehabilitation, patients can expect significant improvements in mobility and quality of life. If you're considering this surgery or have questions about recovery time, exercises, or lifestyle adjustments, speak to an orthopedic specialist to make an informed decision.