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Knee Replacement Surgery

When undergoing a knee replacement surgery, your surgeon will prepare the bone, position the implant, resurface the kneecap and insert a spacer. The surgery can help treat arthritis, damaged cartilage and other injuries.

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A knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones are actually replaced.

Knee Replacement Surgery Procedure

There are four basic steps to a knee replacement procedure.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Reasons to Have Knee Replacement Surgery

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis occurs when the immune system, the body’s normal defenses, attacks the synovial membrane causing inflammation. This can result in pain, stiffness, swelling, and loss of function. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee. These injuries can happen immediately like in a car crash or accumulated damage over time from an old injury (sports for example). 1

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Knee Replacement Options

Multiple kinds of knee replacement surgery exist, as well as various options for device components. Also, surgeons may tailor their approach based on the condition of the patient’s knee and overall health.

Knee Replacement Types
Total knee replacement (TKR) With total knee arthroplasty, a surgeon will prepare femur (thigh) and tibia (shin) bone surfaces and remove cartilage before inserting metal implants. The patella (kneecap) also may be resurfaced using a plastic button. A plastic spacer takes the place of the removed cartilage to help the joint move smoothly. 2
Unicompartmental (partial) knee replacement If only the lateral (outer) or medial (inner) portion of the knee is damaged, then that portion can be replaced without the need to reconstruct the entire knee. As with total knee arthroplasty, the surgeon will clean out the damaged bone, tissue or cartilage and implant metal and plastic components. 3
Patellofemoral (kneecap) replacement Similar to partial replacement, patellofemoral replacement removes the damaged or arthritic parts of the kneecap. The surgeon will cement a metal shield and a plastic implant in place of the portions that are removed. 4
Complex knee replacement If a patient has suffered significant deformity, extensive bone loss from fractures or arthritis, or ligament weakness, more complex replacement may be necessary. With complex replacement, longer stems are used to help keep the device in place, and the larger pieces of removed bone and cartilage are substituted with additional metal or plastic components. Patients having revision knee surgery often require a more complex replacement. 5

The basic desired result of knee replacement surgery is to remove the old, damaged components of the knee in order to relieve knee pain that cannot be controlled by other treatments. During knee joint replacement surgery, damaged cartilage and bone are removed from the knee joint. A knee implant, called prostheses, is then placed in the joint depending on the type of surgery that you and your doctor have discussed.

  1. American Academy of Orthopaedic Surgeons. Total Knee Replacement. (December 2011). Accessed July 22, 2014 

  2. Arthritis Research UK. What are the different types of knee replacement surgery? (1998-2013). Accessed July 22, 2014. 

  3. Ma, C. Benjamin. Partial Knee Replacement. (Aug. 12, 2013). Medline Plus (NIH.gov). Accessed July 22, 2014. 

  4. American Academy of Orthopaedic Surgeons. Patellofemoral Arthritis. (March 2011). Accessed July 22, 2014. 

  5. Arthritis Research UK. Complex or revision knee replacement. Accessed July 22, 2014.