Total knee replacement is a surgical solution indicated in cases of advanced osteoarthritis or debilitating joint conditions. This procedure, while common, is technically demanding and aims to relieve pain and restore knee mobility. From indications to the surgical steps, including post-operative care and long-term results, this article provides all the essential information step by step.
Why opt for a total knee replacement?
Total knee replacement is recommended when medical treatments are no longer sufficient to relieve knee joint pain. Several conditions can lead to this procedure.
Main medical indications:
The most common indication is knee osteoarthritis, also known as gonarthrosis. It can be primary, related to natural joint aging, or secondary to trauma, a fracture, or deformity. Chronic inflammatory diseases such as rheumatoid arthritis or chondrocalcinosis can also lead to cartilage degradation requiring prosthetic replacement.
When should surgery be considered?
Surgery is considered when the pain becomes persistent, even at rest, and significantly affects quality of life. If injections, pain medications, and rehabilitation fail, total knee replacement becomes a reliable and lasting option. If the surgeon recommends surgery, the final decision lies with the patient, as the operation’s sole aim is to relieve pain, discomfort, and disability.
How does the surgical procedure unfold?
Total knee replacement surgery is now well mastered and uses modern techniques to reduce risks and improve recovery.
Preparing for surgery
Before the procedure, a pre-operative assessment is performed: blood tests, imaging (X-rays), anesthesia consultation, and sometimes a meeting with a rehabilitation physician. This step helps tailor the choice of prosthesis to each patient (shape, size, type of implant).
Key step: the pre-operative consultation
Before any surgery, a pre-operative surgical consultation is necessary. The orthopedic surgeon examines the patient, reviews medical history and imaging results (X-rays, MRI if needed). They explain in detail the procedure, expected benefits, potential risks, and the post-operative course.
The choice of prosthesis is personalized based on the patient’s anatomy, age, and activity level. This consultation is also the time to ask practical questions about hospitalization, rehabilitation, or post-operative management.
Once the surgical decision is confirmed, a full pre-operative check-up will be prescribed. The surgeon will ask for blood tests to rule out any contraindications. A panoramic dental X-ray may also be necessary if there is any suspicion of oral infection.
Additionally, a cardiology consultation is required to assess your fitness for anesthesia and orthopedic surgery. Finally, you will meet with the anesthesiologist a few days before the procedure to choose the type of anesthesia and organize safety measures tailored to your health condition.
Consultation with the anesthesiologist
The consultation with the anesthesiologist is mandatory and must take place a few days to a few weeks before the surgery. It determines the type of anesthesia (regional or general) and evaluates anesthetic risks based on the patient’s medical profile (hypertension, diabetes, allergies, ongoing treatments, etc.).
The anesthesiologist also provides pre-operative instructions (stopping certain medications, fasting, skin preparation). It is a key step to ensure the safety of the procedure.
Note: Quitting smoking is essential at least one month before surgery.
The surgical procedure
The operation lasts on average 1 hour and 30 minutes. The surgeon replaces the damaged joint surfaces (ends of the femur and tibia, sometimes the patella) with a prosthesis made of highly durable metal and plastic components. It is securely fixed to the bone and allows for functional joint movement. Hospitalization usually lasts 2 to 4 days.
During the operation, the surgeon ensures the knee is properly realigned if there was any misalignment before surgery. Careful hemostasis is performed, particularly by cauterizing small blood vessels, to minimize blood loss. In some cases, a specific aspiration system is used: blood lost during the procedure is collected, filtered, concentrated by centrifugation, and then reinfused into the patient after surgery. This autotransfusion technique is entirely safe, as it uses the patient’s own blood, eliminating any risk of contamination or rejection.
At the end of the surgery, you will be taken to the recovery room, where your general condition (blood pressure, heart rate, pain) will be closely monitored for about two hours. If autotransfusion is planned, it will take place during this time.
You will then return to your room to begin recovery in optimal conditions. Starting the next day, the medical team will support you: nurses will administer prescribed pain medications, and a physiotherapist will begin rehabilitation. The first sessions focus on quadriceps contraction and progressive knee flexion movements. In most cases, patients can sit in a chair as early as the first post-operative day.
What are the post-operative steps after a total knee replacement?
Recovery after total knee replacement requires rigorous rehabilitation and careful medical monitoring. Pain is generally well managed, and mobility improves gradually.
Walking again
Walking is possible the day after surgery with the help of crutches. Weight-bearing on the operated leg is allowed immediately. Special attention is given to pain management using a combination of medications and local anesthetic techniques.
Post-operative rehabilitation
Physical therapy begins during hospitalization. It continues at home or in a specialized center. The goal is to restore knee mobility, strengthen muscles (especially the quadriceps), and promote a natural gait. Full recovery usually takes between 3 and 6 months.
Post-operative follow-up after a total knee replacement
Medical follow-up is essential to ensure good recovery and adapt rehabilitation to each patient’s progress. Three main consultations take place during the first year after surgery.
First follow-up at 30 days
One month after surgery, a first check-up is done. During this period, compression stockings (prescribed before surgery) are recommended, and rehabilitation has already begun to restore range of motion. At this stage, the knee begins to gradually deflate and the pain decreases.
The surgeon examines the scar, joint mobility, and any residual pain. Post-operative X-rays are reviewed to ensure proper prosthesis positioning. Based on your progress, rehabilitation guidelines may be adjusted. Driving is generally allowed between 30 and 45 days, depending on your recovery.
Second follow-up at 6 months
During this consultation, the focus is on muscle strengthening, particularly of the quadriceps, which is essential for knee stability. You begin to become accustomed to your new joint while remaining attentive to its limitations.
Some residual muscle weakness may persist but can be corrected with appropriate exercises, alone or with a physiotherapist. The surgeon will provide personalized recommendations to avoid any movements or activities that could jeopardize the outcome. If the knee is stable and the quadriceps strong, activities such as cycling or swimming may be considered at this stage.
Third follow-up at 12 months
One year after the operation, the goal is to have regained normal, pain-free walking and full independence. Each patient recovers at their own pace, and the surgeon will assess your functional capabilities to give specific advice on returning to sports.
Returning to sports is possible with a total knee replacement, favoring low-impact activities such as golf, tennis, skiing, or moderate running. However, contact or high-impact sports (football, rugby, judo…) are possible but not recommended in order to preserve the longevity of the prosthesis.
What are the results after a total knee replacement?
Total knee replacement yields excellent long-term outcomes, with a high satisfaction rate among patients.
Improved quality of life
Over 90% of patients report significant improvement in comfort and mobility. Chronic pain disappears in the vast majority of cases, enabling a return to an active life.
Prosthesis lifespan and resumption of activities
Current prostheses have an estimated lifespan of 15 to 20 years, or even longer depending on the patient’s age and lifestyle. Low-impact sports such as walking, cycling, or swimming are recommended. High-impact sports (running, contact sports) are discouraged to protect the implant’s longevity.
Durée de vie de la prothèse et reprise des activités
Les prothèses actuelles ont une durée de vie estimée entre 15 et 20 ans, voire plus en fonction de l’âge du patient et de son mode de vie. Les activités sportives douces comme la marche, le vélo ou la natation sont recommandées. Les sports à fort impact (course à pied, sports de contact) sont déconseillés pour préserver la longévité de l’implant.
Total knee replacement is a radical solution to relieve pain caused by joint wear. When well prepared and carefully followed up, this procedure can lead to a significant improvement in mobility and quality of life. Feel free to consult us if you need to assess your situation and determine whether this operation is necessary.
