Living with chronic knee pain can make even the simplest daily activities—walking, climbing stairs, getting out of a chair or enjoying time with family—painful and frustrating. When non-surgical treatments such as medication, physiotherapy, injections and lifestyle modifications no longer provide lasting relief, a total knee replacement may offer the opportunity to regain mobility, reduce pain and return to a more active lifestyle. Let us learn what happens during a total knee replacement?
Although most knee replacements are performed for advanced osteoarthritis, the procedure may also be recommended for other conditions that cause significant damage to the knee joint, including rheumatoid arthritis and other inflammatory arthritic conditions, post-traumatic arthritis following previous fractures or injuries, severe knee deformity, avascular necrosis (bone death due to reduced blood supply), or when previous knee surgery has failed to relieve symptoms.
Modern knee replacement surgery is one of the most successful orthopaedic procedures performed today. Advances in surgical techniques, implant design and rehabilitation have helped millions of people regain comfort, restore mobility and enjoy a significantly improved quality of life.
During a total knee replacement, the damaged cartilage and worn bone surfaces are carefully removed and replaced with precision-engineered metal and medical-grade plastic components. Rather than replacing the entire knee, the procedure resurfaces the damaged joint surfaces while preserving as much healthy bone and surrounding tissue as possible. The operation typically takes between one and two hours.
Anaesthesia
Before surgery, you will receive either general anaesthesia, where you are completely asleep during the procedure, or spinal (regional) anaesthesia, where you remain awake but are numb from the waist down. Your anaesthetist will discuss the safest and most appropriate option based on your medical history and overall health.
Incision and Joint Preparation
The surgeon makes an incision over the front of the knee to access the joint. The kneecap (patella) is gently moved aside, allowing clear access to the damaged joint surfaces.
Removing the Damaged Bone and Cartilage
The worn cartilage and a small amount of damaged bone are carefully removed from the ends of the thigh bone (femur) and shin bone (tibia). Specialised instruments are used to prepare the bone with exceptional precision, ensuring the implants fit accurately and the new joint functions smoothly.
Implant Placement
The artificial knee components are then positioned onto the prepared bone surfaces. Manufactured from durable metal alloys, these implants are designed to provide many years of reliable function.
Depending on your bone quality and the type of implant selected, the components are either:
- Fixed securely using specialised bone cement, or
- Press-fitted, allowing your own bone to grow naturally into the implant over time.
Inserting the Plastic Bearing
A high-density medical-grade plastic insert is placed between the metal components. This acts as the new cartilage, allowing the joint to move smoothly while providing stability, cushioning and long-term durability.
Kneecap Resurfacing
In some patients, the underside of the kneecap is resurfaced with a smooth plastic component. Whether this is necessary depends on your individual anatomy, the condition of your kneecap and your surgeon’s assessment during the procedure.
Closing the Incision
Once the new knee has been carefully checked for alignment, stability and smooth movement, the kneecap is returned to its normal position. The incision is then closed using sutures or staples and covered with a sterile dressing.
Recovery Begins Immediately
Recovery begins soon after surgery. Most patients are encouraged to stand and take their first steps with the assistance of a physiotherapist on the day of surgery or the following morning. Early mobilisation promotes healing, improves circulation, reduces the risk of complications and forms an important part of the recovery process.
Successful outcomes depend not only on the surgery itself but also on your commitment to rehabilitation. With a structured physiotherapy programme and guided recovery, most patients experience substantial pain relief, improved mobility and a return to many of the activities they enjoy.
A total knee replacement is more than simply replacing a worn joint—it is an investment in your future mobility, independence and quality of life. With modern surgical techniques and comprehensive rehabilitation, the vast majority of patients achieve excellent long-term outcomes and enjoy many years of comfortable, confident movement.
What Happens During a Total Knee Replacement?
This article “What Happens During a Total Knee Replacement?” does not provide medical advice and is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor for all medical advice.
Sources:
https://orthosurgeon.co.za/knee-replacement-explained
https://orthoinfo.aaos.org/
https://my.clevelandclinic.org/
https://www.nhs.uk/
Meet Dr Peter Smith, a leading Orthopaedic Surgeon operating from the Mediclinic Milnerton in Cape Town, Western Cape. His practice is situated in the heart of this seaside town. Dr Peter Smith not only offers patients the full spectrum of professional orthopaedic treatments, but specialises in total knee replacement, total hip replacement, sports injuries and the latest arthroscopic surgery techniques and computer guided surgery. He gained extensive experience in the latest arthroplasty techniques during his stay of 6 years in Australia where he performed more than a hundred primary and revision hip and knee replacements cases in a year.
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