Knee Replacement Surgery: What to Expect on the Day of Surgery

surgeon holding a scalpel

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In This Article

Knee replacement surgery—also called total knee arthroplasty—is performed by an orthopedic surgeon in a hospital or surgical center. This surgery is performed to improve pain and knee functioning in patients with an injured or arthritis knee joint that cannot be adequately managed with nonsurgical therapies like taking nonsteroidal anti-inflammatory drugs (NSAIDs) or undergoing physical therapy.

Before the Surgery

Prior to undergoing a knee replacement surgery, you will discuss anesthetic options with your surgical team.

The surgery can be performed with one of the following three types of anesthesia:

The type of anesthesia you and your doctor choose will have no effect on your surgeon's ability to perform the knee replacement. Instead, the anesthesia choice depends on factors like personal preference and whether you have any underlying medical conditions.

On the actual day of your knee replacement surgery, you will first go to a surgical pre-operative room. Here, you will change into a hospital gown and place your clothes and other personal belongings in a plastic bag. The bag may be stored in a locker or given to a loved one.

After changing into your gown and relaxing on the hospital bed, a nurse will check your vital signs and place a peripheral IV in your arm. This IV is used to give you fluids and medications during the surgery.

Next, your surgical team and the anesthesiologist will likely come to greet you. They may briefly review the surgery with you and ask you to sign additional consent forms.

Finally, you will be wheeled into the operating room on your hospital bed. You will transfer to an operating table and be given anesthesia medication to put you to sleep (if undergoing general anesthesia).

During the Surgery

When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are first removed. The surgeon then places an implant, also called a prosthesis, on the joint. The prosthesis is usually made up of metal (e.g., cobalt chrome or titanium) and plastic (polyethylene).

Each prosthesis typically replaces up to three bone surfaces:

  • The top surface of the tibia
  • The lower end of the femur
  • The back surface of the kneecap (patella)

Knee replacement surgery, which takes one to two hours, generally proceeds with the following steps:

  • In the operating room, your surgeon will make a six to eight-inch incision (cut) over the knee.
  • The surgeon will then remove the damaged parts of the knee joint using precise instruments to create exact surfaces in order to accommodate the prosthesis.
  • After removing the damaged bone and tissue, the surgeon will attach a prosthesis to the bone. Usually, cement fixation is performed. This means that the implant is fit tightly into position and is immediately and solidly fixed into the bone with cement. Sometimes, especially in younger patients, a cement-less fixation is used. This means that the implant is "press-fit" onto the bone. Over time the surrounding bone grows into the implant holding it solidly in position.
  • Once the prosthesis is placed, the surgeon will close the incision site with staples or stitches. A drain may be placed at the wound site to remove excess fluid.
  • A bandage will then be placed over the knee.

The specific implant used for your knee replacement will depend on various factors, such as: 

  • The patient's age and activity level
  • The surgeon's preference
  • The amount of arthritis-related bone loss that has occurred
  • The integrity of the ligaments supporting the patient's knee

After the Surgery

After your knee replacement surgery, you will be taken to a recovery room where a nurse will monitor your vital signs and manage your pain.

Once your vitals are stable and your pain is under control (usually within a few hours), you will be taken to a hospital room.

While recovering in the hospital, your surgical team may recommend a blood thinner or compression boots to help prevent blood clots in your legs. Additionally, your surgeon may inject a numbing agent around your knee to decrease pain after surgery. A physical therapist will also come to visit you in your hospital room to teach you various exercises.

Upon being discharged from the hospital, you will be given various post-operative instructions to follow at home.

These instructions may include:

  • Applying ice and elevating your knee to reduce swelling.
  • Taking pain medication as directed—which may include an NSAID, an opioid, Tylenol (acetaminophen), a local anesthetic, or some combination.
  • Resuming your normal diet. Your surgeon may recommend iron supplements to optimize healing and muscle strength.
  • Keeping your wound clean and dry until the stitches or surgical staples are removed (several weeks after surgery).
  • Resuming normal activities within three to six weeks after surgery.
  • Resuming driving around four to six weeks after surgery.
  • Performing home exercises and attending physical therapy appointments, which will begin immediately after surgery.
  • Using a cane or walker, as well as other fall preventive measures, such as handrails along stairs until your knee is adequately strong.

A Word From Verywell

Once you have decided to have knee replacement surgery, you have committed yourself to a bit of work. Knee replacement surgery is successful, but the success of the procedure is due, in part, to the rehabilitation that follows the knee replacement surgery. For patients to expect a good result from knee replacement surgery, they must be an active rehab participant.

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Article Sources
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