A total knee replacement (TKR) is a replacement of the femoral and tibial surfaces of the knee joint, , and generally also part of the patella, with metal and plastic.
The most common indication for total knee replacement is significant pain related to arthritis in the mature or older patient where medications and physiotherapy not longer offer effective relief.
The articulating surfaces of the joint are removed, so there is no going back after a total knee replacement.
Components of a total knee replacement
Total knee replacement usually implies replacing all three of the articulating areas in the knee with implants comprised of metal and plastic. A femoral and a tibial implant replace the two joint surfaces between femur and tibia, and a patellar implant replaces the joint surface between femur and patella.
Between the two larger implants is a plastic spacer, which effectively replaces the two menisci.
If you look at the implant from the back, you can better appreciate that each rounded condyle of the joint is really a separate articulation (or contact point). In a partial knee replacement the surgeon can replace just one of these articulations. In fact, even in a so-called total knee replacement it is quite common for the surgeon to avoid replacing the patellar implant if the joint cartilage there is still good.
Steps of total knee replacement surgery
The surgeon will walk through the following stages during surgery:
- Shaping the end of the femur
- Shaping the top of the tibia
- Cementing the femoral component into place
- Cementing the tibial tray into place
- Attaching the plastic spacer
- Shaping the back of the patella
- Cementing the patellar button into place
- Closing the wound in layers
Watching out for complications
Rehabilitation is commonly started some time before the surgery, to optimise range of motion and muscle strength and give the patient the best chance of early mobilisation. It is critical to prevent clotting (deep vein thrombosis) and infection as a result of surgery, and blood thinners (eg heparin) and antibiotics are administered for a period before surgery. The most dreaded complication is infection which may result in months of treatment, and even temporary removal of the implant until the joint is clear of the infection.
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Relevant content -
- Total knee replacement
- Partial knee replacement
- Robot-assisted knee arthroplasty
Special considerations -
- Total knee replacement operating room considerations
- Rehabilitation after total knee replacement
- Total knee replacement failure and revision.
Other interesting material from Knee Surgeons -
- 2020 - What does metal allergy mean for patients waiting to have knee replacement surgery? - by Dr (Mr) Tarek Boutefnouchet (Knee Surgeon)
- 2006 - Heterotopic ossification after total knee arthroplasty Authors: Atamaz F et al. - interpreted by Dr Sheila Strover (Clinical Editor)
- 2017 - Non-surgery factors affecting knee replacement - by Prof Raju Vaishya (Knee Surgeon)