Procedures to Prepare for a Total Knee Replacement Operation

22nd Apr 2021

Knee replacement surgery, also known as arthroplasty or total knee replacement procedure, is a surgical procedure to resurface a knee damaged by arthritis. It’s typically done to relieve pain and restore function in severely diseased knee joints.

Generally, the procedure involves cutting away damaged bone and cartilage from the thighbone (femur), shinbone (tibia) and kneecap (patella), and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.

That said, there are many steps to a knee replacement surgery, from the incision to preparing the bones, to implanting the component. All of which requires an orthopaedic surgeon to make precise measurements and skilfully remove the damaged portion of the bone, to shape the remaining bone to accommodate the knee implant.

What are the Steps Involved During a Knee Replacement Surgery?

Like any other surgical procedures, a knee replacement surgery involves multiple steps which we explain step by step in the following section.

You’ll first be taken into the operating room and given anaesthesia. Once the anaesthesia has taken effect, the skin around your knee will be thoroughly scrubbed with an antiseptic liquid. Your knee is then flexed at about 90 degrees and the lower portion of your leg is placed in a special device to hold it in place during the surgery.

Bear in mind that there are several risks involved such as bleeding, infection, blood clots in the legs or lungs, loosening or wearing out of the prosthesis, fracture, and continued pain or stiffness. Make sure to discuss any of your concerns with the doctor or surgeon before the surgery.

#1 Making the knee incision

The surgeon makes an incision across the front of your knee to gain access to the kneecap. In a traditional total knee replacement procedure step by step, the incision is typically about 8 to 10 inches long. For minimally invasive knee replacement surgery, the incision is usually about 4 to 6 inches long.

#2 Rotating the kneecap (patella)

Once the incision is made on your knee, the surgeon will rotate the kneecap outside the knee area. As nerve-racking as it sounds, this step is necessary to allow the surgeon to view the area needed to perform the knee replacement surgery.

#3 Preparing the thighbone (femur)

The first bone that your surgeon will resurface is your thighbone, also known as the femur. Once your knee joint is exposed, the surgeon will carefully measure your bones and make precise cuts using special instruments. The damaged bone and cartilage from the end of your thighbone are then cut away and resurfaced to fit the first part of the artificial knee, the femoral component.

#4 Implanting the femoral component

The surgeon attaches the femoral component to the end of your femur and uses bone cement to seal it into place.

#5 Preparing the shinbone (tibia)

After the femoral component implant, the surgeon will then resurface your shinbone, also known as the tibia. The damaged bone and cartilage is then removed from the top of your shinbone, allowing the surgeon to shape the bone to fit the metal and plastic tibial components.

#6 Implanting the tibial components

The lower portion of the implant, known as the tibial tray, is fitted to your tibia and secured into place using bone cement. Once the tray is in place, the surgeon will snap in a polyethylene insert to sit between the tibial tray and femoral component which acts as a buffer. It will provide support for your body as you bend and flex your knee.

#7 Re-adjusting the kneecap

Before returning the kneecap to its original position, the surgeon might need to flatten the kneecap and fit it with an additional plastic component to ensure a proper fit with the rest of your implant. If needed, the plastic component will be cemented to the underlying bone.

#8 Finalising the procedure

To ensure that the implant is working correctly, the surgeon will bend and flex your knee to see whether the alignment, sizing, and positioning of the implant is suitable. Your knee replacement procedure is finalised when the surgeon closes the incision with stitches or staples, and bandages it and prep you for recovery.

What happens after a knee replacement surgery?

You will most likely spend a couple of days in the hospital during which you’ll be encouraged to move your foot and ankle to increase blood flow to your leg muscles and prevent swelling and blood clots.

During your stay in the hospital, a physiotherapist will plan an exercise programme for your knee to strengthen it and you’ll have to continue the exercise at home or a rehabilitation centre once you leave the hospital. Note that you’ll have to follow the physiotherapist’s advice to avoid complications or dislocation of your new joint.

How is minimally invasive knee replacement surgery different from traditional knee replacement surgery?

For a traditional knee replacement procedure, the surgeon typically makes a vertical incision measuring 8 to 10 inches long over the front of the knee to expose the joint. But, the incision for minimally invasive knee replacement is shorter, ranging between 4 and 6 inches. The surgeon will then proceed accordingly, as explained in our total knee replacement procedure step by step.

The artificial implants used for this minimally invasive procedure are the same as those used for traditional knee replacement. However, the surgeon will use specially designed surgical instruments to prepare your thighbone and shinbone and to place the implants accurately.

Aside from that, the technique used is less invasive, known as quadriceps sparing. The surgeon will avoid trauma to the quadriceps tendon and muscles in front of the thigh. This allows for less tissue disturbance, leading to less post-operative pain and reduced recovery time.

While this procedure may seem appealing, minimally invasive knee replacement surgery isn’t for every patient, especially those who are overweight or have already undergone other knee surgeries.

Patients who are very muscular, have a significant knee deformity or have health problems that may increase the recovery time are also not suitable to undergo minimally invasive knee replacement surgery. Hence, you should consult your doctor to determine whether this procedure is right for you.

At Spire Orthopaedic Centre, everyone should be cared for and healed holistically in comfort without having to travel to different locations to seek medical and surgical help and rehabilitation support.

With a combined facility for collaboration between physicians, physiotherapists, and surgeons, you will experience a seamless service from diagnosis, to treatment and rehabilitation, that’s tailored just for you at our clinic.