A total knee replacement surgery, also known as knee arthroplasty, is a process in which the knee surface is replaced. Whilst it is a common procedure administered among those above the age of 60, knee replacement surgery could also be performed on younger age groups if necessary.

Total knee replacement is considered a major surgery and would require a lengthy evaluation process. It is uncommon for total knee replacement to be considered as the first course of treatment without exploring more conservative treatments or minor surgeries to improve one’s condition.

Symptoms that may require total knee replacement surgery as treatment include:

• Severe pain and stiffness of the knee joint
• Pain region on entire knee or under the kneecap
• Inability to conduct daily activities
• Dependent on walkers or cane for mobility for a prolonged period
• Chronic inflammation and swelling that does not subside

Additionally, factors deciding the suitability of total knee surgeries include:

• Degenerative conditions: gradually worsening degenerative knee conditions such as osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and juvenile arthritis all of which significantly impact mobility, cause a lot of discomfort and pain and significantly lower the quality of life.
• Congenital conditions: congenital conditions such as bowed legs can reduce the functionality of the knee due to abnormal anatomical knee structures that cause impediments in one’s life.
• Ineffective treatments: whether it's physiotherapy, injections, or other surgeries, if continued degradation of knee structure and functionality is evident, a total knee replacement would be the next course of action.

Following your orthopaedic evaluation, imaging tests such as x-rays and magnetic resonance imaging (MRI) will be conducted to confirm surgery suitability. A surgery date will then be assigned. During the surgery, an incision is first made over the knee. Muscles and other soft tissues would be cut to obtain a better view of your knee’s condition. Upon assessment, damaged cartilage and bones are removed to provide space and address injuries.

The removed cartilage and bones are then replaced with metal implants fitted into the area or by cementation. These implants may be inserted at the thigh bone, shinbone, and kneecap, depending on your condition. If necessary, your kneecap will be cut and resurfaced with a plastic button. Additionally, if your ligaments are dysfunctional and are incapable of holding joints together, connective implants would be used to ensure they replace the functionality of ligaments.

A plastic spacer is then inserted between the metal to provide a smooth gliding surface. Finally, the site of surgery is cleaned with antiseptic solutions to prevent infections. The incisions are then closed with sutures.

• Reduces pain
• Overcomes stiffness of the joint
• Increased mobility
• Effective
• Improved quality of life

Total knee replacement surgery can be used to treat the following conditions:

• Osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Juvenile arthritis
• Haemophilia
• Avascular necrosis
• Gout
• Pseudogout
• Bone/skeletal dysplasias

An entire joint in your body has been modified, thus, it will take time (shorter than the prolonged discomfort one faced prior to surgery) to witness improvements.

It takes approximately 6 months to recover from the surgery and 12 months to resume activity. Whilst pain and stiffness would subside, your range of movement can be as limited as it was prior to surgery. However, it is best assured, you will be more functional in your day-to-day routine as satisfaction rates have been reported between 80-100% post-operation.

Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.

Typically, implant functionality can last up to 15-20 years,  provided that joint condition is properly maintained and a good lifestyle is adhered to. If noticeable degradation of implants is noticed before the set time frame, a following knee replacement surgery might be necessary.  

Despite 15-20 years being seemingly long for many, this is not the case for someone who’s in their childhood, teens, or young adulthood. Thus, the apprehension for orthopaedists to conduct total knee surgeries in a younger demographic. However, if deemed completely necessary, this surgery would be performed nevertheless with future plans debriefed during consultation.

Continuously gaining weight or excess stress on knee joints through demanding activities will reduce the lifespan of your implant. Habits such as smoking will also impede the recovery rate. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers, antibiotics and blood thinners. The frequency of physiotherapy sessions will vary according to your condition and the ability of your knee joint.