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A total knee replacement replaces  the joint surface of the bottom of the thighbone and the top of the shinbone. The kneecap may be resurfaced as well. The artificial knee is made of metal components that are secured to the bone using special bone cement. A polyethylene insert fixed to the metal tray of the shinbone component acts as the gliding surface. The kneecap button is made of the same polyethylene.


Total knee replacement is the ultimate solution for the pain caused by arthritis in the joint. In the first instance though you should try to manage your pain with lifestyle changes, exercise and medication. You can find further advice on this here. If you still cannot walk as much as you would like because of pain or cannot sleep the time has come to consider surgery.

The NJR decision support tool can help you get an idea of what you can expect from the surgery.


    Preparing for your operation

    We need to make sure you are as fit and prepared as possible to minimise the risk of complications and to ensure a speedy and smooth recovery. You will have a pre-assessment to identify any correctable abnormalities such as high blood pressure, anaemia​ and diabetes. It is advised that you stop smoking and try to loose weight if applicable. If you have a BMI of 40 or more we may have to postpone your surgery until you can loose some weight.

    We will ask you to take part in a joint replacement class which is run by our physiotherapists. This is an invaluable resource to prepare you for your joint replacement journey from pre-surgery exercises to rehabilitation afterwards.

    Surgical procedure

    Knee replacement requires a general or spinal anaesthetic and the consultant carrying this out will discuss with you which one is best considering your circumstances and preferences.

    During surgery a cut is made over the front of the knee and the joint is exposed. The damaged joint surfaces are removed, the bone is ​prepared for the artificial components which are fixed using bone cement. To conclude the operation the soft tissues and the skin are carefully closed. Learn more.


    We aim to get you back on your feet and walking on the day of your operation. We will keep you comfortable using the least possible amount of pain medication.

    Our physiotherapists will guide you through the process of how to get in and out of bed and use any walking aid you may require. All being well you can go home after one or two nights in hospital.

    We will give you an exercise program for home and our physiotherapists will assess your progress regularly. You can walk and use your knee as you are comfortable.


    Pain relief. The knee joint is more painful than the hip and takes longer to settle down. You need to exercise the knee gently so the inflammation and swelling can gradually settle down.

    Range of movement improves over time, although this may take longer if you had a very stiff knee to start with.

    Your mobility should improve gradually and if there are no other limiting conditions you should be able to walk a few miles after 6 weeks.

    Correction of bowed or knock knee. The surgery should restore normal alignment of the knee.


    Fracture of the thigh bone or the shin may occur during surgery or later such as after a fall. 

    Persistent pain can occur and sometimes does not settle completely even after months of rehabilitation.

    Infection is a major complication which may require further surgery.

    Significant bleeding is uncommon.

    Nerve injury is rare. 

    Blood clots can form in the deep veins of the leg or cause a blockage of the arteries of the lung. 

    A sensitive scar usually improves over time.

    Serious anaesthetic complications are rare.

    The overall benefit of surgery should far outweigh the risks, but it is important that you understand these in detail so you can make an informed decision. Learn more.
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