What to expect from a total knee replacement

A total knee replacement is a common procedure for people whose knees are severely affected by arthritis or injury. This knee replacement surgery can relieve pain, restore mobility, and improve quality of life.

In this article, consultant orthopaedic and trauma surgeon Mr Sujit Agarwal explains what happens before, during, and after the operation, so patients understand what to expect at each stage of their journey.

Why a total knee replacement may be needed

Knee replacement surgery is usually recommended when conservative treatments, such as medication, physiotherapy, or injections, are no longer effective. Most patients have severe osteoarthritis, which causes pain, stiffness, and reduced mobility. Other causes include rheumatoid arthritis, previous knee injuries, or deformities. Surgeons assess symptoms, medical history, and imaging scans to determine whether a total knee replacement is appropriate.

Preparing for surgery

Before the operation, patients attend a preoperative assessment clinic. The team reviews overall health, discusses anaesthesia options, and performs any necessary blood tests or scans. A physiotherapist may provide exercises to aid recovery.

Lifestyle considerations

Maintaining a healthy weight, quitting smoking, and optimising general fitness can improve surgical outcomes. Preparing the home for recovery, such as arranging a safe space for mobility aids, is also recommended.

The procedure

During a total knee replacement, the damaged surfaces of the knee joint are removed and replaced with artificial components made of metal and plastic. The surgery usually takes 1–2 hours and is performed under general or spinal anaesthesia. The surgical team takes every precaution to minimise infection risk and ensure the best possible alignment of the new joint.

Recovery and rehabilitation

Most patients remain in hospital for 1–2 days. Pain management, early mobilisation, and physiotherapy begin immediately after surgery. Patients are encouraged to walk with support, bend the knee, and perform simple exercises to restore movement.

Physiotherapy and home recovery

After discharge, physiotherapy continues for several weeks. Regular exercises strengthen muscles around the knee and improve flexibility. Full recovery can take 3–6 months, though significant pain relief and improved mobility are often noticed within the first few weeks.

Lifestyle after surgery

Some activities may need adjustment, particularly high-impact sports. Most patients can return to walking, swimming, and cycling, but running or jumping is usually discouraged to protect the implant.

Risks and considerations

As with any surgery, knee replacement surgery carries risks, including infection, blood clots, stiffness, or implant loosening over time. Surgeons discuss these risks and strategies to minimise them. Following advice on physiotherapy and lifestyle changes is key to achieving the best outcome.

Understanding what to expect before, during, and after total knee replacement surgery helps patients approach the procedure with confidence and participate actively in their recovery. Discussing concerns with the surgeon, following physiotherapy guidance, and optimising overall health support the best possible results.