Total Knee Replacement
Total knee replacement — known clinically as total knee arthroplasty (TKA) — is one of the most successful elective surgical procedures in all of medicine, with more than one million procedures performed annually in the United States and a long track record of dramatic pain relief and restored function. For patients whose knee arthritis has progressed beyond the reach of conservative care, TKA reliably eliminates debilitating pain, corrects deformity, and returns the independence and quality of life that arthritis has steadily eroded. The board-certified adult reconstruction specialists at Maryland Orthopedic Specialists (MOS) perform TKA using modern techniques and evidence-based rapid-recovery protocols, guiding each patient from evaluation through return to activity with personalized, attentive care.
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What is total knee replacement?
Anatomy and the Problem The knee is divided into three compartments: the medial (inner), lateral (outer), and patellofemoral (front, between the kneecap and thigh bone). Each compartment is lined with articular cartilage — the smooth, shock-absorbing tissue that allows the joint surfaces to glide painlessly against one another.
Anatomy and the Problem
The knee is divided into three compartments: the medial (inner), lateral (outer), and patellofemoral (front, between the kneecap and thigh bone). Each compartment is lined with articular cartilage — the smooth, shock-absorbing tissue that allows the joint surfaces to glide painlessly against one another. In osteoarthritis (OA), the most common reason for TKA, that cartilage progressively wears away. As the joint space narrows and bone eventually contacts bone, the result is pain, stiffness, swelling, and deformity.
What the Surgery Does
Total knee arthroplasty resurfaces — rather than replaces — the diseased bone ends. The surgeon precisely removes the damaged cartilage and a thin layer of underlying bone from the distal femur (thigh bone), the proximal tibia (shin bone), and, when appropriate, the undersurface of the patella (kneecap). These surfaces are replaced with precisely fitted metal alloy components (cobalt-chromium on the femur; titanium or cobalt-chromium on the tibia) and a high-grade polyethylene (plastic) spacer that recreates a smooth, low-friction gliding surface. The result is a reconstructed joint that moves naturally, bears full weight, and is free of arthritic pain.
Indications for TKA
Total knee arthroplasty is indicated when the knee has been destroyed by:
- End-stage knee osteoarthritis — by far the most common indication
- Post-traumatic arthritis — arising years after a fracture or ligament injury
- Rheumatoid arthritis (RA) — inflammatory destruction of cartilage and bone
- Osteonecrosis of the knee — loss of blood supply causing collapse of the joint surface
Partial Knee Replacement as an Alternative
When disease is confined to a single compartment — most often the medial compartment — a unicompartmental (partial) knee replacement may be a better option. Partial replacement preserves the healthy compartments and the native cruciate ligaments, typically resulting in a more natural feel and faster recovery. MOS surgeons assess candidacy for partial versus total replacement as part of every evaluation.
Treatment options
Total knee arthroplasty resurfaces the worn cartilage of all three knee compartments with precisely fitted metal and polyethylene components, reliably eliminating pain and restoring function in patients with end-stage disease. The decision to proceed with surgery is always made collaboratively, after confirming that appropriate conservative measures have been given a fair trial.
Before Surgery: Considering All Options
Most patients spend months or years managing knee arthritis conservatively before reaching the threshold for surgery, and for good reason — non-operative treatment is the appropriate first step for the large majority of patients. Physical therapy strengthens the muscles around the knee and improves mechanics; weight loss reduces joint loading and is one of the most impactful interventions available; anti-inflammatory medications reduce pain and swelling; and corticosteroid or hyaluronic acid injections can provide meaningful short-term relief and serve as a useful bridge while patients optimize their health before surgery. The right time for TKA is when pain and functional limitation are no longer acceptable, conservative measures have been given a fair trial, and you are medically ready for surgery.
Outpatient and Same-Day TKA
Advances in regional anesthesia, multimodal pain management, and rapid-recovery protocols have made same-day discharge safe and effective for carefully selected patients, with multiple studies confirming complication and readmission rates comparable to overnight stays. Most patients still spend one night in the facility for monitoring and to begin physical therapy, and MOS evaluates every patient individually for outpatient eligibility based on overall health, home support, and recovery readiness.
Total Knee Replacement
Complete resurfacing of the knee joint — femur, tibia, and patella — with metal and polyethylene implants to eliminate arthritis pain and restore mechanical alignment. Performed at a hospital facility with full inpatient support services.
Click for more Surgical ProcedureRevision Total Knee Replacement
Complex re-operation to address worn, loose, unstable, or infected knee replacement components. Requires modular augments, intramedullary stems, and increased constraint levels matched to the degree of bone and ligament deficiency.
Click for moreFrequently Asked Questions
Am I too young — or too old — for total knee replacement?
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Can I kneel after a total knee replacement?
What are the risks of total knee replacement?
What is the difference between partial and total knee replacement?
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References
- Implant longevity — 20-year survival cohort: Lee BS, Bin SI, Kim JM, et al. "Twenty-year survivorship cohort study of total knee arthroplasty in Asian patients using a single posterior-stabilized implant performed by a single surgeon." Orthopaedics & Traumatology: Surgery & Research. 2023;109(5):103644. doi:10.1016/j.otsr.2023.103644. Reported 20-year cumulative survival exceeding 95% in patients aged 60 and older.
- Implant longevity — high-flexion vs. standard TKA at 20 years: Published in Journal of Arthroplasty (2021). "20-Year Minimum Outcomes and Survival Rate of High-Flexion Versus Standard Total Knee Arthroplasty." J Arthroplasty. 2021;36(2):560–565. doi:10.1016/j.arth.2020.07.084. Survival rate at 20 years was 94.8–96.8% depending on implant design.
- Outpatient TKA safety — same-day discharge: Schmidt A, Garval M, Gromov K, et al. "Feasibility, safety, and patient-reported outcomes 90 days after same-day total knee arthroplasty: a matched cohort study." Acta Orthopaedica. 2022;93. doi:10.2340/17453674.2022.2807. Demonstrated equivalent safety and patient-reported outcomes comparing same-day discharge to standard care.
- Outpatient TKA safety — systematic review with meta-analysis: Bemelmans Y, Keulen M, Heymans M, et al. "Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis." Archives of Orthopaedic and Trauma Surgery. 2021. doi:10.1007/s00402-021-03811-5. Meta-analysis confirmed comparable complication and readmission rates for outpatient vs. inpatient TKA in appropriately selected patients.
- Rapid recovery / ERAS protocols: Charron B, Bolz NJ, Lanting B, et al. "Short-Term (90 Days) Clinical Outcomes Following the Day of Surgery Conversion of Inpatient to Same-Day Hip and Knee Arthroplasty." Journal of Arthroplasty. 2024;39. doi:10.1016/j.arth.2024.05.080. Demonstrated that systematic conversion to same-day arthroplasty using ERAS protocols produced no increase in 90-day complications or readmissions.
- Patient satisfaction and outcomes — JBJS: Zheng H, Ash AS, Liu S-H, et al. "Satisfied but Failed: Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare & Medicaid Services." Journal of Bone and Joint Surgery. 2025. doi:10.2106/JBJS.25.00896. Analysis of over 1 million annual TKAs confirming high overall satisfaction rates, with identification of patient-level predictors of outcomes.
- AAOS OrthoInfo — Total Knee Replacement (patient reference): American Academy of Orthopaedic Surgeons. "Total Knee Replacement." OrthoInfo. Available at: https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/. Comprehensive evidence-based patient resource covering indications, procedure, and recovery.