Total Knee Replacement (Total Knee Arthroplasty)

Review the clinical overview, symptoms, and recovery timeline for this procedure.

Duration: 1-2 Hours Anesthesia: General or Spinal

Procedure Overview

What Is a Total Knee Replacement?

A total knee replacement (also called total knee arthroplasty) is a surgical procedure in which a damaged or worn knee joint is replaced with artificial components. The knee joint surfaces at the end of the thigh bone (femur), top of the shin bone (tibia), and sometimes the underside of the kneecap (patella) are resurfaced with metal and plastic components.
The goal of knee replacement surgery is to relieve pain, improve mobility, and restore function when non-surgical treatments are no longer effective.

Why You Might Need This

Why Might a Total Knee Replacement Be Recommended?

You may be advised to have a total knee replacement if you have:
  • Severe knee pain that limits daily activities such as walking, climbing stairs, or standing
  • Pain at rest or at night
  • Significant stiffness, swelling, or deformity of the knee
  • Symptoms that persist despite medications, injections, physiotherapy, or activity modification
  • Common causes include:
  • Osteoarthritis (most common)
  • Rheumatoid or inflammatory arthritis
  • Post-traumatic arthritis following injury or fracture

Clinical Outcomes & Patient Safety

Key Benefits

Benefits of Total Knee Replacement

  • Significant reduction or elimination of knee pain
  • Improved walking and function
  • Increased independence in daily activities
  • Improved quality of life and sleep

Risks & Considerations

Risks and Possible Complications

As with any major surgery, total knee replacement carries risks, including:
  • Infection
  • Blood clots in the legs or lungs
  • Ongoing pain or stiffness
  • Knee instability or limited range of motion
  • Nerve or blood vessel injury
  • Fracture around the implant
  • Implant loosening or wear over time
  • Your surgical team will take steps to reduce these risks and will discuss them with you before surgery.

Preparing for Surgery
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Medical Preparation

  • Attending a preoperative assessment clinic to review your overall health. This may require blood tests, X-rays, and heart tests.
  • Reviewing medications with your healthcare provider, as some may need to be stopped before surgery.
  • Managing existing conditions (such as diabetes, anemia, high blood pressure, or heart disease) as well as possible
  • Treating existing infections (including dental, skin, or urinary infections) before surgery
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Lifestyle Preparation

  • Stop smoking, ideally several weeks before surgery, as smoking can delay healing and increase risk of complications
  • Maintain a healthy diet rich in protein, vitamins, and minerals to support healing
  • If advised, try to lose excess weight to reduce stress on the new joint
  • Begin preoperative exercises ("prehabilitation") to strengthen hip and leg muscles and improve flexibility
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Plan Ahead

  • Arrange time off work and discuss return-to-work plans with your healthcare provider
  • Organize help at home for the first few weeks after surgery
  • Plan transportation to and from the hospital on the day of surgery and for follow-up appointments. You will not be able to drive initially.
  • Prepare questions and concerns to discuss with your surgical team

What to Expect After Surgery

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  • Hospital stay is usually 1–3 days, depending on recovery and overall health
  • Pain will be managed with medications
  • You will begin standing and walking with assistance (walker or crutches) within a day
  • Physiotherapy starts early to restore movement, strength, and confidence
  • Blood-thinning medications and compression devices may be used to reduce the risk of blood clots
  • Nurses and therapists will teach you how to move safely, get in and out of bed, dress, and use the bathroom

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Preparing your home before surgery can help make your recovery smoother and more comfortable. Upon your return home, you can expect to:
  • Continue physiotherapy exercises daily
  • Gradually increase walking and activity as advised
  • Experience pain, swelling and stiffness initially
  • Use walking aids until your surgeon or physiotherapist says they are no longer needed, which is typically after several weeks
  • Keep the surgical wound clean and dry and monitor for signs of infection (as per post-operative instructions)
  • Take medications as prescribed

Return to Work, Driving & Sports

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The timing of return to work depends on the type of work you do:
  • Sedentary work: 6–8 weeks
  • Light physical work: 8–12 weeks
  • Heavy manual labour: 3 months or longer
A gradual return is recommended.

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In Ontario, you may return to driving when:
  • You are no longer taking narcotic pain medication
  • You can safely control the vehicle and perform an emergency stop
  • Your surgeon confirms it is safe
This is typically around 6 weeks after surgery, but timing can vary.

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Low-impact activities are encouraged:
  • Walking
  • Swimming
  • Cycling
  • Lower-impact fitness programs
High-impact activities such as running or jumping sports are generally discouraged as they may increase wear on the implant. Discuss specific activities with your surgeon.

Implant Longevity & Dental Advisory

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How Long Will a Knee Replacement Last?

Modern knee replacements are designed to last many years. For most patients:
  • About 90–95% are functioning well at 10 years
  • Many last 15–20 years or longer
Longevity depends on activity level, body weight, implant type, and overall health.

IconDental & Antibiotics

In most cases, routine dental work does not require antibiotics after a hip replacement. Current guidelines generally do not recommend routine antibiotic prophylaxis for dental procedures in patients with joint replacements. The COA, CDA, and AMMI Canada provide the following guidance concerning the management of dental patients with orthopedic devices. CDA   →Canadian Dental Assoication.
  • Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
  • Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
  • Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread.
However, antibiotics may be recommended in certain situations, particularly for patients who:
  • Have a weakened immune system
  • Have poorly controlled diabetes
  • Have had previous joint infections
  • Are undergoing invasive dental procedures involving significant gum manipulation

Frequently Asked Questions

Will my knee feel completely normal after surgery?

Most patients experience major pain relief and improved function, but the knee may feel different than a natural knee.

Will I have a scar?

Yes. You will have a scar on the front of your knee, which usually fades over time.

Can I kneel after knee replacement?

Kneeling may be uncomfortable for some patients but is usually safe. Comfort varies.

Can my knee replacement get infected years later?

Although rare, infections can occur at any time if bacteria enter the bloodstream. Maintaining good dental hygiene, treating infections promptly, and following medical advice help reduce this risk.

Will I set off metal detectors at airports?

Most knee replacements contain metal, but they rarely trigger airport metal detectors. You do not need a special card. If asked, simply inform security staff that you have a hip replacement.