What To Expect During Knee Replacement Surgery

For those living with chronic knee pain caused by arthritis, knee replacement surgery can offer a path back to a more active, comfortable lifestyle. Tyler M. Scott, MD, a fellowship-trained orthopedic surgeon at North Oaks Orthopedic Specialty Center, is dedicated to helping patients relieve pain, restore mobility, and improve their quality of life through hip and knee joint reconstruction.

In this interview, Dr. Scott explains what total knee replacement surgery really involves, when it's typically recommended, and what patients can expect from preparation through recovery.

What is knee replacement surgery?

Knee replacement surgery is essentially resurfacing the ends of the bones. We're not replacing the entire knee—we're resurfacing the arthritic parts at the end of the femur and tibia. Those damaged surfaces are covered with metal implants, and a plastic piece is placed in between to help the joint move more smoothly and without pain.

When is knee replacement surgery recommended?

We perform knee replacements primarily for arthritis. There are other conditions that can lead to needing a knee replacement, but arthritis is by far the most common reason. Generally, knee replacement is recommended when conservative treatments, such as medications, injections, or physical therapy, are no longer providing enough relief.

Can you explain how patients should prepare for knee replacement surgery?

We have what's called Joint Camp, which takes place the week before surgery. One of our nurse practitioners leads it and goes over everything patients need to know to prepare, like how to get your home ready, what to do if you have pets, how to manage stairs, and what equipment you may need after surgery.

We try to make it as individualized as possible. We spend time getting a sense of each patient's home and social situation so we can plan accordingly. For example, if someone has transportation issues or can't get to outpatient physical therapy, we can arrange home health therapy instead.

What should patients expect on the day of the procedure?

On the day of the procedure, you'll typically arrive at the hospital a couple of hours before your scheduled surgery. You'll check in through our same-day surgery area, where the nursing staff will get you settled in a room and start preparing you for surgery.

Before surgery, you'll meet with me so we can go over the plan one more time and make sure we're all on the same page. You'll also meet with the anesthesiologist.

Once everything is ready, you'll be taken back to the operating room. We get everything set up, prep and clean the knee, and then perform the surgery. The knee replacement itself usually takes about 45 minutes to an hour. When you factor in all the prep before and after the procedure, you're typically back there for around three hours total.

After surgery, you'll spend some time in the recovery area, usually about 30 minutes to an hour. If you're planning to go home the same day, you'll then return to the same-day surgery unit. We'll let you wake up and make sure your pain is under control.

Physical therapy will see you before you leave, and if you do well and meet the therapy goals, you can go home that day. In fact, about 80% of our hip and knee replacement patients go home the same day.

Physical therapy typically starts about three days after surgery, and that's when we really begin working on your recovery and getting you back to your normal activities.

What should a patient expect from the recovery process?

Mobility-wise, most patients are up and walking the same day as surgery. In fact, if you're planning to go home that day, you have to be able to walk and clear physical therapy before you're discharged.

As far as pain goes, the first couple of days are usually the toughest. It is major surgery, so the knee is going to be sore, swollen, and painful, and we're asking you to start moving it right away. That's a lot for the body to handle. To help with that, we send patients home with a multimodal pain management plan designed to keep them as comfortable as possible while recovering.

By about two weeks after surgery, most people are around 50% to 60% recovered. A lot of the swelling has started to come down. They've been working with physical therapy, and they're getting stronger.

Many patients are still using a walker at that point, but they're usually getting close to transitioning away from it. A lot of that depends on how stable and confident they feel, as well as how their strength is coming along.

We typically see patients back at the six-week mark. By then, most people are closer to 70% recovered. Their range of motion is usually improving, the pain has decreased quite a bit, and while there may still be some soreness in the muscles and soft tissues around the knee, most of the arthritic bone pain is gone.

By three months, most patients are about 80% to 90% recovered and are getting back to many of their daily activities. Recovery continues after that, though, and it can take up to a full year to see the final results of a knee replacement.

How long does a knee replacement last?

The largest studies looking at long-term outcomes show that roughly 80% to 90% of knee replacements are still working well at the 20-year mark. Those numbers take everything into account, including complications such as infection, instability, or implant loosening.

For many patients, it doesn't make sense to wait until they're miserable. If arthritis is affecting your quality of life, it's often worth having the conversation sooner rather than later.

What advice would you give someone who is nervous about having knee replacement surgery?

It's completely normal to be nervous about a knee replacement. It is a major surgery. But one thing I always tell patients is that we have an outstanding team that will guide you through every step of the process and make sure you feel comfortable and informed along the way.

We never push surgery on anyone. The decision to have a knee replacement is always the patient's decision. I'm never going to tell someone they have to have surgery. It's a shared decision, and we only move forward when the patient feels comfortable and ready.

I think it also helps to know that this is what we do every day. We have a dedicated joint replacement team and a well-established program focused on caring for patients before, during, and after surgery. We spend a lot of time making sure patients are prepared for what to expect, and then we stay involved throughout the recovery process to make sure they're doing well.

Our goal is to help you feel confident, supported, and informed every step of the way, from your first visit through your recovery after surgery.

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Is joint pain affecting your quality of life? Schedule an appointment with one of our total joint specialists at (985) 230-2663.

Find out more about Dr. Scott and his specialty here.

Learn more about knee replacement surgery and other orthopedic services at North Oaks Health here.