The goal of total knee replacement surgery is to relieve knee pain and increase knee function by resurfacing the bones that meet at the knee joint. The surgeon removes damaged portions of bone at the end of the femur (thigh-bone) and top of the tibia (shin-bone) and replaces them with prosthetic components. Some surgeries also resurface the back of the patella, or kneecap.

Total Knee Replacement
Illustration of total knee replacement surgery.

Below is a step-by-step description of a typical total knee replacement surgery. The actual surgery typically lasts for two hours per knee.

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Knee Replacement Surgery Step-by-Step Description

Surgical procedures differ depending on the patient’s needs and the surgeon’s approach, but generally the steps are as follows:

  1. The patient’s vital signs are checked to make sure blood pressure, heart rate, body temperature, and oxygenation levels are normal and surgery can proceed. A mark is made on the knee undergoing surgery.
  2. Anesthesia is administered. The patient may receive general anesthesia (be put to sleep) or be given a regional anesthesia to block sensation from the waste down along with a relaxant. What type of anesthesia a patient receives is decided well ahead of time.
  3. The surgeon makes an incision down the center of the knee about 8 to 10 inches long, and then cuts through deeper tissue, including the quadriceps tendon, and flips over the kneecap to access the femur and tibia. Alternatively, some surgeons make smaller incisions and use minimally invasive techniques for total knee replacement.
  4. To improve the surgeon’s ability to access to the joint, the knee is bent to 90 degrees.
  5. The surgeon uses a bone saw to remove the arthritically damaged areas at bottom of the femur and the top of the tibia. Each bone is reshaped to exactly fit its new prosthesis. Because these cuts must be precise, the surgeon uses either a metal jig or computer assistance to line up the cuts.
  6. A surgeon may resurface the back of the kneecap, or patella, and attach an implant. A polyethylene component may be attached to facilitate the patella’s gliding against the new joint. Research has not shown a significant difference in outcomes for patients who received patella resurfacing and those who did not.9,10
  7. Components are attached to the femur and tibia and patella, if applicable. How the components are attached to the bone will depend on what type of component is used. Most knee replacement surgeries use cemented components that are affixed using bone cement. Cemented and cementless components offer different advantages.
  8. A flexible cushion made of polyethylene is attached on top of the new tibia surfaces. This spacer acts as a shock absorber between the two new prosthetic surfaces.
  9. The leg is flexed and extended to test the fit of the components and the new knee’s range of motion.
  10. The surgeon straightens the knee to allow the components, cement, and bone to bond together. Because the bone cement is fast acting, this takes only about 10 minutes.
  11. The surgeon will repair any deep tissue that was cut during surgery and then stitch the skin at the incision.

See The Pros and Cons of Double Knee Replacement

After surgery, a patient may be taken to a recovery room for several hours while the surgical anesthesia wears off. Afterwards a patient typically is taken to a hospital room where he or she will spend 3 to 7 days before being discharged.


  1. Breeman S, Campbell M, Dakin H, Fiddian N, Fitzpatrick R, Grant A, Gray A, Johnston L, Maclennan G, Morris R, Murray D; KAT Trial Group. Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. J Bone Joint Surg Am. 2011 Aug 17;93(16):1473-81. PubMed PMID: 22204002.
  2. Pavlou G, Meyer C, Leonidou A, As-Sultany M, West R, Tsiridis E. Patellar resurfacing in total knee arthroplasty: does design matter? A meta-analysis of 7075 cases. J Bone Joint Surg Am. 2011 Jul 20;93(14):1301-9. PubMed PMID: 21792496.