Total Knee Arthroplasty

How total knee replacement works

The knee is formed where the end of the thigh bone meets the top of the shin bone, with the kneecap gliding in a groove at the front. In advanced arthritis, the cartilage covering these surfaces is thinned or gone, and bone can rub against bone. A total knee replacement does not remove the whole knee. It removes a thin layer of damaged bone and cartilage from the end of the thigh bone and the top of the shin bone, and reshapes those surfaces so that implant components can be fitted onto them.

The components are typically a metal surface on the thigh bone, a metal platform on the shin bone, and a smooth plastic bearing between them that acts as the new gliding surface. The back of the kneecap may also be resurfaced. The surgeon works to restore the alignment of the leg and to balance the soft tissues and ligaments around the knee so that the joint moves and feels stable through its range of motion. The word arthroplasty simply means surgical reshaping of a joint.

Symptoms that often lead people to consider it

• Knee pain that persists at rest or at night, not only with activity
• Difficulty with walking distances, stairs, or getting out of a chair or car
• Stiffness or a knee that will not straighten or bend as it used to
• Progressive bowing or angulation of the leg
• Limited relief from therapy, medication, bracing or injections over time

How it is evaluated

A decision about knee replacement rests on the examination and imaging together with how much the knee is affecting your life. Standing x-rays show the joint under load and how much cartilage space remains in each compartment. Examination assesses alignment, motion, ligament stability and the strength of the surrounding muscles. General health matters as well, since anesthesia, other medical conditions, skin condition and support at home all factor into planning. Conditions that can mimic knee pain, such as referred pain from the hip or spine, may also be considered.

Treatment options in general terms

Replacement is generally considered only after non-surgical care has been given a fair trial. Measures that may be discussed first include:

• Therapy and conditioning. Strengthening and range-of-motion work, and low-impact activity.
• Medication and injections. Anti-inflammatory options, and injection categories such as anti-inflammatory or hyaluronic acid preparations.
• Bracing and activity change. Unloading the affected side of the knee and adjusting demanding activities.

If surgery is appropriate, several forms of arthroplasty may be discussed:

• Total knee replacement. Resurfacing the whole joint when arthritis involves more than one compartment.
• Partial, or unicompartmental, replacement. Resurfacing only one worn compartment in selected cases.
• Patient-specific implants. Components and instruments shaped from imaging of your own knee anatomy.
• Revision arthroplasty. Surgery on a knee that has already been replaced, if a problem develops with an existing implant.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada and takes a conservative view of surgery, preferring to exhaust reasonable alternatives first. A consultation covers your history, your imaging, an examination, and an honest discussion of what a replacement is intended to address and what it is not. Preparation before surgery, anesthesia, and the rehabilitation that follows are all part of that conversation. Second opinions are welcome.

This page provides general information about total knee arthroplasty and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]