Knee Replacement Surgery and the Recovery Process

Knee replacement surgery is a highly effective procedure designed to relieve the severe pain and restricted mobility caused by irreversible wear and tear of the cartilage in the knee joint. By replacing the damaged joint surfaces with specially designed artificial materials, this method allows patients to return to their daily lives pain-free and independently.

• It is considered the most effective and long-lasting surgical treatment for gonarthrosis (knee osteoarthritis).
• The surgery takes about one hour on average, and patients are usually encouraged to walk the day after the operation.
• Thanks to advancing technology, new-generation knee prostheses can last up to 18 to 20 years under the right conditions.
• Starting physical therapy early in the postoperative period is critical for a full and smooth recovery.

What Are Knee Osteoarthritis (Gonarthrosis) and Knee Replacement?

Gonarthrosis is a condition where the cartilage layer of the knee joint suffers progressive and irreversible damage, whether from unknown causes (idiopathic) or due to various diseases affecting the joint. Commonly known as knee osteoarthritis or "calcification" of the knee in Türkiye, this condition leads to severe functional impairment, loss of mobility, and intense pain. Pain that does not respond to treatment severely disrupts a patient's quality of life and, if left untreated, can eventually become disabling.

A knee replacement is a permanent and highly effective surgical solution that comes into play when the cartilage tissue has completely lost its function. It involves surgically removing the deteriorated joint surfaces and replacing them with an artificial joint made of metal and polyethylene (a specially durable plastic) components. Using custom-prepared materials and advanced surgical techniques, a synthetic joint is created that can comfortably bear the body's weight and restore a certain range of motion. This allows the patient to regain their former mobility.

Causes and Risk Factors of Knee Osteoarthritis

Multiple factors play a role in the development of knee osteoarthritis. The most common cause is obesity accompanying advanced age. An increase in body weight directly increases the load on the knee joints, causing the cartilage tissue to wear out much faster than normal. The natural weakening of the cartilage structure with aging, especially in individuals aged fifty and over, is also a fundamental risk factor.

In addition, permanent cartilage damage caused by various infections affecting the knee joint is a significant cause. Past traumas that disrupt the intra-articular alignment, meniscus or ligament injuries, and fractures involving the joint accelerate the osteoarthritis process. Congenital or acquired alignment disorders in the legs (such as bowlegs) also lead to excessive loading on specific areas of the knee, initiating cartilage destruction. Genetic predisposition is another factor that should not be overlooked.

Symptoms of Knee Osteoarthritis

The symptoms of the disease usually begin gradually and worsen over the years. In the early stages, the most prominent complaint is knee pain that increases with prolonged walking, climbing stairs, or squatting. Patients often report that the pain eases when they rest. However, as cartilage damage progresses, pain begins to be felt even while resting or during sleep at night.

In addition to pain, a feeling of stiffness and tightness in the knee is prominent, especially after waking up in the morning or remaining inactive for a long time. Friction or cracking sounds (crepitus) coming from the knee when the joint is moved are another common symptom. In advanced stages, swelling, deformity, and inward or outward bowing of the leg may be observed. Over time, patients become unable to fully bend or straighten their knees, making it impossible to perform daily life activities independently.

How Is It Diagnosed at the Hospital?

For patients presenting with knee pain, the diagnostic process begins with a detailed physical examination. The orthopedic doctor checks for swelling in the knee, range of motion, ligament stability, and leg alignment. The patient's walking pattern and the specific movements that trigger the pain are carefully evaluated.

The most fundamental and widely used imaging method for a definitive diagnosis is an X-ray. Two-way knee X-rays taken while standing and bearing weight clearly show how much the joint space between the bones has narrowed, the degree of cartilage loss, and the new bone spurs (osteophytes) formed at the bone edges. In most gonarthrosis cases, X-ray findings are sufficient to make a diagnosis and plan treatment. However, if accompanying soft tissue problems such as meniscus tears, ligament injuries, or bone marrow edema are suspected, your doctor may also request a Magnetic Resonance Imaging (MRI) scan for a more detailed assessment.

Non-Surgical Treatment Options

When planning treatment for knee osteoarthritis, non-surgical methods are primarily evaluated based on the stage of the disease. In early and middle-stage gonarthrosis patients, the main goal is to control pain and slow the progression of the disease. The most important step at this stage is weight management; losing even a few kilograms significantly reduces the load on the knee joint.

Physical therapy and rehabilitation practices are highly effective in reducing stress on the joint by strengthening the muscles around the knee. Painkillers and anti-inflammatory medications are used to alleviate complaints during flare-ups. Intra-articular injections are also among the frequently utilized methods. Hyaluronic acid (joint fluid) injections lubricate the joint, while PRP and stem cell therapies aim to support tissue healing. For more detailed information, you can review our article titled Stem Cell Applications in Knee Pain. If the patient's pain persists and their quality of life declines despite all these methods, surgical treatment comes to the forefront.

Pre-Surgery Preparation Process

Once the decision for a knee replacement is made, a comprehensive preparation process is initiated to ensure the patient undergoes surgery as safely as possible. First, the patient's general health status is evaluated through detailed blood tests, an electrocardiogram (ECG), and a chest X-ray. An anesthesiologist examines the patient and decides on the anesthesia method to be applied (usually spinal or epidural anesthesia, commonly known as a nerve block from the waist down).

If the patient uses blood thinners, these medications must be stopped or adjusted a certain period before the surgery under a doctor's supervision. Since any active infection in the body (such as tooth decay or a urinary tract infection) increases the risk of prosthesis infection, it is essential to detect and treat these conditions before surgery. Additionally, patients preparing their homes for the postoperative period—such as removing rugs that pose a tripping hazard and acquiring assistive equipment like raised toilet seats—will facilitate the recovery process.

How Is Knee Replacement Surgery Performed?

Knee replacement surgery is a procedure requiring high precision that takes about one hour on average. During the surgery, the deteriorated cartilage structures and the thin bone layer beneath them are removed from the joint by making millimetric incisions with the help of special guiding instruments. Based on the patient's preoperative evaluation, the most suitable materials to be used are decided in advance.

Fundamentally, knee prostheses consist of three main parts: metal components implanted into the thigh bone (femur) and shin bone (tibia), and a durable polyethylene (plastic) piece situated between them that minimizes friction. In some cases, a polyethylene piece may also be added under the kneecap (patella). These metal parts are firmly attached to the bone using a special filler called bone cement. The orthopedic surgeon decides which prosthesis brand or system to use based on the patient's bone structure and mobility expectations, and successfully completes the surgery.

Physical Therapy and Recovery

Following a successful surgery, the most critical stage of the recovery process after a knee replacement is physical therapy. The standard expected process involves the patient standing up and walking with the help of a walker the day after the surgery. Early movement is vital for both regaining joint range of motion and preventing blood clot formation.

Patients are usually able to walk up and down a flight of stairs (10-12 steps) within a week. The surgical stitches are typically removed, and wound care is completed after about two weeks. With regular exercises, the goal is for the patient to walk without support within an average of six weeks. Achieving a completely pain-free, natural-feeling, and functional knee takes anywhere from 2 to 6 months, depending on the individual. Consistently performing the prescribed home exercises during this period directly impacts the longevity and success of the prosthesis.

Complications and How Long Does a Knee Replacement Last?

As with any major surgical procedure, there are certain risks associated with knee replacement. The two most important complications are blood clot formation in the leg veins (deep vein thrombosis) and the development of an infection around the prosthesis. To minimize these risks, patients are prescribed special blood-thinning medications post-surgery, and antibiotic treatment is administered starting during the operation and continuing for a specific period. Early mobilization and the use of compression stockings also reduce the risk of blood clots.

One of the questions patients ask most frequently is how long a knee replacement lasts. With advancing technology, improvements in manufacturing techniques and material quality have significantly extended the lifespan of prostheses. Currently, an average lifespan of 18 to 20 years is expected for patients who maintain a healthy weight and protect the joint from heavy impacts. If wear or loosening of the prosthesis occurs in later years, a revision knee replacement surgery can successfully remove the old components and implant new-generation specialized prostheses that compensate for any bone loss.

When Should You See a Doctor?

If knee pain begins to restrict your daily life, you should see a specialist without delay. You should consult an orthopedic doctor especially if the pain occurs while resting or is severe enough to wake you from sleep at night, if there is sudden swelling, redness, or locking in the knee, or if your walking distance has significantly decreased.

In the postoperative period, there are certain warning signs that require emergency medical intervention. If sudden and severe pain or excessive swelling develops in the calf of your operated leg, or if you experience chest pain or shortness of breath (suspected pulmonary embolism), you must immediately call 112 (or your local emergency number) or go to the nearest emergency room. Furthermore, foul-smelling, purulent discharge from the surgical wound or a persistent fever above 38°C (100.4°F) can be signs of infection, making it essential to contact your doctor without losing time.

The Knee Replacement Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Orthopedics and Traumatology department, we provide services in the field of knee osteoarthritis and joint replacement surgery with state-of-the-art medical equipment and an experienced medical staff at international standards. Our patients' detailed preoperative planning, surgical operations, and postoperative physical therapy processes are meticulously managed under one roof with a multidisciplinary approach.

Our hospital's fully equipped operating rooms, advanced technology imaging devices, and strict infection control standards ensure that surgical success is kept at the highest level. Our 24/7 emergency service and intensive care units are always ready for any potential emergencies or postoperative needs. To get more detailed information about knee osteoarthritis treatment and the knee replacement process, to consult with our specialist Op. Dr. Zafer SOYDAN, and to have a comprehensive examination, you can book an appointment through our call center or website.

Frequently Asked Questions

Can double knee replacement be done at the same time?

If the patient's general health, age, and cardiopulmonary capacity are suitable, bilateral knee replacement surgery can be performed in the same session. However, for elderly individuals or those with severe comorbidities, it may be preferable to perform the surgeries one at a time, a few months apart, to reduce risks.

Can I play sports after the surgery?

Once the recovery process is complete, low-impact sports such as walking, swimming, cycling, and light hiking can be safely enjoyed. However, high-impact sports like football, basketball, or heavy running are not recommended as they can shorten the lifespan of the prosthesis.

Is knee replacement surgery very painful?

Since anesthesia is administered during the surgery, no pain is felt. After the surgery, modern pain pumps (via epidural or intravenous routes) and strong painkillers are used to ensure the patient goes through this process as comfortably as possible.

At what age is knee replacement surgery performed?

Although it is generally performed on patients aged 60 and over, it can also be done at younger ages depending on the severity of the osteoarthritis and the decline in the patient's quality of life. When making the decision, the degree of cartilage damage is taken into consideration rather than age alone.

Is prosthesis replacement (revision) possible?

Yes, knee prostheses that wear out, loosen, or develop an infection over time can be replaced with a second surgery called revision surgery. This procedure uses more specialized revision prostheses that compensate for bone loss.

This article is for informational purposes only; please be sure to consult your doctor for diagnosis and treatment.