If you're considering knee replacement, orthopedic surgeon Peter White, DO, MS, shares what to know, including whether you're a candidate, alternatives to surgery and what to expect before and after your procedure.
What is knee replacement surgery?
Knee replacement, also called knee arthroplasty, is a procedure that removes damaged cartilage and bone and replaces them with an artificial joint.
It's typically recommended when non-surgical treatments like physical therapy, medications or injections no longer provide relief. At that point, the goal shifts to improving quality of life and restoring function.
As Dr. White explains, "Knee replacement is really about improving quality of life. When pain starts limiting everyday activities, that's when we begin to consider surgical options."
Who is a candidate for knee replacement?
You may be a candidate if you experience:
- Persistent knee pain that limits daily activities
- Difficulty walking, climbing stairs or standing
- Pain at rest or during sleep
- Stiffness or swelling that doesn't improve
- Limited relief from non-surgical treatments
Many patients also experience frustration or loss when they can no longer do the activities they enjoy.
"We really look at how pain is affecting a patient's daily life," Dr. White says. "If it's interfering with simple activities, it may be time to talk about knee replacement."
Ultimately, candidacy is based on how much your symptoms affect your quality of life—not just imaging findings or age.
What are the alternatives to knee replacement?
Before surgery, several non-operative treatments may help manage knee osteoarthritis, including:
- Anti-inflammatory medications
- Cortisone or other injections
- Physical therapy
- Activity modification
- Weight management
"These treatments can be very effective for a period of time," Dr. White notes, "but they don't reverse arthritis. When they stop working, we start discussing surgical options."
What is a partial knee replacement—and who is it for?
A partial knee replacement replaces only the damaged portion of the knee rather than the entire joint.
You may be a candidate if your pain and arthritis are isolated to one part of the knee and the rest of the joint, including the ligaments, remains healthy.
"By only replacing the part of the knee that's damaged, we can often preserve more natural motion and make recovery easier and safer," says Dr. White.
Benefits may include:
- Smaller incision
- Less invasive surgery
- Faster recovery
- More natural knee function
That said, not everyone is a candidate. In cases of more widespread arthritis, a total knee replacement may be the better option. Partial knee replacements may also have a higher reoperation rate at 10 to 15 years.
"Through shared decision-making, I try to assess and educate patients on the two operations to help them choose the right one for their personal goals," says Dr. White.
Is knee replacement done robotically?
Yes. Many knee replacements today can be performed using robotic-assisted technology, such as the Mako Robotic-Arm Assisted Surgery System or VELYS Robotic-Assisted Solution.
These systems use advanced imaging to create a detailed, personalized surgical plan before the operation. During surgery, they help the surgeon perform highly precise bone preparation and implant positioning based on each patient's anatomy.
"Robotic-assisted surgery allows us to tailor the procedure to each patient's anatomy and improve precision in the operating room," says Dr. White.
Robotic technology does not perform the surgery on its own—it enhances the surgeon's accuracy and control to help optimize alignment and implant placement.
Do you offer minimally invasive knee replacement?
Yes. Minimally invasive techniques such as the subvastus approach can be used for total knee replacement in appropriate patients. This approach focuses on using smaller incisions, preserving the quadriceps tendon and limiting disruption to muscles and soft tissue around the knee.
The goal is to reduce surgical trauma, which may lead to less postoperative pain and a faster initial recovery in suitable candidates.
Minimally invasive surgery may be performed with or without robotic assistance, depending on the patient's anatomy and surgical plan. When combined with robotic technology like Mako, it allows for both a tissue-sparing technique and highly precise implant positioning.
What if I've had a knee replacement and it doesn't feel right?
This is more common than many people realize.
Symptoms may include:
- Persistent pain
- Instability or a loose feeling
- Stiffness
- A knee that simply doesn't feel natural
"The most important step is getting a proper evaluation," says Dr. White. "There are many reasons a knee replacement may not feel right, and identifying the cause is key to fixing the problem."
If something feels off, don't ignore it. A consultation with a specialist can help determine the next steps.
How to prepare for knee replacement surgery
Preparing ahead of time can make recovery smoother and help you feel more confident going into surgery.
You'll want to:
- See your primary care physician for medical clearance
- Complete pre-surgical testing
- Review medications with your care team
- Manage chronic conditions
- Prepare your home for recovery
- Arrange help for the first few days after surgery
Removing tripping hazards, setting up a recovery space and planning transportation can also make a big difference.
"Patients who prepare and educate themselves ahead of time tend to feel more comfortable and recover more smoothly," Dr. White says.
What happens on the day of surgery?
Knee replacement surgery typically takes one to two hours. Many surgeries are performed with spinal anesthesia, while some are done with general anesthesia.
After anesthesia wears off, most patients begin moving the knee and walking with the support of physical therapy.
Depending on your recovery plan, you may go home the same day or stay briefly in the hospital.
What to expect after knee replacement
Recovery begins right away and continues over several months. Movement and physical therapy usually start immediately after surgery.
Dr. White describes recovery this way: "It's the long game. Everyone is a little different, but on average, the first two weeks focus on incision healing. The following month focuses on regaining range of motion. During the first four to six weeks, patients may feel somewhat worse than before surgery. After that, most patients turn the corner, and by three months, most are feeling better than when they started and continuing to improve."
Pain is managed with a combination of medication, movement and therapy. Over time, most patients regain independence and return to daily activities.
"Recovery is a partnership," Dr. White emphasizes. "The surgery is one step, but physical therapy and patient engagement are just as important to achieving a great outcome."
Frequently asked questions
How long does a knee replacement last?
Most knee replacements last 20 years or longer, depending on activity level and overall health.
When can I walk after surgery?
Most patients begin walking the day of surgery using a walker or cane.
How long is the recovery process?
While most people walk right away, initial recovery often takes several weeks, with continued improvement over a few months.
When can I drive again?
You can typically start driving two to six weeks depending on your recovery and which knee was treated.
Will I need physical therapy?
Yes. Physical therapy is essential to restore strength, flexibility and function.
Are there risks with knee replacement?
As with any surgery, risks include fracture, infection or blood clots. These risks are uncommon, and your care team will take steps to reduce them.
When can I start exercising?
You can do low-impact activities like walking, swimming or cycling after recovery. Dr. White does not routinely limit his patients' activities. The goal of surgery is to improve quality of life, including helping you return to activities you enjoy.
The bottom line
Knee replacement surgery is a highly effective option for people with chronic knee pain that limits daily life. With advances like robotic-assisted and minimally invasive techniques, patients can expect more personalized care and improved outcomes.
Chronic knee pain doesn't have to limit your life. Meet with a Tufts Medicine orthopedic specialist to explore your treatment options.
