Knee Replacement Surgery

Total knee replacement, also known as total knee arthroplasty, is a procedure used to treat severe knee arthritis and other forms of advanced knee joint damage. It is usually recommended when pain, stiffness, and reduced mobility can no longer be managed adequately with non-surgical treatment. The aim of surgery is to relieve pain, improve function, correct deformity where present, and help patients return to everyday activities with a more comfortable and reliable knee.

When is knee replacement surgery considered?

Knee replacement surgery may be considered when knee pain has become chronic and is no longer responding to conservative treatment such as physiotherapy, anti-inflammatory medication, injections, activity modification, weight management, or walking aids. It may also be appropriate when pain is severe enough to limit daily activities, disturb sleep, reduce walking distance, or interfere with work and quality of life. Common reasons for surgery include advanced osteoarthritis, inflammatory arthritis, post-traumatic arthritis, deformity, and significant joint damage seen on X-ray imaging.

What is a total knee replacement?

The knee joint is formed by the femur, tibia, and patella. In a healthy knee, the ends of the bones are covered with smooth cartilage that allows the joint to move freely with minimal friction. When this cartilage is badly worn or the joint becomes damaged, pain, swelling, stiffness, deformity, and reduced function can develop. A total knee replacement involves removing the damaged joint surfaces and replacing them with prosthetic components made from metal and polyethylene to recreate a smooth, stable joint surface.

How knee replacement surgery is performed

Knee replacement surgery is usually performed under general or spinal anaesthesia. An incision is made at the front of the knee to allow access to the joint. The damaged cartilage and a measured amount of underlying bone are removed from the femur, tibia, and in some cases the patella. The bone is then carefully shaped so that the prosthetic components fit accurately and align properly with the patient’s anatomy and soft tissue balance.

A trial prosthesis is usually inserted first so the surgeon can assess size, fit, alignment, stability, and range of motion before the final components are implanted. Once the surgeon is satisfied that the knee is balanced and the prosthesis is correctly positioned, the final implants are secured in place. The knee is then bent and straightened to confirm stability, implant positioning, tracking, and movement before the wound is closed. The procedure commonly takes around 1 to 2 hours, after which postoperative care begins in recovery and on the ward.

A typical total knee replacement procedure may include:

• >Anaesthesia and preparation of the leg for surgery.

>An incision at the front of the knee to expose the joint.

>Removal of damaged cartilage and bone from the femur and tibia.

>Preparation and shaping of the bone to fit the prosthesis accurately.

>Trial implantation to assess size, balance, stability, and movement.

>Insertion of the final prosthetic components.

>Assessment of alignment, range of motion, and knee stability.

>Closure of the tissues and skin, followed by recovery and postoperative monitoring.

Benefits of knee replacement

The main goals of knee replacement are pain relief, improved walking ability, better knee movement, and improved quality of life. Many patients experience a major reduction in arthritic pain and are able to return to daily tasks such as walking, stairs, shopping, and low-impact exercise with greater comfort. Success depends on factors such as the severity of arthritis, the condition of the surrounding muscles and ligaments, overall health, and commitment to rehabilitation after surgery.

MAKO robotic knee replacement

MAKO robotic-assisted knee replacement is performed by Dr Kosta Calligeros and Dr Theo Partsalis at Principle Orthopaedics. This technology allows the surgeon to plan the operation using three-dimensional CT-based imaging before entering the operating theatre. A personalised surgical plan is created based on the patient’s individual anatomy, which helps guide bone preparation, implant size selection, alignment, and positioning during the procedure.

How MAKO technology works

Before surgery, a CT scan of the knee is used to build a three-dimensional model of the joint. This model allows the surgeon to map out the replacement in detail and tailor implant positioning to the patient’s anatomy. During surgery, the robotic system provides real-time data and guidance while the surgeon remains fully in control. The system helps the surgeon work within the planned boundaries and can assist with precise implant placement and soft tissue balancing.

Potential advantages of robotic-assisted surgery

Robotic-assisted surgery aims to improve the precision and consistency of knee replacement. More accurate implant positioning may help optimise alignment, balance, and the overall mechanics of the replaced knee. The draft currently states that MAKO robotic surgery may reduce the chance of readmission in the first 30 days by about 36.3 percent, but that specific percentage should only be used on the live website if it is supported by a properly cited and current source from the device manufacturer or published clinical evidence. [page:22][web:148][web:156]

• >CT-based three-dimensional pre-operative planning.

>Personalised implant positioning based on the patient’s anatomy.

>Real-time intraoperative guidance for the surgeon.

>Improved accuracy and consistency in bone preparation and alignment.

>A tailored approach to knee replacement using MAKO robotic assistance.

Risks and complications

As with any major orthopaedic procedure, total knee replacement carries potential risks. These include infection, bleeding, blood clots, stiffness, persistent pain, nerve or blood vessel injury, fracture, wound problems, instability, implant loosening, wear over time, and the possibility of revision surgery in the future. Robotic-assisted surgery carries many of the same risks as conventional knee replacement, with additional considerations related to the technology and surgical workflow.

Recovery after knee replacement

Recovery begins soon after surgery, with pain management, wound care, and early mobilisation forming the first stage of treatment. Most patients begin standing and walking with assistance shortly after the procedure, and physiotherapy is started to improve knee movement, walking pattern, strength, and confidence. Although early gains occur in the first few weeks, recovery continues for several months as swelling settles and function improves.

A general recovery pathway may include:

• >Postoperative pain management and monitoring on the ward.

>Early standing and walking with assistance.

>Physiotherapy to restore knee movement and strength.

>Gradual return to daily activities such as walking, stairs, and driving when appropriate.

>Ongoing improvement in function over several months after surgery.

Is knee replacement right for you?

If knee arthritis is causing ongoing pain, stiffness, sleep disturbance, or major limitations in daily activity, a knee replacement may be worth considering. A detailed consultation, examination, and imaging review can help determine whether total knee replacement is appropriate and whether robotic-assisted surgery such as MAKO may be suitable in your case. The goal is to provide durable pain relief, restore function, and improve quality of life with a treatment plan tailored to your needs.

Additional information

Patients who would like more information about MAKO total knee replacement can read the manufacturer’s overview here:

https://www.stryker.com/us/en/joint-replacement/systems/mako-total-knee.html