Knee Replacement Surgery - Types, Cost, Indications, Preparation, Risks, and Recovery

What is Knee Replacement Surgery?

Knee replacement surgery, also known as knee arthroplasty, is a medical procedure where a damaged or worn-out knee joint is replaced with an artificial implant. This procedure is typically recommended for individuals suffering from severe knee pain and reduced mobility due to conditions like osteoarthritis, rheumatoid arthritis, or traumatic injury.

The goal of knee replacement is to relieve pain, improve joint function, and enhance quality of life. During the procedure, the surgeon removes the damaged surfaces of the knee joint and replaces them with metal and plastic components that replicate the natural movement of the knee. The surgery can be partial or total, depending on the extent of the joint damage.

Knee replacement surgery is considered when non-surgical treatments such as medications, injections, physical therapy, or lifestyle modifications fail to provide relief. It is a highly effective solution that has helped millions of people regain mobility and live more active lives.

Why is Knee Replacement Surgery Done?

Knee replacement surgery is performed to relieve chronic knee pain, improve joint function, and restore your ability to perform everyday tasks like walking, climbing stairs, or getting out of a chair. It’s typically recommended when knee damage becomes severe and no longer responds to non-surgical treatments such as medications, steroid injections, physiotherapy, or lifestyle changes.

This surgery is not only about reducing pain—it's about restoring independence, mobility, and overall quality of life. For many patients, it provides the opportunity to return to hobbies, work, or family activities that had become too difficult due to joint issues.

Common Conditions That Lead to Knee Replacement Surgery

Several underlying conditions can damage the knee joint to a point where surgery becomes necessary:

• Osteoarthritis:
  Osteoarthritis is the most common reason for knee replacement. Osteoarthritis is a degenerative joint condition in which the protective cartilage wears down over time. As the cartilage erodes, bones begin to rub against each other, causing pain, swelling, stiffness, and reduced mobility. It’s most common in older adults but may also affect younger individuals due to obesity or joint trauma.
• Rheumatoid Arthritis:
   An autoimmune disorder where the immune system mistakenly attacks the synovial lining of the knee joint. The resulting chronic inflammation can destroy cartilage and bone, causing pain, deformity, and joint instability. If medications fail to manage symptoms, surgery may be needed to restore function.
• Post-Traumatic Arthritis:
   This develops after significant knee injuries such as fractures, ligament tears, or meniscus damage. These injuries can alter joint mechanics and cause early wear and tear of cartilage, leading to chronic pain and stiffness.
• Knee Deformities:
   Conditions like bow legs (varus deformity) or knock knees (valgus deformity) place abnormal stress on the knee joint, accelerating joint damage. Knee replacement can correct alignment issues and relieve associated symptoms.
• Severe and Persistent Pain:
   Constant pain, especially one that persists even while resting or sleeping, is a strong indication for surgery—especially when it impacts your ability to perform simple tasks like walking or standing for extended periods.
• Loss of Joint Mobility or Function:
   If your knee becomes so stiff, weak, or unstable that it limits movement or requires a walking aid, knee replacement may restore stability and improve your ability to perform routine activities independently.
• Reduced Quality of Life:
   Many people seek surgery when knee problems interfere with their personal and social life—whether that’s playing with grandchildren, gardening, working, or travelling. When joint issues limit your lifestyle and well-being, surgery can be a life-changing option.
   

When is Knee Replacement Surgery Recommended? 

Doctors typically recommend knee replacement surgery when:

• You have severe knee pain that limits daily activities such as walking, climbing stairs, or even getting out of bed.
• You experience persistent swelling or stiffness that doesn't improve with conservative treatments.
• Your knee has visible deformity or misalignment that affects how you walk or stand.
• Non-surgical treatments—including physical therapy, medications, steroid injections, or weight loss—have failed to provide lasting relief.
• Your sleep or mental well-being is affected by chronic pain or limited mobility.

Timely surgical intervention can help prevent further joint deterioration and significantly improve your mobility and quality of life.
 

When is Knee Replacement Surgery Not Recommended?

While knee replacement is safe and effective for many patients, certain conditions may make surgery unsuitable or riskier. Contraindications include:

• Active infections:
  Any infection in the body, especially around the knee joint, must be fully treated before considering surgery. Implanting a prosthetic in an infected area can lead to serious complications.
   
• Uncontrolled chronic illnesses:
  Poorly managed diabetes, advanced heart disease, or severe lung conditions can increase surgical and recovery risks.
   
• Morbid obesity:
  Excessive body weight puts additional strain on the knee joint and prosthetic, increasing the risk of implant failure, delayed wound healing, or infections.
   
• Severe peripheral vascular disease:
  Poor blood circulation in the legs can impair wound healing and raise the risk of complications after surgery.
   
• Neurological disorders:
  Conditions like Parkinson’s disease, stroke, or multiple sclerosis can affect coordination, muscle control, or rehabilitation outcomes, reducing the effectiveness of the surgery.
   
• Allergies to implant materials:
  Rarely, patients may have hypersensitivity to materials like nickel, cobalt, or chromium used in prosthetic components. Allergy testing may be advised before surgery in suspected cases.
   
• Inability to comply with rehabilitation:
  Successful recovery requires physical therapy and active participation. Patients with cognitive issues, lack of motivation, or inability to follow instructions may not achieve desired results.
   
• Limited life expectancy or terminal illness:
  In cases where overall health is poor and the benefit of surgery is unlikely to outweigh the risks, knee replacement may not be appropriate.
   

Types of Knee Replacement Surgery

Knee replacement surgery is not a one-size-fits-all procedure. Depending on the extent of joint damage, patient age, activity level, and overall health, different types of knee replacement surgeries are available. Each type aims to restore knee function and relieve pain while preserving as much healthy tissue as possible.

1. Total Knee Replacement (TKR)

This is the most common and widely performed type of knee replacement surgery. In a total knee replacement, the surgeon removes the entire damaged knee joint and replaces it with artificial components made of metal and durable plastic. This procedure is usually recommended when arthritis or injury has severely damaged the entire knee joint, causing significant pain and mobility issues.

• Suitable for patients with severe osteoarthritis or rheumatoid arthritis.
• Improves overall knee alignment and stability.
• Typically offers long-lasting relief and improved function.

2. Partial Knee Replacement (PKR)

Also called unicompartmental knee replacement, this surgery targets only the part of the knee that is damaged. Instead of replacing the whole joint, only the affected compartment—either the inner (medial), outer (lateral), or kneecap (patellofemoral)—is resurfaced with an implant. This procedure preserves healthy bone, cartilage, and ligaments, leading to a more natural knee movement.

• Best for patients with early-stage arthritis limited to one compartment.
• Smaller incision, faster recovery, and less pain compared to total knee replacement.
• Not suitable for patients with widespread joint damage.

3. Bilateral Knee Replacement

This option involves replacing both knees either during the same surgery (simultaneous bilateral replacement) or in two separate surgeries spaced weeks or months apart (staged bilateral replacement). It is usually chosen by patients with severe arthritis affecting both knees and who want to reduce overall recovery time.

• Can improve mobility in both knees quickly.
• Requires a more intensive rehabilitation plan.
• Slightly higher surgical risk, so thorough preoperative assessment is essential.

4. Revision Knee Replacement

Sometimes, the initial knee replacement implant may wear out, loosen, or become infected years after surgery. In such cases, a revision knee replacement is performed to remove the old prosthesis and replace it with a new one. This surgery is more complex because of scar tissue, bone loss, and the need for specialized implants.

• Typically needed 15 to 20 years after the original replacement.
• Longer surgery and recovery time compared to primary knee replacement.
• Success depends on bone quality and overall health.

5. Fast Track Daycare Total Knee Replacement

Fast Track Daycare Total Knee Replacement is the modern approach that focuses on accelerated recovery. Patients begin walking within hours of surgery and are often discharged within 24 to 48 hours. It involves advanced pain management, minimally invasive techniques, and early mobilization.

• Ideal for medically fit patients with support at home.
• Reduces hospital stay and costs by up to 30%.
• Backed by enhanced recovery protocols and tele-rehabilitation.

6. Minimally Invasive Subvastus Total Knee Replacement

In the Minimally Invasive Subvastus Total Knee Replacement muscle-sparing technique, the surgeon accesses the knee joint by going under the quadriceps muscle (subvastus), avoiding cutting it. This results in less postoperative pain and faster functional recovery.

• Suitable for patients seeking quicker return to normal activities.
• Shorter incision and less soft tissue trauma.
• Requires expertise and careful patient selection.

7. Ceramic Total Knee Replacement (Ceramic TKR)

In Ceramic Total Knee Replacement, ceramic components are used instead of traditional metal implants. Ceramic is biocompatible and less likely to cause allergic reactions or metal sensitivity.

• Beneficial for patients with metal allergies.
• Offers excellent wear resistance and longevity.
• May be slightly more expensive than conventional implants.

How to Prepare for Knee Replacement Surgery

Proper preparation before knee replacement surgery can make a significant difference in your surgical outcome and speed of recovery. Here’s a comprehensive guide to help you get ready:

1. Medical Evaluation and Tests

Your surgeon and healthcare team will conduct a full medical assessment to ensure you are fit for surgery. This typically includes:

• Blood tests to check for anemia, infections, and overall health status.
• Electrocardiogram (ECG) to evaluate heart health.
• Chest X-rays to check lung condition.
• Knee X-rays or MRI to assess the extent of joint damage.
• Review of your medical history, including chronic illnesses like diabetes or hypertension.

Any underlying conditions will be managed before scheduling surgery to reduce complications.

2. Medications Review

Inform your surgeon about all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements you take regularly. Certain medications, especially blood thinners (like aspirin, warfarin) and some anti-inflammatory drugs, may need to be stopped several days before surgery to reduce bleeding risk. Always follow your doctor’s instructions carefully.

3. Pre-Surgery Exercises

Building strength before surgery helps your muscles support the new joint and speeds up rehabilitation. Focus on:

• Quadriceps strengthening exercises (e.g., straight leg raises).
• Hamstring stretches and strengthening.
• Low-impact activities like walking or swimming if advised.

Physical therapy may be recommended preoperatively to maximize your knee function.

4. Home Preparation and Safety Modifications

Create a safe, comfortable environment at home to support your recovery:

• Arrange for assistive devices like a raised toilet seat, shower chair, and handrails on stairs or in the bathroom
• Place chairs with firm cushions and armrests for easy sitting and standing.
• Remove loose rugs, clutter, and cords that can cause falls.
• Set up your living space so essential items are easily reachable without excessive bending or stretching.

Having help arranged from family or friends during the first few weeks is also beneficial.

5. Lifestyle Adjustments

Certain habits can affect surgery outcomes:

• Quit smoking at least several weeks before surgery to improve blood flow and healing.
• Limit or avoid alcohol consumption, as it can interfere with anesthesia and recovery.
• Maintain a balanced diet to support your immune system and tissue repair.

6. Mental and Emotional Preparation

Understand what to expect during and after surgery to reduce anxiety:

• Discuss the surgical procedure, risks, benefits, and recovery timeline with your surgeon.
• Learn about postoperative pain management and rehabilitation plans.
• Join support groups or talk to patients who have undergone knee replacement.
• Prepare yourself for temporary limitations in mobility and activities.

Being mentally prepared helps with motivation and adherence to your recovery program.

 

Knee Replacement Surgery: Step-by-Step Procedure

Before the Surgery: Preparation

• Hospital Admission: You’ll be admitted to the hospital on the day of surgery or earlier, depending on your condition.
• Fasting: You will be instructed not to eat or drink for several hours before surgery to reduce the risk of complications during anesthesia.
• Anesthesia: The anesthesiologist will administer anesthesia—usually either general anesthesia (where you are fully asleep) or spinal anesthesia (numbing the lower half of your body).
• Sterilization: The surgical area around your knee will be thoroughly cleaned and sterilized to prevent infection.

During the Surgery: The Procedure

• Incision: The surgeon makes an incision, typically about 6 to 10 inches long, over the front of your knee to access the joint.
• Removing Damaged Tissue: The damaged cartilage and bone surfaces from the femur (thigh bone), tibia (shin bone), and sometimes the patella (kneecap) are carefully removed.
• Bone Preparation: The ends of the femur and tibia are shaped precisely to fit the new artificial components.
• Implant Placement: Artificial components made of metal and durable plastic are implanted to replace the damaged joint surfaces.
• Alignment and Movement Testing: The surgeon moves your knee through its range of motion to ensure the implant fits correctly and functions smoothly.
• Closing the Incision: The incision is closed with stitches or surgical staples, and a sterile dressing is applied.

After the Surgery: Recovery Begins

• Recovery Room: You will be transferred to a recovery room where vital signs are monitored closely.
• Medications: Pain relief medications, antibiotics to prevent infection, and blood thinners to reduce the risk of clots are administered.
• Physical Therapy: Rehabilitation usually starts within 24 hours, focusing on gentle exercises to improve knee movement and strength.
• Hospital Stay: The entire surgery typically takes 1 to 2 hours. Most patients stay in the hospital for 2 to 4 days to ensure stable recovery before discharge.

Risks and Complications of Knee Replacement Surgery

While knee replacement surgery is highly effective for relieving pain and restoring function in patients with severe joint damage, like any major surgical procedure, it comes with potential risks and complications. Understanding these can help patients make informed decisions and take proactive steps for a smooth recovery.

Common Risks (Typically Temporary and Manageable)

1. Swelling, Bruising, and Pain Around the Knee
   These symptoms are common immediately after surgery and are part of the normal healing process. Pain is typically managed with prescribed medications, and swelling can be minimized with elevation, ice packs, and compression stockings.
2. Blood Clots (Deep Vein Thrombosis - DVT)
   Blood clots may form in the deep veins of the leg after surgery, especially in the early recovery period. To reduce this risk, doctors often prescribe blood thinners and encourage early movement or use of pneumatic compression devices.
3. Infection at the Incision Site
   Infections can occur externally (superficial) or internally (deep infections near the joint). Superficial infections are treated with antibiotics, while deep infections may require surgical intervention to clean or replace the implant.
4. Temporary Stiffness or Difficulty Moving the Knee
   Post-surgical stiffness is common, especially if rehabilitation exercises are delayed. Adhering to a structured physiotherapy program is essential to regain flexibility and joint mobility.
    

Rare but Serious Risks

1. Implant Loosening or Wear Over Time
   Although modern implants are built to last 15–20 years or more, they can gradually loosen or wear out, especially in highly active individuals. This may require revision surgery.
2. Nerve or Blood Vessel Damage
   In rare cases, surrounding nerves or blood vessels may be injured during surgery, leading to numbness, tingling, or weakness. Most cases resolve over time, but severe damage may need further treatment.
3. Allergic Reaction to Metal Components
   Some patients may have a hypersensitivity to metals like nickel, cobalt, or chromium used in implants. Those with known metal allergies should inform their surgeon in advance, as hypoallergenic implants are available.
4. Persistent Pain or Joint Instability
   Despite successful surgery, a small percentage of patients may continue to experience pain or a feeling of instability in the joint. This could be due to implant malalignment, soft tissue issues, or unresolved arthritis in surrounding joints.

Other Possible Complications

• Scarring and Skin Discoloration
  Post-surgical scars are normal, but some may become raised or darkened. Proper wound care and scar management techniques can help improve their appearance.
• Joint Stiffness Due to Scar Tissue (Arthrofibrosis)
  Excess scar tissue can limit movement. In some cases, a procedure called "manipulation under anesthesia" may be required to improve range of motion.
• Anesthesia-related Reactions
   Reactions to general or spinal anesthesia, though rare, may include nausea, breathing difficulties, or changes in heart rate or blood pressure.

How to Reduce the Risks

• Choose a skilled and experienced orthopedic surgeon.
• Follow all pre-operative instructions, including stopping certain medications.
• Use assistive devices and walk with support to avoid falls.
• Maintain a healthy diet and hydration level to promote healing.
• Attend all post-surgery follow-ups and stick to your rehabilitation plan.

Early detection and immediate medical intervention can greatly improve outcomes and reduce the likelihood of long-term complications. Always report any unusual symptoms—like redness, warmth, increased pain, or fever—to your healthcare provider right away.

Recovery After Knee Replacement Surgery

Recovery time for knee replacement varies by individual but generally follows this timeline:

Week 1–2:

• Start with assisted walking using a walker.
• Gentle knee bending and stretching exercises.
• Pain and swelling are common but manageable with medications.

Week 3–6:

• Walking longer distances with less support.
• Resuming some household activities.
• Continued physiotherapy to regain range of motion.

Week 6–12:

• Most patients resume driving and light activities.
• Best sitting positions include straight-back chairs with feet flat on the floor.
• Avoid kneeling, running, or high-impact exercises.

After 3–6 Months:

• Major improvements in strength and mobility.
• Some patients may still feel occasional stiffness.
• Full recovery can take up to 12 months.

Recovery time for elderly patients may be slightly longer, and personalized rehabilitation programs are often recommended.

Benefits of Knee Replacement Surgery

Knee replacement surgery can be life-changing, especially for individuals struggling with severe knee pain or limited mobility. The procedure offers several important benefits that significantly improve both physical function and overall quality of life:

Pain Relief

One of the most immediate and noticeable benefits is relief from chronic knee pain. Most patients experience a significant reduction in pain, and in many cases, the discomfort disappears entirely. This allows for a more comfortable and active lifestyle, free from the constant reliance on pain medications.

Improved Mobility and Function

After recovery, patients are usually able to walk more comfortably, climb stairs with less difficulty, and engage in day-to-day activities that were once painful or impossible. Tasks like standing for extended periods, getting up from a chair, or even taking a leisurely stroll become easier and less tiring.

Enhanced Quality of Life

Living without pain and with better mobility means patients can return to hobbies, social events, and even light sports or fitness routines. Many report feeling more independent and confident in their movements, which greatly contributes to mental well-being and emotional health.

Correction of Joint Deformities

In cases where the knee joint is misaligned—such as in bow-legged or knock-kneed conditions—knee replacement surgery can help straighten the leg and restore proper alignment. This not only improves function but also helps prevent further joint wear or back and hip problems caused by poor posture.

Long-Lasting Results

Modern knee implants are made of durable materials like titanium or cobalt-chromium and are designed to withstand years of daily use. With proper care and activity modification, these implants can last 15 to 20 years or longer, reducing the likelihood of needing another surgery in the near future.

Improved Sleep

Many patients with chronic knee pain experience difficulty sleeping due to discomfort. After knee replacement surgery, as pain diminishes, sleep quality often improves, contributing to better overall health and faster recovery.

 

 

Knee Replacement Surgery vs. Arthroscopy

Both knee replacement surgery and arthroscopy are used to address knee joint issues, but they differ significantly in purpose, invasiveness, and effectiveness. The table below highlights the key differences:

 

Cost of Knee Replacement Surgery in India

The cost of knee replacement surgery in India varies based on factors such as the city, hospital, and type of implant used. On average, a single knee replacement procedure costs between ₹2,00,000 and ₹3,50,000, while a bilateral knee replacement (both knees) typically ranges from ₹4,00,000 to ₹7,00,000.

This usually includes hospital stay, surgery, anesthesia, and physiotherapy.

To know the exact cost, contact your nearest Apollo Hospitals. Knee replacement in Apollo Hospitals India offers significant cost savings compared to Western countries with immediate appointments, and better recovery times. Explore affordable knee replacement options in India with this essential guide for patients and caregivers

 

Frequently Asked Questions

Frequently Asked Questions About Knee Replacement Surgery

1. Is knee replacement surgery painful?
Knee replacement surgery may cause temporary pain during recovery, but it is well-managed with medications. Over time, the surgery significantly reduces chronic knee pain and improves mobility, especially when performed at expert centres like Apollo Hospitals.

2. How long does it take to walk after knee replacement surgery?
Most patients begin walking with a walker or crutches within 24–48 hours post-surgery. Independent walking typically resumes within 4 to 6 weeks, depending on your physiotherapy and recovery progress.

3. How long will my knee replacement implant last?
Modern knee replacement implants usually last 15 to 20 years or more. Longevity depends on your weight, activity level, implant type, and adherence to post-op care instructions.

4. What is the typical recovery time after knee replacement surgery?
Most patients resume daily activities within 6–8 weeks. Full recovery and optimal joint function may take 3 to 6 months or more, especially for elderly patients or those with underlying health conditions.

5. What are the risks or complications of knee replacement surgery?
Complications are rare but may include infection, blood clots, stiffness, or implant loosening. Choosing experienced surgeons at Apollo Hospitals helps minimize these risks.

6. Is knee replacement safe for elderly patients?
Yes, knee replacement is safe for elderly patients with proper medical evaluation and care. Apollo Hospitals offers comprehensive geriatric orthopedic care tailored to elderly individuals.

7. What is the role of diet before and after knee replacement surgery?
A balanced diet rich in protein, calcium, and vitamins helps prepare your body for surgery and speeds up healing. After knee replacement surgery, hydration and nutrient-rich foods support tissue repair and strengthen bones.

8. Can people with diabetes undergo knee replacement surgery?
Yes, people with diabetes can undergo knee replacement surgery. However, blood sugar must be well-controlled before and after surgery to reduce the risk of infections and ensure proper healing.

9. Is knee replacement surgery suitable for obese patients?
Yes, but patients with obesity may face higher risks during surgery. Pre-surgical weight management is often advised. Apollo Hospitals offers personalized plans for safe knee replacement in obese patients.

10. How does knee replacement surgery in India compare to other countries?
Knee replacement surgery in India, especially at hospitals like Apollo, offers world-class quality at a fraction of the cost in Western countries. With expert surgeons and advanced facilities, outcomes match or exceed global standards.

11. How long does knee replacement surgery take?
The surgical procedure typically lasts 1 to 2 hours. Including preparation and post-op care, the total hospital time may extend to 3 to 5 days, depending on individual recovery.

12. When can I drive after knee replacement surgery?
Most patients can resume driving 6 to 8 weeks after surgery, once they regain control and strength in the operated leg. Always consult your doctor before driving.

13. Can I kneel or squat after knee replacement surgery?
Many patients find kneeling or squatting uncomfortable. While it's not medically harmful, it's best to avoid prolonged pressure on the knee, especially on hard surfaces.

14. What physical activities are allowed after knee replacement surgery?
Low-impact activities like walking, cycling, and swimming are encouraged. High-impact sports like running or jumping should be avoided to protect the implant.

15. Can both knees be replaced at the same time?
Yes, bilateral knee replacement is an option for suitable candidates. It reduces total recovery time but carries slightly higher short-term risk. Discuss with your Apollo Hospitals specialist.

16. What is the difference between partial and total knee replacement?
Total knee replacement involves replacing the entire joint, while partial replacement targets only the damaged part. Your orthopedic surgeon will recommend the best option based on your condition.

17. Will I need physiotherapy after knee replacement surgery?
Yes, physiotherapy is essential. It begins within 24 hours after surgery and continues for several weeks to restore strength, flexibility, and full function.

18. How do I sleep after knee replacement surgery?
Sleep on your back with a pillow under your leg to elevate it slightly. Avoid placing pillows directly under the knee. Side sleeping is usually safe after a few weeks.

19. Are there alternatives to knee replacement surgery?
Yes, early-stage arthritis can be managed with medications, physiotherapy, injections, or arthroscopy. However, these may not provide long-term relief in severe cases.

20. Can pregnant women undergo knee replacement surgery?
Knee replacement is generally postponed until after childbirth unless there's an urgent medical need. Always consult both an orthopedic surgeon and obstetrician to assess risks.

21. Is knee replacement recommended for patients with high blood pressure?
Yes, but blood pressure should be controlled before surgery. At Apollo Hospitals, a multidisciplinary team ensures safe outcomes for patients with hypertension and other comorbidities.

22. Can patients with a previous hip or spine surgery undergo knee replacement?
Yes, but a thorough evaluation is essential to assess joint alignment, mobility, and potential complications. Your Apollo orthopedic specialist will tailor your treatment accordingly.

23. What is the cost of knee replacement surgery in India?
The cost of knee replacement in India ranges from ₹2–4 lakhs, depending on the implant and hospital. Apollo Hospitals provides transparent packages with high-quality outcomes at competitive prices.

Conclusion

Knee replacement surgery is a transformative solution for individuals suffering from chronic knee pain and joint damage. With the right preparation, care, and rehabilitation, patients can expect significant improvements in mobility and quality of life. If you're considering this surgery or have questions about recovery time, exercises, or lifestyle adjustments, speak to an orthopedic specialist to make an informed decision.