Total Knee Replacement patient information

This page is general information intended for patients of Dr. Borshch. Your situation may be different, so please follow the advice of your surgeon and treating team.

A total knee replacement (also called a total knee arthroplasty) is an operation where the damaged joint surfaces of the knee are replaced with metal and plastic components. The aim is to:

• reduce pain
• improve walking and daily function
• improve quality of life

The kneecap surface may also be replaced with a plastic component in some cases, this depends on the quality of the remaining cartilage on the kneecap at the time of surgery.

The most common reason is knee arthritis (especially osteoarthritis), where the smooth cartilage wears away and the exposed underlying bone begins to transmit pain signals.

A knee replacement is usually considered when:

• Pain is affecting walking, stairs, sleep, or work
• The knee is stiff or deformed (bow-legged/knock-kneed) or sometimes unstable.
• Other treatment methods have been tried, but are no longer enough to manage symptoms.

Good preparation lowers risk and helps recovery.

• Stop smoking/vaping if possible (smoking increases wound and infection risks).
• If you have diabetes, aim for good blood sugar control.
• Work on fitness and weight where possible—stronger muscles and better general health usually mean smoother recovery.
• Tell the team about any history of blood clots, sleep apnoea, heart/lung disease, or immune-suppressing medications.

• Arrange help for the first 1–2 weeks (meals, shopping, transport).
• Make your home safer: remove loose rugs, organise a stable chair, consider railings, and set up a bed/bathroom plan.
• Prepare icing options and comfortable walking paths.

Your team will advise what to stop or continue (for example, some blood thinners, anti-inflammatories, or supplements). Always check before changing anything.

• Pain control using a multimodal plan (several types of pain relief together).
• Early walking and exercises with the help of an inpatient Physiotherapist.
• A blood clot prevention plan (medication and movement), guided by your risk factors.

• You will have your first review back in the office (usually with the nurse), this is mainly to check that the incision is healing well, make sure your pain is controlled and address any other concerns.
• Your walking improves steadily, usually with a walker/crutches early, then a stick, then independently.
• Swelling is common (often worse in the afternoon).
• You’ll do regular exercises to regain movement and strength with the help of an outpatient Physiotherapist.  We are aiming for at least 90 degrees of flexion by 6 weeks post surgery.
• Driving is usually not safe until 6 weeks post surgery or when leg strength is close to normal.

• You will have your first review in the office with me, this is mainly to check your knee range of motion.
• Most people notice major improvements in daily activities.
• Strength and endurance continue to build.
• Some stiffness or swelling can still be normal.

• Ongoing improvement in strength, balance, confidence and cosmetic appearance of the knee.
• Some people continue to notice gains up to a year (or longer).

Most people get substantial pain relief and improved function after knee replacement.

Modern knee replacements often last a long time. A major review of population and registry data estimated that:

• about 9 in 10 knee replacements are still working at 15 years
• many still last 20 years or more

Most patients are very happy with the result, but not everyone is satisfied with the outcome.

• A well-known study found about 1 in 5 patients were not fully satisfied (often due to pain, function limits, or expectations).
• Persistent long-term pain occurs in a minority, often quoted around ~20% in some studies and reviews. (https://pmc.ncbi.nlm.nih.gov/articles/PMC6134884/)

It is very important for us to discuss the indications for surgery beforehand, optimise pre-operative treatment and have clear expectations of the short-term and long-term outcomes.

Contact our office, your GP, or go to hospital urgently if you notice:

• increasing redness, warmth, or swelling around the wound
• worsening pain after initial improvement
• pus or bad-smelling discharge
• fevers or feeling very unwell

(Periprosthetic joint infection after primary knee replacement is uncommon (around 1.5%) but very serious) (https://pmc.ncbi.nlm.nih.gov/articles/PMC11470562/)

• new calf pain/tenderness, increasing swelling in one leg
• sudden shortness of breath, chest pain, coughing blood (call emergency services)

• Difficulty bending/straightening despite regular exercises and physio (early review can help improve the movement).

• leaking through dressings, opening wound edges, or rapidly increasing bruising/swelling.

• worsening numbness/weakness in the foot, cold/pale foot, severe escalating pain.