Total Knee Replacement Surgery
When knee arthritis has taken your stairs, your walks and your sleep, and injections and physiotherapy have stopped working, replacement is what gives them back. Our orthopaedic surgeons use computer-navigated and robotic-assisted techniques for precise alignment. Most patients walk with support the same day and climb stairs within three weeks.
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What is Knee Replacement?
A total knee replacement resurfaces a knee joint destroyed by arthritis. The damaged surfaces of the thigh bone and shin bone are removed — a few millimetres of bone, not the whole joint — and replaced with metal components, separated by a smooth polyethylene bearing that does the work the worn cartilage no longer can.
The condition it treats is usually osteoarthritis. Cartilage, the smooth layer covering the ends of bones, wears away over years until bone rubs on bone. The result is pain, stiffness, grinding, deformity — knees that bow outwards or inwards — and a steady contraction of what you can do. Rheumatoid arthritis, post-traumatic arthritis after a fracture, and avascular necrosis all produce the same end state.
The honest framing is that this is an operation of last resort, and that is a good thing. Knee replacement is one of the most successful operations in modern surgery, with over 95% of implants still functioning at ten years and most patients reporting substantial pain relief. But it is major surgery with a real recovery, and there is a long list of things to try first: weight loss, which reduces knee load by roughly four kilos for every kilo lost; targeted quadriceps strengthening, which is the single most under-used treatment in knee arthritis; analgesia; and injections. A surgeon who offers replacement before those have been tried properly is skipping steps.
Timing matters in both directions. Operating too early means using up an implant's lifespan while the knee still had years of function left — and a replacement done at 55 will very likely need revising, which is a bigger operation with less predictable results. Operating too late has its own cost: severe deformity, wasted muscle and a knee that has been stiff for years all make the technical operation harder and the rehabilitation slower. The right time is when pain limits your daily life and disturbs your sleep despite proper non-surgical treatment.
Two expectations worth setting honestly. First, a replaced knee is not a normal knee. It is very good at walking, stairs, standing and sleeping without pain. Most patients cannot kneel comfortably, deep squatting and floor-sitting are usually not advised, and running and jumping sports are off the list. In Indian households, where floor-sitting and squatting toilets are part of daily life, this deserves a proper conversation before surgery rather than a discovery afterwards. Second, the result depends on rehabilitation as much as on the surgery. The operation creates the possibility of a good knee; physiotherapy is what realises it.
Treatment information
| Condition | Knee Osteoarthritis / Advanced Knee Arthritis |
|---|---|
| Procedure | Total Knee Replacement (Arthroplasty) |
| Duration | 90 to 120 minutes per knee |
| Treated by | Orthopaedic Joint Replacement Surgeon |
| Anaesthesia | Spinal anaesthesia, usually with a nerve block |
| Success rate | 95–98% at 10 years |
| Recovery time | 6 to 12 weeks for daily activity |
| Hospital stay | 3 to 5 days |
Signs you may need Knee Replacement treatment
- Knee pain that persists at rest and disturbs your sleep
- Pain climbing or descending stairs, and difficulty getting up from a low chair
- Morning stiffness that eases after moving about
- Grinding, grating or clicking within the joint
- Swelling that comes and goes, worse after activity
- Progressive bowing of the leg — inward or outward deformity
- Reducing walking distance, measured in a shrinking number of minutes
- The knee giving way or feeling unstable
- Loss of full straightening or full bending
- Reliance on a stick, a railing or another person
- Painkillers needed most days just to function
What causes it?
- Osteoarthritis — progressive wearing of the joint cartilage, by far the commonest cause
- Rheumatoid arthritis and other inflammatory joint diseases
- Post-traumatic arthritis, following a fracture involving the joint surface
- Long-standing ligament injury or meniscal loss causing abnormal load distribution
- Avascular necrosis, where the bone loses its blood supply and collapses
- Malalignment — a knee that has always been bowed, loading one compartment excessively
- Previous knee infection that damaged the cartilage
Who is more likely to be affected
- Age above 55, when the cumulative wear becomes symptomatic
- Obesity — the single most modifiable factor, since every kilo adds several kilos of load through the knee
- Female sex, with a higher incidence of symptomatic knee osteoarthritis
- Previous knee injury, particularly ACL rupture or meniscal tear
- Occupations involving heavy lifting, prolonged squatting or repetitive kneeling
- A family history of osteoarthritis
- Diabetes and metabolic syndrome
- Vitamin D deficiency and low muscle mass
When to see a doctor immediately
- Knee pain that wakes you at night or is present at rest
- Walking distance that has reduced steadily over months
- Difficulty with stairs, or needing both hands to get out of a chair
- A knee that is visibly bowing more than it used to
- Pain not controlled by painkillers, physiotherapy and weight loss
- The knee locking, giving way or catching
- Swelling that is persistent rather than occasional
- A hot, red, acutely swollen knee with fever — this needs same-day assessment to exclude infection
How it is diagnosed
Clinical examination
Assessment of the range of movement, alignment, ligament stability, muscle bulk and gait. It also establishes how far the deformity can be corrected passively, which informs both the implant choice and the surgical plan.
Weight-bearing X-rays
The essential investigation, and specifically taken standing rather than lying down — joint space narrowing only shows properly under load. They confirm the severity of arthritis, show osteophytes and cysts, and quantify the deformity.
Full-length alignment X-ray
A long film from hip to ankle that measures the mechanical axis of the whole limb. Restoring that axis is the primary aim of the surgery, since a well-aligned implant lasts substantially longer than a poorly aligned one.
MRI
Not routinely needed for advanced arthritis, where X-rays tell the story. It is used in earlier disease to assess cartilage, menisci and ligaments, and where avascular necrosis is suspected.
Blood tests and infection screen
Full blood count, sugar, kidney and liver function, vitamin D, and inflammatory markers. An infection screen — including dental and urinary sources — matters because bacteria seeding a new implant is the complication everyone works hardest to avoid.
Cardiac and anaesthetic assessment
ECG, echocardiogram where indicated, and a formal anaesthetic review. Many patients coming for knee replacement are older with other medical conditions, and optimising those before surgery measurably reduces complications.
Pre-operative planning and templating
Implant size and position are planned digitally in advance, and for robotic-assisted surgery a CT-based model of your knee is built. Planning before the day shortens the operation and improves accuracy.
How the options compare
| Feature | Total Knee Replacement | Partial (Unicompartmental) Replacement |
|---|---|---|
| Extent | Whole joint resurfaced | Only the worn compartment replaced |
| Suitability | Arthritis in two or three compartments | Arthritis confined to one compartment, ligaments intact |
| Bone removed | More | Less |
| Incision | Longer | Shorter |
| Recovery | 6–12 weeks | 3–6 weeks |
| Knee feel | Good, but distinctly artificial | More natural |
| Bend achieved | Usually 110–125 degrees | Often better |
| Implant survival | Excellent — over 95% at 10 years | Good, with a higher revision rate |
| Future revision | Possible but complex | Can be converted to a total replacement |
Types of treatment
Non-surgical treatment — to be exhausted first
Weight reduction
The highest-value intervention in knee arthritis, and the least popular. Each kilogram lost removes roughly four kilograms of force from the knee with every step. Meaningful weight loss can defer replacement by years, and it also improves the surgical outcome if you eventually need it.
Structured physiotherapy
Quadriceps and hip abductor strengthening genuinely reduces pain and improves function, and it is consistently under-prescribed. A knee supported by strong muscle is loaded far better than one that is not. Six to twelve weeks of supervised work deserves a proper trial.
Analgesia
Paracetamol and, where safe, anti-inflammatories used sensibly. Topical NSAIDs are effective for knee arthritis with fewer systemic effects, which matters in older patients with kidney or stomach concerns.
Intra-articular injections
Corticosteroid injections give useful relief for weeks to a few months, particularly during a flare. Hyaluronic acid has more modest and more variable evidence. Repeated frequent steroid injections are avoided, since they can damage cartilage further.
Walking aids and footwear
A stick held in the opposite hand unloads the affected knee substantially. Cushioned footwear and, in some patients, an offloading brace reduce symptoms without any procedure at all.
Surgical options
Total knee replacement
The standard operation for arthritis affecting more than one compartment. Worn surfaces of the femur and tibia are resurfaced with metal components and a polyethylene bearing; the patella is resurfaced if needed. Reliable, durable and well studied.
Computer-navigated knee replacement
Infrared tracking gives the surgeon real-time data on alignment and bone cuts during the operation. It improves the consistency of limb alignment, which is the factor most closely linked to how long the implant lasts.
Robotic-assisted knee replacement
A CT-based model of your knee is used to plan the implant position precisely, and the robotic arm constrains the cuts to that plan. It offers the greatest accuracy and preserves soft tissue well; it costs more, and the long-term survival advantage over well-executed conventional surgery is still being established.
Partial (unicompartmental) knee replacement
Where arthritis is confined to one compartment and the ligaments are intact, only that compartment is resurfaced. Less bone removed, faster recovery, a more natural-feeling knee — but strict selection criteria, and a higher chance of needing revision later.
High tibial osteotomy
The shin bone is cut and realigned to shift load away from the worn compartment. Suited to younger, active patients with single-compartment arthritis and a bowed knee, and it preserves the natural joint entirely — buying years before any replacement is considered.
Bilateral (both knees) replacement
Both knees replaced under one anaesthetic, or in staged sittings a few days or months apart. Doing both together means one admission and one rehabilitation, but a bigger physiological insult; the decision depends on your fitness and your surgeon's assessment.
What happens, step by step
- 1
Consultation and decision
45–60 minutes- Assessment of pain, function, walking distance and effect on sleep
- Review of what non-surgical treatment has genuinely been tried
- Weight-bearing and full-length alignment X-rays reviewed with you
- Honest discussion of what a replaced knee will and will not allow — including kneeling and floor-sitting
- 2
Pre-operative optimisation
2 to 6 weeks- Blood tests, ECG, cardiac review and anaesthetic assessment
- Dental and urinary infection screening and treatment — a distant infection can seed a new implant
- Diabetes control optimised; high sugars markedly raise infection risk
- Prehabilitation physiotherapy to strengthen the quadriceps before surgery, which speeds recovery afterwards
- Home prepared: a raised toilet seat, a firm chair with arms, and cleared walking routes
- 3
The operation
90–120 minutes per knee- Spinal anaesthesia with a nerve block for post-operative pain control
- An incision is made over the front of the knee
- A few millimetres of worn bone are removed from the femur and tibia, guided by navigation or robotics
- Trial components are fitted and the knee tested through its full range for balance and stability
- Final metal components are fixed, usually with bone cement, and the polyethylene bearing inserted
- Soft tissues are balanced, tranexamic acid is used to reduce blood loss, and the wound closed in layers
- 4
Early mobilisation
Day 0 to Day 4- Standing and taking a few steps with a walker on the same day or the next morning
- Physiotherapy twice daily from day one — bending and straightening start immediately
- Pain controlled with a multimodal regimen so that movement is possible
- Blood thinners and calf pumps to prevent clots
- Discharge at day 3 to 5, once you can walk with a walker and manage stairs safely
How to prepare
- Lose weight before surgery if you can — it improves the result and reduces complications
- Start prehabilitation physiotherapy; strong quadriceps before surgery means a faster recovery after
- Get dental problems treated and any urinary infection cleared before the date
- Bring diabetes and blood pressure under good control
- Stop smoking at least four weeks before — it substantially raises wound and infection risk
- Review blood thinners with your cardiologist and surgeon together
- Prepare your home: a firm chair with armrests, a raised toilet seat, no loose rugs, a clear path to the bathroom
- Arrange a family member or attendant for at least the first two weeks
- Plan how you will manage stairs at home; discuss it before surgery, not after
Why patients choose this procedure
Pain relief that is genuinely transformative
The great majority of patients get substantial and lasting relief from the constant pain, including the night pain that disturbs sleep for years beforehand.
Mobility returns
Walking distance improves markedly, stairs become manageable again, and most patients stop needing a stick within a few months.
Deformity corrected
The bowing is straightened and the mechanical axis of the limb restored — which relieves the secondary strain on the hip, the ankle and the other knee.
Long-lasting result
Over 95% of modern knee implants are still functioning well at ten years, and a majority at fifteen to twenty.
Sleep and mood improve
Constant pain wrecks sleep and drags mood down. Patients and their families frequently describe the change here as bigger than the change in walking distance.
Independence restored
Being able to shop, use stairs, travel and manage without relying on someone else has a value that no clinical score captures well.
Possible risks and side effects
Infection of the implant
The most serious complication, occurring in roughly one to two per cent. It can require prolonged antibiotics and, in some cases, removal and re-implantation of the prosthesis. This is why dental and urinary infections are screened beforehand and diabetes control is insisted upon.
Deep vein thrombosis and pulmonary embolism
A recognised risk after lower limb surgery, reduced by blood thinners, compression devices and early walking. Calf pain, swelling, breathlessness or chest pain must be reported immediately.
Stiffness
Some knees scar down and fail to achieve a good bend. Prevention is diligent early physiotherapy; established stiffness may need manipulation under anaesthesia. This is the complication most directly influenced by how hard you work at rehabilitation.
Persistent pain
A minority of patients — around one in ten — remain dissatisfied despite a technically sound replacement. Causes include unrealistic expectations, pain sensitisation from years of arthritis, and referred pain from the hip or spine. It is worth knowing this figure before surgery.
Implant loosening or wear
Over fifteen to twenty years, components can loosen or the polyethylene bearing wear out, requiring revision surgery. Revision is a bigger operation with less predictable results, which is a strong argument against operating too young.
Numbness lateral to the scar
Almost universal. A small skin nerve is inevitably divided at the incision, leaving a permanent patch of numbness on the outer side of the scar. Harmless, but worth expecting.
Nerve or vessel injury
Rare, and more likely in knees with severe deformity requiring extensive correction.
Fracture around the implant
Uncommon during surgery, and possible later after a fall. Bone quality and fall prevention both matter in the years afterwards.
What recovery looks like
Recovery from knee replacement is real work, and this is the part patients most often underestimate. The surgery creates the possibility of a good knee; physiotherapy is what delivers it. Patients who do their exercises consistently get good knees. Patients who do not get stiff ones, and stiffness is far harder to fix than to prevent.
Days 0 to 4: you stand and take your first steps with a walker on the day of surgery or the next morning. Physiotherapy begins immediately, twice a day, working on bending and straightening. Pain is controlled with a combination of medicines and a nerve block precisely so that you can move. Ice and elevation control swelling. Discharge is usually day three to five.
Weeks 1 to 2: home exercises three to four times daily, walking with a walker, and a target of achieving full straightening — which matters more than bend at this stage, because a knee that will not straighten gives a permanent limp. Wound checks and suture removal at around two weeks. Ice after every session.
Weeks 3 to 6: progress from walker to stick. Bend typically reaches 90 to 110 degrees. Stairs become manageable. Most patients drive again at four to six weeks, once they can control the pedals confidently. Swelling and warmth in the knee are still normal at this stage and can persist for months.
Weeks 6 to 12: walking without support for most patients. Bend improves towards 110 to 125 degrees. Return to desk work between six and eight weeks; physically demanding work takes three months or more. Cycling on a stationary bike and swimming are excellent at this stage.
Three to twelve months: strength and endurance continue improving throughout the first year. Residual swelling settles. The knee may click, feel warm, or feel like metal in cold weather — all normal for a replaced joint.
Long term: walking, swimming, cycling, golf and doubles tennis are encouraged. Running, jumping, contact sport and heavy squatting are not. Tell any dentist or surgeon that you have a joint replacement, since antibiotic cover may be advised for certain procedures.
Contact your care coordinator immediately for fever, spreading redness or discharge from the wound, calf pain or swelling, breathlessness, chest pain, or a sudden inability to bear weight.
What to eat and what to avoid
Recommended
- Protein at every meal — dals, eggs, paneer, fish, chicken — muscle rebuilding depends on it
- Calcium-rich foods: milk, curd, paneer, ragi, til and green leafy vegetables
- Vitamin D, supplemented where a deficiency has been documented
- Iron-rich foods to recover haemoglobin after surgical blood loss
- Vitamin C from amla, guava and citrus, for collagen and wound healing
- High-fibre foods to prevent constipation from painkillers
- 2 to 3 litres of water daily
Best avoided
- Excess weight gain during the low-activity recovery period — it directly loads the new joint
- Smoking, which significantly raises the risk of wound problems and infection
- Alcohol, particularly while on blood thinners and painkillers
- Excess salt and packaged food, which worsen swelling
- Refined sugar and maida, particularly if you are diabetic
- Skipping meals — undernutrition is a genuine and often missed cause of poor healing in older patients
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Knee Replacement treatment cost
₹1,80,000 – ₹4,50,000
The range depends on whether one knee or both are done, the implant chosen, whether the procedure is conventional, computer-navigated or robotic-assisted, your city, the hospital and your room category. Implant prices in India are capped by regulation, which has made the cost far more predictable than it once was. Knee replacement is covered by most health insurance policies, though waiting periods for joint replacement are typically two to four years — worth checking early. Our insurance desk verifies eligibility and files the cashless request before admission.
Inside the care journey
Knee Replacement — your questions answered
Over 95% of modern implants are still working well at ten years, and a majority at fifteen to twenty. Longevity depends on your weight, activity level, bone quality and — importantly — how accurately the implant was aligned, which is why navigation and robotic techniques exist. This is also the reason surgeons hesitate to replace a knee in a 50-year-old: a revision will very likely be needed, and revision surgery is bigger and less predictable.