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Procedure Steps in Detail-Knee Replacement Surgery

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Procedure Steps in Detail-Knee Replacement Surgery

Orthopedics & Joint Replacement | by CMRI | Published on 04/09/2021

Total Knee Replacement Surgery or knee arthroplasty is a complex invasive procedure wherein the diseased (arthritic) or damaged portions of the knee are removed to be replaced with restorative knee implants. The surgery must be performed by an expert orthopaedic surgeon who can skillfully make precise measurements for the removal of damaged surfaces, shape the remaining bone, and help accommodate the orthopedic prosthesis to build a highly realistic false knee joint. The artificial implants that are used as knee joint replacements can be constructed with metal, plastic, or ceramic materials. They replicate the motion of healthy knee joints and help the patient to live a better quality of life without pain.


Great advances have been made in Total Knee Replacement Surgery at Calcutta Medical Research Institute (CMRI), and the best orthopedic surgeon in Kolkata uses advanced robotic technology in which a ‘3D model’ of the knee is generated. This helps the surgeon to map out the exact incisions and the right angles to be made during the surgery. Every knee replacement surgery is unique and depending on the patient knee anatomy the treatment plan is prepared to remove only the damaged part to deliver early recovery and successful outcomes.


Read further to get an insight into what happens during knee replacement surgery in detail:


Preparation for Knee Replacement Surgery


The surgeon provides the patient with general anesthesia to keep them asleep during surgery. All the vital signs of the patient are monitored continuously throughout the surgery. The patient is dressed in sterile drapes and the knee is exposed for replacements. Before the first incision is made, the skin covering the operation site is scrubbed with an antiseptic solution.


Following steps are performed at the time of knee replacement surgery:


Step 1: Knee incision


A small vertical cut is made by the surgeon across the knee front (about 1 cm above the kneecap towards the lower joint extending upto 8-10 cm) to get access to the kneecap (patella) by dissecting the tissues and muscles using the robotic technology.


Step 2: Rotation of the patella


As the inside of the knee is exposed, the surgeon rotates the kneecap outside the knee area to get a better view of the operation area.


Step 3: Preparation of the femur (thighbone) and insertion of a femoral implant


After getting an exposed knee joint, the surgeon carefully measures the bones and then makes accurate cuts with the help of drills and bone-cutting instruments. All the damaged bones and cartilage at the end of the thighbone are removed and the remaining parts of the end of the femur are reshaped to match the artificial femoral implant to be placed. The surgeon then attaches and fixes the femoral implant in its designated place and secures it using bone cement or stabilizing pins.


Step 4: Preparation of tibia (shinbone) and insertion of a tibial component


The surgeon then removes the damaged bone and cartilage from the upper end of the tibia and then resizes or reshapes the top surface of the tibia to accommodate the artificial tibial components made up of either metal or polyethylene (medical-grade plastic). As the metallic tibial tray (bottom end of the implant) is fitted to the tibia, bone cement is used to stabilize it in its position. Next, the surgeon places a plastic insert (a buffer) onto the tibial tray to be sandwiched with the femoral component. This acts as a support for the body to be able to bend and flex the knee.


Step 5: Adjustments


After the implantation of artificial implants, the patella is repositioned to its original place. For this, readjustments are needed to be done by the surgeon to flatten the patella and ensure the correct fit with the implant. During the surgery, some physical examinations and tests are conducted by the surgeon to make certain the proper fit and placement of an implant. The replaced knee joint is assessed for its range of motion and the degree of mobility to know whether the patient has regained the optimal functioning of the new knee joint.


Step 6: Finalisation or end of the procedure


Lastly, a proper check of the implanted knee joint is performed to confirm that there is no extra bone cement or any unwanted debris remaining in the surgical area. The surgeon ensures that the knee joint is working properly and that all the positioning, sizing, and alignment of the knee components are suitable for the patients by asking them to bend and flex their knees. To complete the operation, all the incisions are closed with sutures or staples and then bandaged. The patient leaves the operation theatre while lying down with the legs continuously moving using a CPM (Continuous passive motion) machine.




  • Joint replacement surgery must not be performed in patients with infection, heart, kidney or lung problems as using general anesthesia can cause an increased risk during the surgery.
  • People suffering from blood clotting disorder are not considered good candidates for joint replacement surgery.


Dr. Rakesh Rajput is the Director and HOD, of the Department of Orthopedics at CMRI Hospital, and a specialist in performing Total Knee Replacement Surgery in Kolkata. He offers advanced treatment for orthopedic problems related to hips, knees, and sporting injuries and is committed to providing world-class care to his patients. To know more schedule an appointment with the best orthopedic surgeon at CMRI.