UnderstandingTotal Knee Replacement
A comprehensive solution for severe knee arthritis or injury, this procedure involves replacing the entire knee joint with an artificial one. It can significantly improve quality of life by relieving pain and restoring function.

Knee Arthritis

Also known as: Knee Osteoarthritis (OA)

  • Osteoarthritis is the most common type of knee arthritis. It is a degenerative joint disease that affects the cartilage in the knee joint.
  • Cartilage is a firm, rubbery tissue that cushions and protects the bones in the joint; it can gradually wear away, causing the bones to rub against each other.
  • This can result in pain, stiffness, and swelling in the knee joint.

Check out this great educational handout on Osteoarthritis from our partners at the AAOS & OrthoInfo.org.

For Knee Arthritis

From Conservative Care to Knee Replacement Surgery

I treat the pain of early arthritis with a combined, conservative approach. A good first step is trying over-the-counter pain and anti-inflammatory medication.

  • Extra-strength Tylenol (pain reliever)
  • Advil, Aleve, or Ibuprofen (anti-inflammatory)

It’s important to check with your primary doctor to make sure you are allowed to take these medicines. If over-the-counter medications aren’t working, I can prescribe you a prescription-strength, long-acting anti-inflammatory like Celebrex or Meloxicam.

For people who still have knee pain, injecting medicine directly into the knee can provide months of relief for some patients. This is a quick and relatively painless procedure that can be done in the office during your appointment. Joint injections are available in a few different formulations and can be repeated every 3-6 months if they are providing excellent relief.

  • Depo Medrol plus bupivacaine (Anti-inflammatory plus instant pain reliever)
  • Hyaluronic acid (Lubricant)

In addition to medications and injections, strengthening and supporting the muscles around the knee can also relieve knee pain for some patients.

  • Physical therapy – strengthen specific muscles around your knee and help offload arthritic areas.
  • Specialized knee braces – used to unload the patient’s weight from an affected area of the knee while walking.

Conservative management is always the first step of treatment. For many patients, conservative treatment can offer months to years of pain relief without the risks of surgery.

While joint replacement is one of the safest surgeries, all surgeries carry the risk of infection, nerve or blood vessel injury, or complications from anesthesia.

Total Knee Replacement

MIS: Minimally Invasive Surgery

My approach is considered minimally invasive, which minimizes or avoids damage to muscles, tendons, and ligaments around your knee joint while still replacing the arthritic joint. The steps of a knee replacement are as follows:

  1. Prior to surgery, epidural anesthesia is administered that numbs your legs and you are given a sleeping medication that allows you to sleep during surgery while still breathing on your own without a breathing tube.
  2. Next, your leg is cleaned with a series of cleaning solutions and sterile drapes are applied to minimize contamination of the surgical field
  3. A small incision is made over the front of your knee, and the knee joint is exposed in a way that avoids the tendons and ligaments of your knee.
  4. The arthritic surfaces of your knee are shaved off with a specialized surgical instrument
  5. The correct shape and size components are measured with custom surgical instruments, and trial components are placed in your knee to triple check fit and function of your knee.
  6. Small adjustments are made until I am 100% satisfied with the outcome of your surgery.
  7. Permanent implants are glued onto the bony surface of your knee with a specialized polymer
  8. The knee is closed in layers with sutures that will dissolve over the next few weeks. The top layer is glue that will fall off on its own. A waterproof dressing is applied that stays on for 7 days.
  9. Patients are brought to the recovery room where they will eat and drink, walk with an assistive device, and practice stairs with a physical therapist before either going home or staying one night in the hospital.

Expected Outcomes

The goal of every total knee replacement is to have one operation that lasts the rest of your life. In the United States, about 20% of knee replacements require repeat surgery in the first 20 years, which means that at the 20-year mark 80% of patients are still doing well.

The implants that I use today have the highest satisfaction rating of any other implant on the market today boasting a survivorship of 97.6% after 20 years.


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Frequently Asked Questions Total Knee Replacement

Yes. Dr. Keating has access to every surgical robot on the market. Most patients are eligible for Dr. Keating’s preferred approach which uses custom instrumentation to perform a minimally invasive operation. Patients who are not candidates for the custom instrumentation can still have robotic surgery.

Every joint replacement has a plastic bearing that can be removed and replaced without disturbing the metals parts fixed to your bones. This allows a new bearing to be placed with a minor surgery compared to the first joint replacement surgery you had.

No! Dr. Keating does not restrict his patients from doing things that they love after surgery. However, patients must understand that the plastic bearing of their joint replacement will wear out faster with higher impact activities.

Every patient is different. Patients are up walking on a knee replacement the same day of surgery, usually with a device like a cane or walker for balance. By three weeks, most patients are off strong pain medication. By 6 weeks, most patients are back to doing most activities and at this point can ease back into higher levels of activity. By 12 weeks, patients are able to return to heavy activity levels.

Total and partial knee replacements are designed to last your whole life, but can wear out over time. At 15 years after joint replacement, about 85% of patients are still doing very well without repeat surgery.

Yes, Dr. Keating is not currently affiliated with a teaching hospital. He performs the incision, entire surgical approach, and personally implants the joint replacement. Dr. Keating works with a surgical team that helps close the surgical incision with plastic-surgery techniques.

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