For the traditional total knee replacement procedure, once you are under general, spinal, or epidural anesthesia (depending on what you and your surgeon have chosen), the surgeon makes an eight- to twelve-inch incision in the front of the knee. Using precision instruments and guides, he or she removes the damaged bone surfaces and cartilage. Small amounts of the bone surface are removed from the front, end, and back of the femur, which allows the implant to fit properly. The amount of bone removed depends on how much damage has been done. A small portion of the top surface of the tibia is also removed, along with the back surface of the knee cap.
The artificial joint is then attached to the thigh bone, shin, and knee cap either with cement or a special material. Some artificial knee implants have pegs, which require small holes to be drilled into the bone after the damaged areas have been removed. Others have central stems or screws. Once the knee implant is in place, the surgeon sews up the incision and places a drain in the wound to allow fluids to drain out during the first few hours post-surgery. Another procedure being used by orthopedic surgeons is minimally invasive knee surgery which involves a smaller incision and less pain and recovery time.