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Total knee arthroplasty

Gregory M Martin, MD
Thomas S Thornhill, MD
Jeffrey N Katz, MD, MSc
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. As of 2010, over 600,000 total knee replacements were being performed annually in the United States and were increasingly common [1]. Among older patients in the US, the per capita number of primary total knee replacements doubled from 1991 to 2010 (from 31 to 62 per 10,000 Medicare enrollees annually) [2]. The number of total knee replacements performed annually in the US is expected to grow by 673 percent to 3.48 million procedures by 2030 [3]. A variety of pathologic conditions affecting the knee can be treated with total knee replacement, leading to pain relief, to restoration of function, and to mobility.

The normal knee joint functions as a complex hinge, primarily allowing flexion and extension but also allowing rotation and gliding. The knee joint is made up of three compartments: lateral, medial, and patellofemoral. Damage to the cartilage of one or more compartments may be the result of osteoarthritis (idiopathic or posttraumatic), inflammatory arthritis (rheumatoid, psoriatic, etc), avascular necrosis, tumors, or congenital deformities. Over 95 percent of total knee replacements in the US are performed for osteoarthritis [1,4].

The introduction of the “total condylar prosthesis” by Insall and colleagues in 1972 is generally considered to mark the era of “modern” knee replacement [5]. This prosthesis was the first to replace all three compartments of the knee. There are variations of the original design, and there is increasing interest in partial (unicompartmental) knee replacements. (See 'Choice of prosthesis and fixation technique' below and 'Alternatives to total knee arthroplasty' below.)

Modern total knee arthroplasty consists of resection of the diseased articular surfaces of the knee, followed by resurfacing with metal and polyethylene prosthetic components. For the properly selected patient, the procedure results in significant pain relief, as well as improved function and quality of life [6].

Despite the potential benefits of total knee arthroplasty, it is an elective procedure and should only be considered after extensive discussion of the risks, benefits, and alternatives. This topic reviews aspects of total knee arthroplasty including preoperative, operative, and postoperative considerations.


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Literature review current through: Sep 2016. | This topic last updated: Aug 4, 2015.
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