Total knee arthroplasty
Total knee arthroplasty
Gregory M Martin, MD
Ian Harris, AM, MBBS, MMed(Clin Epi), MSc(HDS), PhD
Section Editor:
David Hunter, MD, PhD
Deputy Editors:
Philip Seo, MD, MHS
Kathryn A Collins, MD, PhD, FACS
Literature review current through: Apr 2023.
This topic last updated: Sep 16, 2022.


Total knee arthroplasty (TKA), also known as total knee replacement, is one of the most performed orthopedic procedures. As of 2010, over 600,000 TKAs were being performed annually in the United States and were increasingly common [1]. Among older patients in the United States, the per capita number of primary TKAs doubled from 1991 to 2010 (from 31 to 62 per 10,000 Medicare enrollees annually) [2]. The number of TKAs performed annually in the United States is expected to increase in volume by 143 percent by 2050 compared with 2012 [3,4].

TKA consists of resection of the diseased articular surfaces of the knee, followed by resurfacing with metal and polyethylene prosthetic components [5]. For the properly selected patient, the procedure results in significant pain relief, as well as improved function and quality of life. In spite of the potential benefits of TKA, TKA is usually performed on an elective basis and should only be considered after exhaustion of appropriate nonsurgical therapies and extensive discussion of the risks, benefits, and alternatives.

This topic reviews aspects of TKA including indications and perioperative considerations. As with any major surgical procedure, complications may result during or after TKA. Complications of this procedure are discussed separately. (See "Complications of total knee arthroplasty".)


Indications — Generally, total knee arthroplasty (TKA) is performed for destruction of joint cartilage either from osteoarthritis, rheumatoid arthritis/inflammatory arthritis, posttraumatic degenerative joint disease, or osteonecrosis/joint collapse with cartilage destruction. Damage to the synovial joint of one or more of the three compartments (lateral, medial, patellofemoral) may be the result of a variety of pathologic conditions. Such damage causes pain and impairs the normal functioning of the knee joint, which is a complex hinge, primarily allowing flexion and extension but also allowing rotation and gliding.

Osteoarthritis – Osteoarthritis is the most common type of arthritis in adults and can result in degenerative changes in the knee joint. Over 95 percent of TKAs in the United States are performed for osteoarthritis (picture 1) [1,6]. In patients with osteoarthritis, TKA is indicated for the relief of severe knee pain that is refractory to nonoperative treatments. Before proceeding to TKA, a multifaceted regimen of nonoperative treatment should be tried. Nonsurgical treatments offer significant benefit with lower risk. The efficacy of these nonsurgical interventions, even with advanced osteoarthritis, has been supported in clinical trials [7,8] and are appropriate, particularly in patients looking to avoid or postpone surgical intervention or for patients not fit for surgery. (See "Management of knee osteoarthritis", section on 'Moderate/severe knee osteoarthritis' and "Management of moderate to severe knee osteoarthritis", section on 'Surgery' and 'Medical risk assessment' below.)

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