KNEE REPLACEMENT

Arthritis of the knee is one of the most common causes of chronic joint pain and reduced mobility. The condition develops when the protective cartilage that cushions the ends of the bones gradually wears down, causing inflammation, stiffness, and pain. The most common form is osteoarthritis, though rheumatoid arthritis and post-traumatic arthritis can also affect the knee.

A helpful way to understand knee arthritis is to think about the tread on a tire. Over time the tread wears down until it is gone. In the knee, the progression follows a similar pattern. The smooth cartilage surface that lines the joint thins gradually, eventually leading to what is commonly called bone-on-bone arthritis, where the underlying bone is exposed and the joint becomes painful with normal movement.

In the early stages, many people are not aware they have arthritis. Pain may only occur during strenuous activity or after long periods of standing. As the condition worsens, everyday activities such as walking, climbing stairs, kneeling, and getting out of a chair can become difficult and painful.

Knee arthritis is diagnosed through a combination of a physical examination and weight-bearing X-rays. It is important that X-rays are taken with the patient standing, as non-weight-bearing X-rays taken lying down can underestimate the severity of cartilage loss. At Proliance Orthopedic Associates, we use specific standing arthritis X-ray views that accurately show the amount of joint space narrowing and cartilage wear. Arthritis is often missed when the wrong type of X-rays are used. If you have had X-rays at an urgent care or primary care office that were read as normal but you are still experiencing knee pain, we encourage you to come in for a complete evaluation with the correct imaging.

Many patients with knee arthritis can manage their symptoms for months or years without surgery. Non-surgical treatment options include physical therapy and strengthening programs to support the muscles around the knee, oral anti-inflammatory medications, topical pain creams, cortisone injections, gel injections such as hyaluronic acid, and bracing. Our surgeons work with each patient to develop a personalized conservative treatment plan and will always explore appropriate non-surgical options before recommending knee replacement.

Cortisone and gel injections can be very effective at managing arthritis pain, particularly in the earlier stages of the disease. However, injections treat the symptoms of pain and inflammation rather than reversing the underlying cartilage loss. As arthritis progresses, injections tend to provide shorter-lasting relief. When conservative treatments no longer provide meaningful improvement, total knee replacement becomes the most reliable long-term solution for restoring comfort, function, and an active lifestyle.

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the damaged cartilage surfaces of the knee are removed and replaced with metal and plastic components that recreate a smooth, pain-free joint. Despite the name, the vast majority of the knee remains intact after surgery. Three of the four major ligaments are preserved, only the very ends of the bone are resurfaced, and all of the surrounding soft tissue stays in place. Approximately 18 millimeters of bone and worn cartilage are removed and replaced with precision-engineered implant components.

The implant consists of a metal cap on the end of the thighbone (femur), a metal tray on the top of the shinbone (tibia), and a highly durable polyethylene spacer between the two that allows smooth, low-friction movement. The surgery typically takes about one hour, with a total operating room time of approximately 90 minutes including anesthesia preparation.

In some cases, we can avoid the need for a "total" knee replacement and perform a partial knee replacement. In this surgery, only the damaged portion of the knee is replaced and the remaining non-arthritic portion of the knee remains untouched.

Proliance Orthopedic Associates offers robotic-assisted total knee replacement using the DePuy VELYS robotic system. Robotic-assisted surgery uses computer-guided planning to help the surgeon position and align the implant components with a high degree of precision. The robot does not perform the surgery independently. All decision-making, bone preparation, and implant placement are performed by the surgeon, with the robotic system serving as an additional tool for accuracy and reproducibility.

Our surgeons are experienced in both robotic-assisted and conventional instrumented techniques. The choice of approach is individualized for each patient based on their anatomy, bone quality, and clinical factors. During your consultation, your surgeon will discuss whether robotic-assisted surgery is the best option for your specific situation.

Knee replacement surgery at Proliance Orthopedic Associates is performed under spinal anesthesia combined with a long-acting regional nerve block. This approach eliminates the need for general anesthesia in most patients, which reduces common side effects including nausea, grogginess, and sore throat. Patients are comfortably sedated during the procedure and do not remember the surgery.

Pain management uses a multi-modal approach that begins before surgery and continues through recovery. During the operation, a long-acting local anesthetic mixture is injected around the joint and into the knee capsule to provide extended post-operative pain relief. After surgery, patients receive a combination of anti-inflammatory medications, acetaminophen, and a short course of narcotic pain medication as needed. This comprehensive pain protocol allows the large majority of patients to go home comfortably on the same day as surgery and manage their recovery at home from the start.

The majority of total knee replacement patients at Proliance Orthopedic Associates go home the same day as surgery. Research consistently shows that patients who recover at home do at least as well, and often better, than those who recover in a hospital or skilled nursing facility. Patients sleep better in their own bed, are in a familiar and comfortable environment, and avoid the infection risks associated with inpatient facilities.

Same-day discharge is made possible by thorough preparation. Before surgery, patients receive a complete recovery plan including pre-scheduled physical therapy, a detailed pain management regimen, clear home-preparation instructions, and direct access to our clinical team for questions during recovery. Patients begin walking with a rolling walker within hours of surgery and are discharged once they are comfortable, stable, and confident with mobility.

For patients with significant medical complexity or limited home support, an overnight stay at Valley Medical Center in Renton can be arranged. This decision is made together with the patient well before the day of surgery.

Recovery from total knee replacement is a progressive process that starts immediately after surgery. Patients walk with full weight on the operated leg from Day 1 using a rolling walker. Physical therapy begins within the first week and continues two to three times per week for approximately six to eight weeks. The primary focus in the first two weeks is controlling swelling through consistent icing and elevation, as swelling is the main factor that inhibits early quad recovery and range of motion.

Most patients transition from a walker to a cane within two to three weeks, and are walking without any assistive device by four to six weeks after surgery. By six weeks, many patients report feeling better than they did before surgery, though some residual swelling and stiffness are normal and continue to improve. Return to low-impact activities such as golf, swimming, cycling, and walking for exercise typically occurs between six and eight weeks.

Higher-demand activities including hiking, pickleball, skiing, and doubles tennis are generally resumed around three to four months with consistent rehabilitation. Full recovery continues for up to a year as strength, endurance, and confidence improve. Swelling resolves fully, scar tissue matures, and the knee begins to feel increasingly natural with continued activity.