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Total Knee Replacement Surgery "Patient Specific & Kinematically Aligned"

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A personalised knee replacement approach designed to match your natural joint alignment and movement

Total knee replacement (also called total knee arthroplasty) is a surgical procedure that may be recommended to relieve persistent knee pain and improve joint function, particularly in people affected by advanced osteoarthritis, rheumatoid arthritis, or other degenerative joint conditions.

While traditional knee replacement techniques use standard implant sizes and alignment methods, these may not always reflect the unique anatomy and movement patterns of each individual. A patient-specific and kinematically aligned knee replacement approach takes these differences into account. Using detailed imaging, such as MRI or CT scans, a 3D model of your knee is created to assist in planning the surgery and designing custom surgical guides tailored to your anatomy.

At Hunter Sports & Joint Replacement, Dr Ben McGrath performs total knee replacement using advanced technologies such as 3D-printed patient-specific instruments (PSI), anatomical mapping, and the kinematic alignment (KA) technique. These tools aim to support more precise implant positioning and may help achieve a more natural knee movement based on your individual joint structure.

In the information that follows, you’ll find a comprehensive overview of this surgical approach—including how it works, when it may be considered, the surgical process, implant options, potential risks and benefits, and what to expect during recovery. This guide is designed to support your understanding and help you make an informed decision about your treatment options in consultation with Dr McGrath.

Total Knee Replacement Surgery & Your Anatomy

Your knee is a highly specialised hinge joint that plays a central role in everyday movement, supporting walking, standing, bending, and weight-bearing activities. It consists of three primary bones: The femur (thigh bone), The tibia (shin bone) & The patella (kneecap).

These bones are connected and supported by ligaments, tendons, and muscles, all of which work together to allow smooth and stable movement. Between the femur and tibia lies the meniscus, a C-shaped piece of cartilage that acts as a shock absorber, cushioning the joint and helping to evenly distribute weight. The surfaces of the bones are also lined with articular cartilage, a smooth tissue that enables frictionless motion within the joint.

Over time, or due to injury or disease, these protective structures can become damaged. Osteoarthritis is the most common condition affecting the knee joint. It leads to gradual wear and tear of the cartilage, resulting in pain, stiffness, swelling, and reduced mobility. Other causes may include rheumatoid arthritis, post-traumatic injuries, or previous surgeries that have altered joint function.

In the early stages, symptoms may be managed with non-operative treatments, including:

  • Physiotherapy to improve joint strength and mobility
  • Anti-inflammatory medications
  • Corticosteroid or hyaluronic acid injections to reduce pain and inflammation
  • Activity modification and lifestyle measures

When these approaches no longer provide sufficient relief however and the pain begins to interfere with your quality of life such as walking short distances, climbing stairs, or sleeping comfortably total knee replacement surgery may be considered.

This surgical procedure involves replacing the damaged joint surfaces with carefully selected prosthetic components designed to replicate the natural movement of your knee. The goal is to restore function, reduce pain, and help you return to your daily activities with improved comfort and mobility.

Dr Ben McGrath will assess your symptoms, imaging results, and overall health to determine whether total knee replacement is an appropriate treatment option for your individual situation. Where appropriate, a patient-specific approach may also be used to customise the procedure to your unique anatomy.

Signs You May Be Ready for a Knee Replacement

The decision to proceed with TKA is guided by several compelling indications, including:

One of the clearest signs that knee replacement may be necessary is ongoing pain that does not improve with rest, medications, or other non-surgical treatments. If you find yourself regularly taking pain relievers or if the pain interferes with your daily activities, including walking, working, or even sleeping, it might be time to explore knee replacement as an option.

If your knee feels stiff, especially in the morning or after long periods of sitting and this stiffness limits your ability to move or bend the joint, it may be a sign of advanced joint damage. When routine tasks like walking, climbing stairs, or getting out of a chair become difficult, it’s important to seek an evaluation for knee replacement surgery.

Noticeable changes in the appearance of your knee, such as swelling, deformities (like bowing in or out), or if your knee feels unstable and buckles underweight, can indicate serious joint deterioration. These visible signs often suggest that surgery may be the best way to restore function and relieve discomfort.

When knee pain and joint dysfunction significantly impede daily activities, such as walking, climbing stairs, or performing routine tasks like getting in and out of chairs, TKA may be recommended. Restoring functionality is a primary objective of the procedure, enhancing overall quality of life.

Severe Osteoarthritis: TKA is frequently recommended when osteoarthritis progresses to an advanced stage, causing the significant loss of joint cartilage. This results in debilitating pain, stiffness, and diminished mobility. Patients may experience pain even at rest, making routine activities challenging.

Rheumatoid Arthritis/Inflammatory Arthritis: In cases of rheumatoid arthritis or other forms of inflammatory arthritis, chronic inflammation can erode joint surfaces, including the knee. When this inflammation leads to substantial joint dysfunction, severe pain, and a reduced quality of life, TKA becomes a viable option.

If diagnostic imaging reveals severe arthritis-related deterioration of the knee, knee replacement surgery could be a viable option to reduce pain and improve joint function. Advanced knee arthritis can also lead to the development of joint deformities, including bowlegs or knock-knees. TKA can effectively address these deformities by correcting joint alignment and function, thereby relieving pain, and restoring mobility.

Traumatic knee injuries, such as fractures or ligament tears, can ultimately lead to the development of posttraumatic degenerative joint disease. This condition may manifest as persistent pain, instability, and progressive joint damage, necessitating TKA to restore function and alleviate discomfort.

Osteonecrosis, characterised by the loss of blood supply to the bone, can result in joint collapse and subsequent cartilage destruction. TKA is considered when these conditions lead to substantial pain, limited joint motion, and functional impairment.

For individuals who have undergone previous knee surgeries, such as arthroscopy or partial knee replacement, without achieving satisfactory outcomes, TKA may be indicated. Unsatisfactory results, persistent pain, and deteriorating joint health can prompt consideration of TKA as a more effective intervention.

If non-surgical treatments like physiotherapy, exercise, weight management, anti-inflammatory medications, or corticosteroid injections are no longer providing lasting relief, it could be a sign that the damage to your knee has progressed beyond what conservative measures can manage. In such cases, knee replacement surgery may offer the best chance for long-term relief and improved mobility.

Recognising the signs of advanced knee joint deterioration is an important first step in exploring whether knee replacement surgery may be appropriate. This decision is a personal one and depends on how much your symptoms are affecting your daily life, mobility, and overall wellbeing. 

The Prosthetic Implants Used In a Total Knee Replacement

The implants play a pivotal role in total knee replacement surgery, as they are instrumental in restoring the function and stability of the knee joint. These meticulously designed artificial components are crucial to the success of the procedure, and understanding their composition, types, and customisation is essential:

This medial pivot, metal component is designed to replace the end of the femur (thigh bone). It closely replicates the natural shape of the femur’s articular surface, which is essential for maintaining the knee’s natural movement and stability, especially on the medial (inner) side of the knee.

The tibial component replaces the top surface of the tibia (shin bone). It typically includes a metal baseplate and a plastic insert that acts as the cartilage, providing a smooth gliding surface.

In some cases, the undersurface of the patella (kneecap) may also be resurfaced with a plastic implant to improve patellar tracking and reduce friction within the joint.

The material used for the articular surfaces varies but commonly includes a combination of metals and plastic. The femoral component is often made of a metal alloy (e.g., cobalt-chromium), while the tibial component has a metal baseplate and a plastic insert made of ultra-high-molecular-weight polyethylene (UHMWPE). These materials are chosen for their durability and biocompatibility.

These prosthetic components can be secured to the bone using various fixation methods, including cemented fixation (using bone cement) or cementless fixation (relying on bone ingrowth into porous coatings on the implant).

Dr McGrath’s preferred implant choice for total knee replacement is the GMK Sphere knee implant, due to its advanced design features that closely replicate the natural motion of a healthy knee. This implant choice underscores his commitment to optimising patient outcomes, ensuring restored knee function and stability with an emphasis on natural movement and long-term durability.

Mechanical vs Kinematic Alignment Total Knee Replacement Techniques

When considering total knee replacement surgery, it’s important to understand that not all techniques are the same. Dr Ben McGrath offers both traditional and personalised approaches to knee replacement, depending on your unique anatomy, goals, and overall health.

  • Mechanical Alignment (MA): Mechanical alignment is the traditional technique used in many total knee replacements. The aim is to position the knee implant in a straight line from the hip to the ankle, which may help distribute pressure evenly across the joint and support long-term implant durability. However, this method may not fully account for the natural differences in each person’s knee structure. As a result, some patients may experience a less natural feel or reduced knee function after surgery.
  • Kinematic Alignment (KA): With a kinematic alignment technique, the aim is to replicate the natural alignment of your knee before it was affected by arthritis or injury. This personalised approach seeks to restore the knee’s natural movement patterns. Dr McGrath aligns the knee components based on your unique anatomy and the way your knee moves, which can potentially offer a more natural feel and improved biomechanics.

Key Advantages of Kinematic Alignment

  • Natural Movement: By aligning the knee in its natural state, kinematic alignment can lead to a knee that feels and functions more naturally after surgery.
  • Enhanced Stability: This technique helps maintain the natural tension in the knee ligaments, which can improve stability and potentially reduce the risk of implant-related issues.
  • Personalised Approach: Kinematic alignment takes into account the patient’s individual anatomy and movement patterns, providing a tailored surgical solution that can enhance overall satisfaction.

This approach is designed to better mimic the natural function of the knee, potentially leading to improved patient outcomes and satisfaction.

Kinematic Alignment 3D Video animation showing the main steps of TKA Procedure

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Your Patient Specific Total Knee Replacement Journey With Dr Ben McGrath

Embarking on the path to knee replacement surgery with Dr Ben McGrath involves a detailed, personalised plan tailored to your anatomy, health status, and lifestyle. This comprehensive approach is designed to support the best possible outcomes through meticulous planning, advanced technology, and clear communication at every stage.

THE PROCESS:

A step-by-step guide to your personalised care plan

CONSULTATION

A comprehensive evaluation and discussion with Dr McGrath

  • Your journey begins with a referral from your GP and an initial consultation with Dr McGrath at The Orthopaedic Clinic in The Junction. During this visit, Dr McGrath will thoroughly assess your knee’s range of motion, alignment, and stability. You’ll also discuss your symptoms, how they impact your daily life, and your expectations for surgery. This conversation forms the foundation for a care plan tailored to your specific goals.

IMAGING

CT scan of your knee and leg

  • At least 6 weeks before surgery and usually within 1–2 weeks after your consultation, you will undergo imaging, including X-rays and a detailed CT scan of your knee and leg. These images provide a comprehensive view of your joint structure and alignment. The CT scan is particularly important as it allows for the creation of a 3D model of your knee, which will be used to guide the planning and customisation of your surgery.

PRE-OPERATIVE PREPARATIONS

Enhanced Recovery After Surgery (ERAS) Program

  • As part of your lead-up to surgery, you’ll be supported through the Enhanced Recovery After Surgery (ERAS) program. This includes pre-habilitation strategies such as prescribed exercises, physiotherapy, and guidance on nutrition, weight optimisation, and smoking cessation where needed. Dr McGrath will also review your medications and provide any necessary adjustments to help ensure a smooth recovery.

KNEE MODELLING

Creation of your 3D knee model

  • Specialist engineers in Switzerland use the CT scan data to create a highly detailed 3D model of your knee. This model is reviewed closely by Dr McGrath to understand the unique features of your joint.

PLANNING

Customised surgical planning & analysis

  • Using advanced planning software, Dr McGrath runs various surgical simulations to determine the best implant position and surgical approach based on your anatomy. This detailed planning supports precision and helps personalise the surgery to your needs. The plan is typically finalised within 2–3 weeks of your imaging and is central to the personalised nature of your knee replacement.

PRODUCTION OF SURGICAL TOOLS

Your patient-specific instruments are manufactured

  • Based on the 3D model and surgical plan, your personalised surgical cutting guides are manufactured in Switzerland, sterilised, and delivered to the hospital ahead of your operation.

ANAESTHESIA CONSULTATION

Usually over the phone

  • You will have a pre-operative consultation with the anaesthetic team to determine the most appropriate anaesthetic plan for your individual health profile. This ensures your safety and comfort during the procedure.

PRE-ADMISSION

Final Surgical Preparation and Pre-Admission Planning

  • As your surgery approaches, Dr McGrath will review your plan with you in detail, covering the procedure itself, expected recovery, and any potential risks. You’ll receive clear instructions on how to prepare your home for recovery and how to organise help for the post-operative period.

DAY OF SURGERY

Your Hospital Admission

  • You’ll be admitted to hospital on the day of your surgery. Your custom instruments will be ready and waiting in theatre. 

SURGERY

Your personalised total knee replacement procedure

  • Once anaesthesia is administered, Dr McGrath performs your surgery using the patient-specific instruments, which are designed to match your knee anatomy and alignment. These tools support accurate implant positioning and may contribute to a more natural-feeling result and efficient procedure.

RECOVERY

Post-Operative Care

  • Following surgery, you’ll be closely monitored in hospital with a focus on pain relief, wound care, and early mobilisation. Physiotherapy will begin promptly to help restore knee function and strength. Most patients stay in hospital for approximately 3 nights, although this may vary depending on individual recovery and procedure complexity.

    Dr McGrath will schedule follow-up appointments to track your progress, ensure proper healing, and support your long-term recovery.

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Recovering From A Total Knee Replacement

After undergoing knee replacement surgery, the recovery phase marks the beginning of your journey towards regaining mobility and improving your quality of life. Dr McGrath places a strong emphasis on ensuring that you are well-informed about the recovery process, providing you with the knowledge and support needed for a successful outcome .Post-operative rehabilitation following total knee replacement surgery is a critical phase that plays a pivotal role in ensuring optimal recovery, restoring function, and promoting your long-term joint health.

IMMEDIATE POST-OP PERIOD

  • Hospital Stay: Typically, patients stay in the hospital for about 3 nights, depending on the complexity of the surgery, overall health, and individual recovery progress. In some cases, you may even be able to go home the day after your surgery if your recovery is progressing well.
  • Pain Management: Immediately after surgery, managing your pain is a priority. You’ll be given medication to help control pain levels, allowing you to start moving and walking as soon as possible.
  • Monitoring and Wound Care: Your healthcare team will closely monitor your recovery, paying particular attention to your wound, ensuring it’s healing properly and showing no signs of infection.
  • Physiotherapy and Rehabilitation: Starting physiotherapy early is crucial. Under guidance, you’ll begin exercises to improve your knee’s range of motion and strength right from the hospital.
  • Ongoing Rehabilitation: Once home, you’ll continue with a tailored rehabilitation program. Consistent participation in physiotherapy sessions and adhering to prescribed exercises at home are key to a successful recovery.

AT HOME RECOVERY

  • Home Preparation: Ensure your living space is prepared for your return, with trip hazards removed and daily necessities within easy reach. You may also need assistive devices like a walker or handrails in the bathroom. Consider ergonomic adjustments at work and home to ease the strain on your knee, like using a footrest to maintain proper sitting posture or choosing supportive, cushioned footwear.
  • Protect Your Knee: Don’t hesitate to use canes, walkers, or handrails, especially in the early stages of recovery or when navigating uneven surfaces, to prevent falls and protect your knee.
  • Listen to Your Body: Pay attention to signs of overexertion or discomfort and adjust your activities accordingly. If you experience swelling, prolonged pain, or any unusual symptoms, contact Dr McGrath or the hospital without delay.

EARLY POST-DISCHARGE PERIOD (FIRST FEW WEEKS)

  • Home Exercises: Your rehabilitation plan will include a set of prescribed home exercises focusing on knee mobility, gentle strengthening, and maintaining joint flexibility.
  • Ambulation Aid: You may continue using a walker or crutches as recommended by Dr McGrath until you regain sufficient strength and balance.

WEEKS 2-6 POST-OP

  • Physiotherapy Sessions: Regular physiotherapy sessions will continue to progress your exercises, incorporating more challenging activities to enhance strength and range of motion.
  • Gradual Weight-Bearing: Depending on your progress, Dr McGrath may advise a gradual increase in weight-bearing activities 

WEEKS 6-12 POST-OP

  • Advanced Strengthening: As your knee continues to heal, emphasis will be placed on more advanced strengthening exercises. These may include stationary biking, leg presses, and other controlled resistance exercises.
  • Functional Activities: Physiotherapy will shift towards incorporating functional activities such as stairs, getting in and out of chairs, and simulating real-world movements.

BEYOND 12 WEEKS

  • Return to Normal Activities: With the guidance of your physiotherapist and Dr McGrath, you’ll gradually resume normal activities. This may include low-impact exercises, recreational walking, and light recreational sports.
  • Monitoring and Follow-ups: Regular follow-up appointments with Dr McGrath will continue to monitor your progress, address any concerns, and make adjustments to your rehabilitation plan as needed. 

POST-OP PRECAUTIONS

  • Avoid High-Impact Activities: While rehabilitation aims to restore function, high-impact activities and sports may need to be avoided to protect the longevity of the knee replacement.
  • Maintain a Healthy Lifestyle: Incorporate a balanced diet, proper hydration, and overall healthy lifestyle choices to support the healing process.

The recovery phase following total knee replacement surgery is a vital part of your journey toward improved mobility and a better quality of life. Dr McGrath places a strong focus on helping you understand what to expect during this period, providing clear guidance and ongoing support to assist your recovery.

Post-operative rehabilitation plays a key role in restoring joint function, reducing stiffness, and promoting long-term joint health. The rehabilitation plan is tailored to your individual needs—taking into account factors such as your overall health, the specific condition of your knee, and the surgical approach used. Open communication with your healthcare team, along with consistent participation in your physiotherapy and rehabilitation program, is essential. By following your personalised recovery plan, you can support a safe return to daily activities and work toward the best possible outcome after surgery.

Risks Associated With Knee Replacement Surgery

While knee replacement surgery can significantly improve your quality of life by reducing pain and increasing mobility, it is important to be aware of the potential risks and complications associated with the procedure. Dr  McGrath and his team take every precaution to minimise these risks, but understanding them can help you make an informed decision about your surgery.

  • Infection: Infections are a possible risk following knee replacement surgery. These infections may impact the surgical site, surrounding tissues, or even the implanted components. Treatment may involve antibiotics, and in severe cases, removal of the prosthetic components may be necessary. Septic complications represent a more severe form of infection specifically involving the joint, requiring prompt and targeted intervention to preserve joint health.
  • Blood Clots: Blood clots can form in the legs (deep vein thrombosis) and, in rare cases, travel to the lungs (pulmonary embolism). Preventative measures include administering blood-thinning medications, using compression stockings, and encouraging early mobilisation to reduce the risk of clot formation.
  • Pain and Stiffness: Some patients may experience persistent pain and stiffness after surgery. Physiotherapy and pain management strategies are employed to improve mobility and comfort. It’s essential to follow the rehabilitation plan to mitigate these issues and promote better outcomes.
  • Implant Issues: Over time, the artificial knee joint may wear out, loosen, or become unstable. Regular follow-up appointments are crucial to monitor the condition of the implant. In some cases, revision surgery may be necessary to address these issues and restore knee function.
  • Nerve or Blood Vessel Damage: During surgery, there is a small risk of damage to the nerves or blood vessels around the knee. Surgeons take great care to avoid these structures, and any damage is usually temporary. If nerve or blood vessel damage occurs, additional treatments or therapies may be required to facilitate recovery.

Less Common Risks

  • Allergic Reactions: Rarely, patients may have an allergic reaction to the materials used in the implant. Preoperative screening for known allergies and using hypoallergenic materials when necessary, can help manage this risk. If an allergic reaction occurs, it may require medical management or changes to the implant.
  • Bone Fractures: Bones around the implant can fracture during or after surgery. Careful surgical techniques and postoperative precautions are essential to prevent fractures. If a fracture occurs, it may necessitate additional surgical intervention to repair the bone and ensure proper healing.
  • Joint Instability: The new knee joint may feel unstable or dislocate. Proper implant placement and Physiotherapy to strengthen the surrounding muscles can help prevent instability. If instability persists, further medical evaluation and treatment may be required to correct the issue.

Long-Term Considerations

  • Wear and Tear: Artificial joints can wear down over time, especially in active individuals. Following Dr McGrath’s recommendations on activity levels and attending regular check-ups are important to monitor the implant and manage wear and tear effectively.
  • Revisions: Some patients may require a second surgery to replace or repair the artificial joint. Advances in implant technology and surgical techniques aim to extend the lifespan of knee replacements, reducing the need for revision surgeries. If revision surgery becomes necessary, it will be planned and executed with the same precision and care as the initial procedure.

Understanding the risks associated with knee replacement surgery is a crucial part of preparing for the procedure. Dr McGrath and his team are committed to providing you with comprehensive care and support, ensuring you are well-informed and confident in your decision. If you have any concerns or questions about the surgery, please do not hesitate to discuss them with Dr McGrath during your consultation.

Adapting Your Lifestyle Post-Total Knee Replacement: Tips And Guidance

After undergoing total knee replacement surgery, adapting your lifestyle to accommodate your new knee is crucial for ensuring a successful recovery and maintaining the longevity of the implant. Dr McGrath is committed to supporting his patients through every step of their post-operative journey, providing expert advice on how to best adjust your lifestyle for optimal outcomes. Here are some practical tips and guidance to help you navigate life after your knee replacement:

  • Stay Active but Be Mindful: Incorporate low-impact activities such as walking, swimming, or cycling into your routine. These exercises strengthen the muscles around your new knee without putting undue stress on it. High-impact sports and activities that place excessive strain on the knee, such as running, jumping, or heavy lifting, should be avoided to protect the longevity of your knee implant.
  • Maintain a Healthy Weight: Keeping your weight within a healthy range is essential. Excess weight can increase the wear on your knee implant, potentially leading to complications or the need for revision surgery in the future.
  • Follow Your Physiotherapy Regimen: Adhering to the physiotherapy program prescribed by Dr McGrath and your physiotherapist is key to regaining strength and mobility in your knee. Even after formal therapy sessions end, continuing with recommended exercises at home can further enhance your recovery.

Adjusting your lifestyle post-knee replacement surgery involves making mindful choices to support your recovery and the durability of your knee implant. With Dr McGrath’s expert guidance and a commitment to these adjustments, you can look forward to resuming an active, fulfilling life post-surgery.

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