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The Step-by-Step Process of Total Knee Replacement Explained by Surgeons

When a patient visits a doctor with knee pain or discomfort, especially one severe enough to consider a total knee replacement (TKR), the diagnosis process becomes crucial in determining the best course of action. A total knee replacement is typically recommended when the knee joint is severely damaged, usually by arthritis or injury, and conservative treatments no longer provide relief. The diagnosis involves a combination of the patient’s medical history, physical examination, imaging tests, and sometimes laboratory work. Below, we explore what a Total Knee Replacement surgeon in Houston, Texas looks for during the diagnostic process.

1. Medical History

A surgeon begins the diagnosis by reviewing the patient’s medical history. This includes asking questions about the severity and duration of the knee pain, its impact on the patient’s daily activities, and any previous treatments tried. Patients are also asked about their past surgeries, injuries, and any family history of knee-related conditions. Understanding the patient’s medical background helps the surgeon to gauge the underlying causes of the knee problem and determine if knee replacement surgery is appropriate.

Key aspects of medical history include:

• Pain patterns: Surgeons ask if the pain is constant or intermittent, and if it worsens with activity.
• Joint stiffness: Information on how the knee feels when moving, such as stiffness or locking, is also considered.
• Previous treatments: Surgeons want to know if the patient has tried physical therapy, medications, corticosteroid injections, or other treatments.
• Overall health: A patient’s general health and comorbidities (e.g., diabetes, heart disease) are also considered, as these can affect the success of surgery and healing.

2. Physical Examination

The physical examination is a critical step for the surgeon to evaluate the knee joint’s condition. The surgeon will check for signs of inflammation, such as swelling or warmth, and assess the range of motion (ROM) of the knee. In many cases of knee arthritis, the joint may become stiff, and the surgeon will measure how far the knee can bend or straighten.

During the examination, the surgeon will also check for:

• Joint alignment: Abnormalities like bowing or knock-knees are observed. Malalignment can cause uneven stress on the knee, worsening pain and damage.
• Instability: Surgeons assess if the knee feels unstable or “gives way” during movement, which may indicate ligament damage.
• Tenderness: Palpation of the knee helps the surgeon identify areas of pain or tenderness, which can indicate inflammation, arthritis, or cartilage damage.

3. Imaging Tests

Imaging plays a key role in diagnosing the need for a total knee replacement. The surgeon will typically order one or more of the following:

• X-rays: These are the most common imaging tool used to assess the severity of knee arthritis. X-rays allow the surgeon to see the degree of joint space narrowing, bone spurs, and any deformities, which are typical signs of advanced arthritis. A significant reduction in joint space often indicates the need for surgery.
• MRI (Magnetic Resonance Imaging): If the surgeon suspects damage to soft tissues like cartilage or ligaments, they may order an MRI. This can give a more detailed view of the knee joint and help in planning the surgery.
• CT Scan: In some cases, a CT scan may be used to evaluate the bones and joint in greater detail, particularly if deformities or complex issues are present.

4. Laboratory Tests

Though not always necessary, laboratory tests may be used to rule out other conditions that could mimic knee arthritis, such as infections or autoimmune diseases like rheumatoid arthritis. Blood tests can detect inflammation markers or signs of infection, providing a fuller picture of the patient’s health.

5. Assessment of Functional Impact

The surgeon also considers how the knee problem is affecting the patient’s overall quality of life. If knee pain is preventing the patient from walking, climbing stairs, or performing daily activities like bending or squatting, this can support the decision to move forward with surgery. The surgeon will also assess the patient’s goals and expectations for surgery, ensuring that the decision aligns with their desires for improved mobility and pain relief.

A total knee replacement surgeon conducts a thorough evaluation to determine if surgery is the best option. By examining the patient’s medical history, conducting a physical examination, utilizing imaging tests, and sometimes performing laboratory tests, the surgeon ensures an accurate diagnosis. This comprehensive approach allows for informed decision-making and helps the patient understand the expected benefits and risks of the surgery.