Knee Replacement Surgery - Brisbane & Hamilton
Full knee replacement, also known as Total knee arthroplasty, is an operation used to treat advanced knee arthritis when pain, stiffness and loss of function remain significant despite appropriate non-surgical treatment. Dr Alexey Borshch provides knee replacement assessment and surgery in Brisbane, with consultations in Hamilton.
Your individual condition and treatment plan may be different, so this information should be used alongside advice from your surgeon and treating team.
What is Total Knee Replacement Surgery?
A Knee Replacement swaps the damaged knee joint surfaces with metal and polyethylene surfaces.
The aim of Total Knee Replacement is to:
- reduce knee pain
- improve walking and everyday activities
- correct significant bow-legged or knock-kneed deformity
- improve knee stability and function
- improve quality of life
The operation does not replace the entire knee. Rather the surface layer of damaged bone and cartilage is removed from the ends of the femur (thigh bone) and tibia(shin bone) and replaced with artificial surfaces.
Although "Full knee replacement" and "Total knee replacement" describe the same surgery, an important distinction is that in a Total knee replacement the surface of the tibia and the femur are replaced, but the undersurface of the kneecap may be left intact or also be replaced with a plastic component. The decision on whether to replace the patella (kneecap) surface depends partly on the condition of the remaining cartilage, the cause of arthritis (inflammatory or infective) and sometimes patient age. A Partial knee replacement only replaces one or two of the knee articulations (medial, lateral, patellofemoral).
Why is Total Knee Replacement Done?
TKR may be considered when advanced knee arthritis causes ongoing pain and loss of function.
The most common reason for knee replacement surgery is advanced osteoarthritis of the knee. Osteoarthritis causes progressive loss of the smooth cartilage covering the joint. As this cartilage becomes thin or disappears, the underlying bone becomes exposed and can become painful.
A knee replacement may be considered when:
- knee pain affects walking, stairs, sleep, work or recreation
- the knee has become significantly stiff
- arthritis has caused bow-legged or knock-kneed deformity
- the knee feels unstable because of advanced arthritis
- non-surgical treatments are no longer adequately controlling symptoms
Not everyone with knee arthritis needs a knee replacement. Treatment may initially include exercise, physiotherapy, weight management, medications, injections and activity modification.
The decision to proceed with surgery should therefore be based on a combination of your symptoms, examination, X-rays, general health, previous treatment and goals.
How is Total Knee Replacement Surgery Performed?
The damaged knee is resurfaced with carefully positioned knee replacement components.
Exact techniques vary, but my total knee replacements generally involve the following steps.
1. Anaesthetic
A spinal or general anaesthetic may be used, together with additional methods of pain relief around the knee.
2. Accessing the knee
An incision is made at the front of the knee. The kneecap is carefully moved aside and the joint is exposed.
3. Preparing and aligning the knee
A small amount of damaged bone and cartilage is removed from the femur and tibia.
The aim is not simply to insert new components, but to position them so that the leg has appropriate alignment and the knee is stable and balanced throughout its range of movement.
I use computer navigation or robotic assistance during knee replacement surgery to assist with measurement, alignment and positioning of the components.
4. Placing the knee replacement
Metal components are attached to the femur and tibia, commonly using bone cement.
A highly durable plastic insert is placed between the metal components. This creates the new bearing surface of the knee.
5. Closing the knee
The deeper tissues are repaired using strong sutures and the incision is closed in several layers with absorbable sutures.
I generally close the skin with a fine absorbable suture underneath the skin and use a glued mesh over the incision. This provides additional support while the skin heals.
Preparing for Knee Replacement Surgery in Brisbane
Preparation focuses on health, strength, medications and planning for recovery.
Good preparation can reduce the risk of complications and make recovery easier.
Health optimisation
Before surgery:
- stop smoking or vaping if possible
- optimise diabetes and blood sugar control
- work on general fitness and weight where appropriate
- maintain good nutrition
- tell us about previous blood clots, sleep apnoea, heart or lung problems
- provide a complete list of medications and supplements
Exercise before knee replacement
Maintaining knee movement and strengthening the muscles around the knee before surgery can make early rehabilitationeasier.
You do not need to make an arthritic knee pain-free before surgery. The aim is to arrive at surgery as mobile, strong and medically healthy as reasonably possible.
Preparing your home
Arrange help with shopping, meals and transport for the early recovery period. Remove trip hazards and consider where you will sleep, shower and perform your exercises.
Your treating team will also advise which medications should be continued or temporarily stopped.
What to Expect After Total Knee Replacement
Recovery involves early mobilisation followed by progressive rehabilitation and strengthening.
In hospital
Hospital stay is commonly around 1–3 days, although some suitable patients may go home earlier.
You can expect:
- a combination of different types of pain relief
- early walking with physiotherapy
- exercises to restore movement
- measures to reduce the risk of blood clots
First 2–6 weeks
Your first review is primarily to check the incision, pain control and early progress.
Walking usually progresses from a frame or crutches to a stick and eventually independent walking.
Swelling is very common and can remain noticeable for several months. Physiotherapy focuses on restoring movement, strength and a normal walking pattern.
We generally aim for at least 90 degrees of knee flexion by approximately six weeks, although recovery varies between patients.
Driving is commonly avoided for approximately six weeks or until you have adequate strength and control to operate the vehicle safely.
6 weeks to 3 months
You will have a further review to assess your movement and overall recovery.
Pain, walking and everyday activities should progressively improve. Some swelling, warmth and stiffness can still be normal at this stage.
3 to 12 months
Strength, confidence, movement and the appearance of the knee can continue improving for 12 months or longer.
What Are the Long-Term Outcomes After Total Knee Replacement
Most patients improve post TKR, although outcomes and implant longevity vary between individuals.
Pain relief and function
Total knee replacement is generally a successful treatment for appropriately selected patients with advanced knee arthritis.
A large systematic review of patient satisfaction following total knee replacement included more than 95,000 patients. Most of the included studies reported satisfaction rates above 80%, with pain relief and improvement in function being important factors associated with satisfaction.
However, results vary between individuals and a knee replacement cannot guarantee a completely pain-free or “normal” knee.
How long does a total knee replacement last?
Modern knee replacements are designed to function for many years.
A major systematic review and meta-analysis published inThe Lancet examined long-term knee replacement survival using case series and national joint replacement registry data. Registry data suggested that approximately 82% of total knee replacements were still unrevised at 25 years.
This does not mean that every knee replacement will last 25 years. Implant longevity varies depending on age, activity, implant factors and individual circumstances.
Satisfaction and ongoing symptoms
Although most patients are satisfied with their knee replacement, some patients continue to experience pain, stiffness or functional limitations.
A more recent systematic review examining dissatisfaction following total knee replacement reported an average dissatisfaction rate of approximately 10%, lower than the historically quoted figure of around 20%.
This is why it is important for us to discuss the reason for surgery beforehand, optimise treatment before surgery and establish realistic expectations about recovery and long-term outcomes.
Things to Look Out for After Total Knee Replacement
Increasing pain, wound problems, fever, swelling or breathing symptoms need medical review.
Contact our office, your GP, or seek urgent medical attention if you develop:
Possible infection
- increasing redness or warmth around the incision
- increasing pain after initially improving
- persistent wound leakage or pus
- fever or feeling significantly unwell
Joint replacement infection is uncommon but potentially serious and should be assessed promptly.
Possible blood clot
Seek medical attention for:
- new calf pain or tenderness
- significant one-sided leg swelling
- sudden shortness of breath, chest pain or coughing blood
Sudden breathing symptoms require emergency assessment.
Knee stiffness
If the knee is becoming progressively stiffer or you are struggling to regain movement despite physiotherapy, contact us. Early assessment can be important.
Wound problems
Please contact us for persistent leakage, opening of the incision or rapidly increasing swelling or bruising.
Nerve or circulation problems
Increasing weakness or numbness, a cold or pale foot, or severe escalating pain requires urgent assessment.
Total Knee Replacement Surgery
Dr Alexey Borshch is a specialist orthopaedic surgeon in Brisbane with a particular clinical focus on surgery of the hip, knee and lower limb.
His practice as a Brisbane Orthopaedic surgeon focuses on the assessment and treatment of knee arthritis, as well as performing knee replacement surgery, which includes both total knee arthroplasty and partial knee replacement.
Dr. Borshch completed his medical degree at the University of Queensland before undertaking specialist orthopaedic training in Queensland. He completed the Australian Orthopaedic Association training program and the Royal Australasian College of Surgeons Fellowship Examination in Orthopaedic Surgery. He obtained specialist registration in Orthopaedic Surgery in 2022 and is a Fellow of the Australian Orthopaedic Association.
He offers consultations in Hamilton, Brisbane, and conducts private orthopaedic surgery at Brisbane Private Hospital.