Knee Joint Replacement

Orthopedic surgeons in the Sutter Health network specialize in advanced knee replacement techniques that can help ease knee pain and restore mobility in people with severe arthritis. If you’ve tried alternatives to knee replacement without success, talk to a doctor about this common knee surgery.

In the Sutter Health network, orthopedic surgeons use state-of-the-art technology to perform both partial and total knee replacement surgeries (also called knee arthroplasty).

Robotic-Assisted Knee Replacement

Many orthopedic surgeons in the Sutter Health network use robotic arm systems to ensure your knee replacement is positioned and aligned correctly.

With robotic arm systems, your surgical team creates a 3D representation of the unique shapes and profiles of your knee. Using this information, doctors can then determine the size and position of your implant, which is critical to knee alignment and stability.

Surgeons then use a robotic arm to accurately prepare your knee before placing and adjusting your implant. Using robotic assistance, they remove only the damaged bone and resurface only the portion of the knee causing problems. That spares your healthy bone and muscle and helps maintain your knee’s range of motion. Finally, surgeons secure the implant in the joint to allow your knee to move smoothly again.

Depending on your overall health, some robotic-assisted knee replacements are performed as same-day outpatient procedures.

Robotic-assisted knee replacements are available at several hospitals in the Sutter Health network:

• Alta Bates Summit Medical Center in Oakland.
• California Pacific Medical Center in San Francisco.
• Sutter Gould Medical Foundation Stockton Surgery Center.
• Sutter Santa Rosa Regional Hospital in Santa Rosa.
• Sutter Surgical Hospital – North Valley in Yuba City.

Quad-Sparing Knee Replacements

A quadriceps-sparing knee replacement is often called “minimally invasive” because the orthopedic surgeon makes smaller incisions in the muscles that support the knee. The surgeon makes a 3-to-4-inch incision in the side of the knee, and performs the knee replacement using special instruments, guided by computer imaging. The surgeon is able to lift the quadriceps muscles out of the way in order to access the knee joint.

In this quad-sparing knee replacement surgery, the specialist doesn’t cut the quadriceps tendon. This tendon connects the quadriceps muscles in the thigh to the kneecap and provides the power to bend and straighten the knee. As a result, people who have this type of knee replacement usually recover faster.

Quad-sparing knee replacement is a more complex surgery because the doctor has a limited view of the knee joint. It requires a skilled and experienced surgeon, and isn’t right for all patients. Talk to your doctor if you’re considering a quad-sparing knee replacement.

Traditional Total Knee Replacement

In a traditional knee replacement, the surgeon cuts into the quadriceps tendon, which connects the quadriceps muscles on the front of the thigh to the kneecap. The orthopedic specialist then moves the kneecap aside to have clear access to the knee joint.

The orthopedic surgeon removes damaged bone and cartilage from your thighbone, shinbone and kneecap, then replaces it with an artificial joint made of metal and wear-resistant plastic.

Most people can walk without crutches or a cane six weeks after surgery. But it may take up to three months for pain and swelling to completely subside. Recovery of full strength is gradual and may take up to 12 months.

Your New Knee Joint

Regardless of the technique, all knee replacements involve replacing the ends of the thighbone and shinbone with implants made of alloys of cobalt chromium and titanium, and with polyethylene, a medical-grade plastic. The new joint has a plastic spacer in place of cartilage so it can move smoothly. The pieces are either held in place by bone cement or by “ingrowth” technology, in which the bone grows between small beads or mesh on the surface of the prosthetics. 

Typically people spend one to three nights in the hospital after a knee replacement, but if you are healthy, strong and have support at home, your orthopedic surgeon may recommend outpatient surgery. Most commercial insurers will cover outpatient surgery, but at present Medicare does not. Check with your insurer if you are considering an outpatient joint replacement. 

Research published in 2017 in Lancet⁽¹⁾ found that 90 percent of knee replacements last at least 20 years.

1. Lancet. 2017 Apr. 8. Pages 1424-1430.