The procedure is carried out in hospital, in the operating theatre, under general anaesthetic or spinal anaesthetic, i.e. with a shot in the back that puts only the lower limbs to sleep. The advantage of spinal anesthesia is that the patient remains conscious, and is therefore less affected by the consequences of general anesthesia, which can sometimes cause nausea, vomiting or a slowdown in higher functions lasting a few hours. The disadvantage of spinal anaesthesia is the need for passive participation in the procedure, which may appear noisy to some.

You are positioned on your back with a tourniquet at the root of the limb, which is only inflated at the end of the procedure, for around ten minutes, during the cementing phase. An anterior incision is made, allowing access to the knee joint. Using tools to guide the various stages of the procedure, the worn parts of the cartilage and bone are resected with a saw, in line with the axes of the thigh and leg, while respecting the soft tissues, i.e. the vessels, nerves, ligaments, muscles and tendons surrounding the knee joint.

The prosthesis is fitted with the help of guides to optimize its placement, chosen by the surgeon according to the difficulty of the operation, the age of the wear or the extent of the deformity. These may be custom-made cutting guides based on preoperative MRI planning or a navigation system used intraoperatively, or simpler, mechanical guides using the bony axis of the femur and tibia.

Once the trial implants have been placed, the surgeon decides on the size of the final implants, which vary between the sexes and from one person to another. The implants are then impacted into the bone to the nearest millimetre. They are made of a metal alloy (mainly chromium and cobalt) and cemented in place. The patella, the third part of the knee joint, is only exceptionally replaced. However, osteophytes (bone outgrowths that appear with wear) are removed from around the kneecap.

At the end of the procedure, an anesthetic is injected into the synovial and capsular tissues to optimize immediate post-operative pain relief. The skin is closed with staples and a pressure dressing is applied for 24 hours.

You arrive at the clinic the day before your operation. On the day of the operation, which usually takes place in the morning, you will be able to get up for the first time in the afternoon. Most of the time, you will be able to walk under your own power, with the help of a pair of walking sticks, accompanied by a caregiver.

On the first day, general analgesia (via the veins) and local analgesia (anaesthetic injected into the knee at the end of the operation) enable you to spend the first 24 hours in almost complete indolence. After that, post-operative hematoma gradually sets in, and tension in the operated lower limb contributes to pain, which should always remain moderate. Pain control is one of the criteria for discharge.

The day after the operation, your independence will be assessed by the department's physiotherapist and nurses. Various criteria will be used to validate your return home. Pain and bleeding control, autonomy in washing and dressing, and ability to climb stairs are the main criteria. You may be discharged home on the 1st post-operative day, but this takes an average of 48 hours. You can stay longer if you don't feel ready to go home. The length of your hospital stay is discussed on a case-by-case basis between you and your surgeon, but it has been shown that the shorter your stay, the lower your risk of complications.

The entire duration of your hospital stay is governed by a Rapid Recovery protocol, established within the department, with the aim of enabling you to return to your autonomy in a participatory manner. This recovery is based on motivation, which begins pre-operatively and leads to a voluntary, uncomplicated recovery. Indeed, immediate post-operative standing reduces the complications associated with bed rest, such as digestive, urinary, appetite and sleep disorders, as well as the risk of phlebitis. It has been demonstrated that a rapid return to daily life leads to a statistically proven reduction in medical complications, particularly those linked to phlebitis and therefore to the occurrence of pulmonary embolism, the most dreaded complication after any surgery on the lower limbs.

Returning home is essential to reduce the rate of complications. It has been shown that the older the patient, the earlier they can return home. Post-operative hospitalization as a cure is becoming the exception rather than the rule, and should only be proposed in situations where autonomy was already very low pre-operatively, in a person living alone, with little support, and with serious associated defects or illnesses.

When you return home, you will be taught to change the dressing yourself. The dressing is watertight, allowing you to wash without additional protection. The staples are removed on average in the 3rd post-operative week by a home care nurse or your GP. Post-operative haematomas become permanent around the 8th post-operative day. It can sometimes be impressive, making the skin tissues very taut and, in extreme cases, causing phlyctenes (large blisters) to appear on the skin. This hematoma is nothing to worry about; it's normal and necessary for healing. As long as it is not accompanied by unbearable pain, despite painkillers, or by paralysis of the limb, rehabilitation and walking should be continued. If this is not the case, you should contact your surgeon or attending physician to discuss your concerns.

You will be entitled to full support immediately. Canes are used on request, but you are encouraged to wean yourself off them quickly. Daily tasks must be able to be carried out as soon as you return home. It is possible to leave your home in the first few days.

It is advisable not to drive while the staples are in place. Remember that driving is generally resumed one month after surgery.

Medical treatments must be taken as prescribed on the discharge prescriptions. The first post-operative check-up takes place between the second and third month, but will be adapted on a case-by-case basis.

A return to leisure activities is possible between the 2nd and 3rd month, and to sporting activities after the 3rd month, although this resumption must be gradual and the pre-operative level is not reached immediately.

The return to work takes between 1 and 4 months, depending on whether the work is sedentary, requiring few car journeys, or physical, intense, standing work.

In ideal situations, a total knee prosthesis allows the knee to be used without ever having to re-intervene.

The life of the prosthesis can be that of the patient, if the knee is used rationally. These are wearing parts, as in mechanics. Consequently, being overweight, carrying heavy loads or engaging in strenuous sporting activity can reduce the implant's lifespan. It is generally accepted that the average lifespan is 15 years. However, this average increases if the complications mentioned above do not occur.

A healthy lifestyle is essential to the longevity of implants.

Your surgeon will provide radioclinical monitoring, initially on an annual basis, then more frequently. Outside these scheduled periods, you should consult your doctor if you notice any change in the way your knee feels or functions.

Reading this document shows your commitment to your recovery. Your surgeon thanks you and wishes you a speedy recovery!