When walking or climbing stairs starts to feel like a pain in the knee, literally, one might think that it’s just part of aging. But what if they are signs of a condition that may require more than just rest or medication?

For many people suffering from chronic knee pain, Total Knee Replacement (TKR) may be an option. We spoke with Dr. Mohamed Kamal Mohamed Hisa, Consultant Orthopedic Surgeon at Columbia Asia Hospital – Puchong, to uncover what this procedure really involves, who it’s for, and what life after surgery can look like. 

What is Total Knee Replacement? Does it mean that the whole knee is being removed and replaced? 

“A total knee replacement, medically referred to as total knee arthroplasty, is a comprehensive surgical procedure performed to relieve pain and restore function in severely damaged knee joints. This procedure involves the careful removal of the worn-out, diseased, or damaged portions of the articular surfaces of the knee and replacing them with artificial components made of smooth, durable metal alloys and highly cross-linked polyethylene plastic. These materials are specifically designed to mimic the natural movement of the knee and provide long-lasting joint stability and comfort.”

What conditions or diseases will require patients to undergo this treatment? 

“The most common indication for performing a primary total knee replacement is osteoarthritis, a chronic and progressive degenerative joint disease that leads to the breakdown and eventual loss of cartilage within the knee joint. As the protective cartilage wears away, bones begin to rub against each other, causing pain, swelling, stiffness, and reduced mobility. Over time, this can significantly impact a patient’s quality of life and ability to perform routine daily activities.

“In addition to osteoarthritis, several other conditions may also necessitate total knee replacement surgery. These include post-traumatic arthritis, which results from previous injury to the knee such as fractures or ligament tears that have led to joint degeneration over time; rheumatoid arthritis, an autoimmune disorder that causes inflammation of the synovial membrane and subsequent cartilage damage; and gouty arthritis, a form of inflammatory arthritis caused by the deposition of uric acid crystals in the joint, leading to chronic pain and joint deterioration.

“I generally recommend total knee replacement to patients when conservative, non-surgical treatments—such as physical therapy, medications, joint injections, or lifestyle modifications—have not provided adequate relief. If a patient is experiencing persistent or severe knee pain, stiffness, or functional limitations that interfere with everyday tasks such as walking, climbing stairs, or even standing up from a chair, and their symptoms continue to worsen despite non-operative measures, total knee arthroplasty may be the most effective solution to help restore mobility and improve overall quality of life.”

What’s the process of TKR? Is it long and painful as the knee is being replaced?

“Pre-operative assessment is important before surgery and upon arrival at the hospital, patient will be evaluated by anesthetist. The most common types of anesthesia are general anesthesia, spinal anesthesia, epidural or regional nerve block anesthesia.

“The surgical procedure usually takes two hours. Orthopedic surgeon will remove the damage cartilage then position the new metal and plastic implants to restore the alignment and function of your knee.

“Medications are often prescribed for short term pain relief after surgery, including opioids, nonsteroidal anti-inflammatory drugs (NSAID) and etc.”

What are the symptoms that people should look out for them to know that they might need TKR, instead of just physiotherapy or medicines?

“People who benefit from a total knee replacement often have the following symptoms:

• Severe knee pain or stiffness that limits activities such as walking, climbing stairs and getting in and out of chairs, unable to walk more than a few blocks without significant pain and may be necessary to use a cane or walker.
• Moderate or severe knee pain while resting, either day or night.
• Chronic knee inflammation and swelling that does not improve with rest or medications.
• Knee deformity – bowing in or out of the knee.”

How long is the recovery process? What kind of limitations will patients face while recovering?

“The recovery process will take up to a year but you will be able to resume some of your usual activities gradually. On the first few weeks, your knee will be swollen, inflamed and painful. Most people are able to walk without a walker in 6 weeks after the knee replacement. 

“However, one of the most common limitations that patients will face while recovering is limitation of motions and residual stiffness. This can be overcome and slowly improved by having regular rehabilitation exercises. Stiffness is normal for six months to one-year post surgery.”

Will patients acquire full functionality after the surgery?  

“Most patients are able to gradually return to the majority of their regular daily activities following a total knee replacement surgery, often experiencing significant improvements in mobility and a reduction in pain.

“However, it is important to understand that while the new joint is designed to be durable and functional, it is not identical to a natural, healthy knee. As such, patients are generally advised to avoid engaging in activities that place excessive or repetitive stress on the artificial joint.

“High-impact activities—such as jumping, running, or skiing—can increase the risk of premature wear or potential damage to the prosthetic components. To help ensure the long-term success and lifespan of the implant, patients are encouraged to participate in low-impact exercises like walking, swimming, or cycling, which support joint health without overloading the knee.”

What’s the difference between the new knee and the old knee? Do patients need a new replacement in the future?

“Total knee arthroplasty is a safe and effective procedure that helps numerous people regain their mobility and relieves long term pain. Most people who receive a ‘new knee’ experience reduced pain, increased mobility and knee function, and, not to forget, an improved quality of life.

“Most knee replacements last for about 20 years or more. Depending on when you had the operation, you may need another replacement later in life, but this is not common.”

What are the risks of this treatment? 

“There are several risks or complications of TKR. The first one is blood clots or deep vein thrombosis (DVT). If you have blood clots that form in the leg, your doctor can give you anticoagulant therapy and to reduce the risk of blood clots, you may be advised to wear compression stockings and exercise your legs. The next is wound infection. This is usually treated with antibiotics however, a major or deep infection may require more surgery and removal of the prosthesis. Thirdly, damages to nerves or tissue. During the surgery, there is a chance that blood vessels, nerve or ligament around the knee joint would be damaged. This is not common and can either be repaired during the surgery or will heal on its own. Finally, the other risks could be knee stiffness and implants failure such as loosening.”

Knee pain doesn’t have to slow you down for good. If you’ve tried different ways to manage the pain and it’s still affecting your daily life, it may be time to consult a specialist and for treatment options.

This medical information is contributed by Dr Mohamed Kamal Mohamed Hisa, Consultant Orthopedic Surgeon, Columbia Asia Hospital – Puchong