Total Knee Replacement

Total knee arthroplasty is a major orthopaedic procedure performed under spinal or general anaesthesia, lasting approximately ninety minutes to two hours. The surgeon removes the damaged articular surfaces of the femur and tibia and resurfaces them with metal components fixed to the bone with bone cement or press-fit techniques. A plastic (polyethylene) tibial insert provides the bearing surface, and the patella may be resurfaced depending on the surgeon's preference and the extent of patellar involvement. Alignment is achieved using conventional mechanical guides, computer navigation, or robotic-assisted systems.

Candidacy is based on radiographic evidence of severe joint space narrowing with corresponding functional limitation unresponsive to weight loss, physiotherapy, analgesics, and intra-articular injections. Age and activity level influence implant selection: highly active patients may place excessive demands on bearing surfaces, whereas very elderly or low-demand patients may be suitable candidates at lower symptom thresholds. Patients with significant comorbidities (poorly controlled diabetes, severe cardiac disease, active infection) require optimisation before surgery.

Ambulation begins on the day of or the day after surgery, and the focus of in-patient physiotherapy is restoring range of motion and safe independent mobility. Discharge to a rehabilitation facility or home typically occurs at three to five days. Achieving ninety degrees of flexion by six weeks is a commonly used milestone. Full recovery — including return to comfortable walking on most surfaces — typically takes three to six months, with ongoing improvement possible over twelve months. Patients with poor pre-operative flexibility or significant stiffness face more challenging rehabilitation.

Total knee replacement pricing encompasses the implant system, surgeon's fee, anaesthesia, theatre costs, and a standard inpatient stay of three to five days including physiotherapy. Implant cost is a major variable: premium brands with long-term clinical data (DePuy, Zimmer Biomet, Stryker, Smith & Nephew) are more expensive than generic alternatives, and robotic-assisted systems may attract an additional facility premium. Patients should request the specific implant catalogue name and confirm whether it is a standard primary implant.

Additional costs may include pre-operative investigations (blood tests, ECG, chest X-ray, cardiac clearance), the anaesthetist's separate fee, extended physiotherapy sessions beyond those included in the inpatient programme, assistive devices (crutches, walking frame), post-discharge accommodation if the patient is unable to fly immediately, and anticoagulation medications for the prescribed duration. Extended rehabilitation in a facility rather than at home will add considerable cost. Implant documentation is important for long-term follow-up and must be retained.

Mobilisation begins on the day of surgery or the morning after, with a physiotherapist supporting the patient to stand and take initial steps using a walking frame. Daily physiotherapy sessions during the inpatient stay focus on building knee flexion, extending the leg fully, and building the confidence for safe ambulation. Most patients are discharged at three to five days, able to manage stairs with a rail and walk short distances. Anticoagulation therapy to prevent DVT continues for the duration prescribed — typically two to six weeks — and is essential during this vulnerable period.

By two to three weeks, most patients can negotiate stairs more confidently and no longer require a walking frame, though a stick may still be used outdoors. Driving is typically permitted at six to eight weeks when the patient can perform an emergency stop safely. Physiotherapy continues for several months, with progressive exercises aimed at achieving ninety degrees of flexion — a key milestone for normal daily activities — by six weeks. Swelling, warmth, and stiffness in the knee are normal and gradually resolve over three to six months. Full functional recovery, including comfortable walking on uneven ground and a return to low-impact activity such as swimming or cycling, is typically achieved within three to six months.

Total knee replacement is one of the most logistically challenging procedures for medical tourism due to its extended recovery and intensive rehabilitation requirements. Long-haul flights should be avoided for a minimum of four to six weeks post-operatively, as the combination of reduced mobility, post-surgical hypercoagulability, and prolonged seated immobility creates a high risk of deep vein thrombosis and potentially fatal pulmonary embolism. Patients must arrange accommodation at or near the treatment destination for an adequate recovery period before any significant travel.

Post-operative physiotherapy is not optional — it is a primary determinant of the final range of motion and functional outcome. Patients should arrange a detailed physiotherapy programme in their home country in advance of travelling, as the transition from facility-based rehabilitation abroad to a local physiotherapist must be seamless. A letter detailing the surgical approach, implant used, and post-operative physiotherapy protocol should be obtained from the overseas surgical team to hand to the home physiotherapist. Patients should also retain full implant documentation (brand, catalogue number, lot number) as this information is required for future revision procedures and implant registry reporting in the home country.