A total knee replacement (TKR) is a complex procedure that requires an orthopedic surgeon to make precise measurements and skillfully remove the diseased portions of your bone.

The surgeon makes an incision across the front of your knee to gain access to the patella, more commonly referred to as the kneecap. In a traditional knee replacement, the incision is usually about 8 to 10 inches long.

The first bone your surgeon will resurface is your femur, commonly known as the thighbone. Once the surgeon has opened up and exposed your knee joint, he or she will carefully measure your bones 

The next bone your surgeon resurfaces is your tibia, or shinbone. The surgeon removes damaged bone and cartilage from the top of the tibia and then shapes the bone to fit the metal and plastic tibial components.

The bottom portion of the implant, called the tibial tray, is fitted to the tibia and secured into place using bone cement. Once the tray is in place, the surgeon will snap in a polyethylene (medical-grade plastic)

Before returning the patella to its normal position, the surgeon might need to flatten the patella and fit it with an additional plastic component in order to ensure a proper fit with the rest of your implant. 

Your surgeon will bend and flex the knee to ensure that the implant is working correctly, and that alignment, sizing, and positioning is suitable. To complete the procedure, the surgeon will close the incision with stitches or staples.