Patients are placed under general anesthesia, or spinal/epidural anesthesia (numb below the waist), then an 8- to 12-inch incision is made anterior to the knee. The damaged part of the joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal or plastic artificial joint. The artificial joint is attached to the femur, tibia and patella either with cement or a special material. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function. (adapted from WebMD).
Image source: Genufix.com, Wnorowski DC, MD, MBA (link)
Left knee flexed: after complete resurfacing “total knee replacement”
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