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Complex Total Knee Replacement

Knee Service

Colorado Springs Orthopaedic Group

Your knees absorb significant stress with every step, making them particularly vulnerable to injury, overuse, and wear over time. Knee pain can interfere with walking, exercise, work, sports, and many of the activities you enjoy.

CSOG provides comprehensive evaluation and treatment for knee conditions affecting patients of all ages and activity levels. Our specialists treat sports injuries, ligament and meniscus problems, arthritis, fractures, and other conditions using both nonsurgical and surgical approaches.

Depending on your diagnosis, treatment may include physical therapy, medications, injections, bracing, minimally invasive procedures, or surgery. We take your symptoms, activity level, and goals into account when developing your treatment plan, with a focus on reducing pain and helping you regain strength, stability, and function.

What is Complex Total Knee Replacement?

Total knee replacement, also called total knee arthroplasty, is a surgical treatment for painful arthritis of the knee in which the worn-out or damaged surfaces of the knee joint are removed and replaced with an artificial prosthesis.

Complex total knee replacement is employed in patients whose arthritis is especially severe, or who have already undergone a previous knee replacement in the same leg. The surgery takes about 2 to 3 hours to perform.

Some conditions involving the knee joint that warrant a complex total knee replacement include the following:

  • Weak knee ligaments
  • Major knee deformity
  • Considerable bone loss due to fracture or arthritis
  • Knee fracture that has healed in a deformed or malunited position
  • Failed prior knee replacements
  • Significant knee stiffness due to joint degeneration
  • Gross knee instability due to tearing or stretching of ligaments
  • Severe knee injury or knee fracture
  • Prosthetic joint infection

In these circumstances, a complex total knee replacement affords a variety of features and benefits, such as utilizing more complex prosthetic parts with longer stems to ensure the component is securely fitted in the cavity. Some components may interlock like a hinge at the front of the knee to provide more stability. In addition, larger plastic liners, and bone grafting are often required to ensure correct alignment and length of the lower leg, replace absent bone stock, and to sufficiently restore the collateral ligaments and other soft tissue structures.

What is the Knee Joint Comprised Of?

The lower end of the thighbone, or femur, meets the upper end of the shinbone, or tibia, at the knee joint. A small disc of bone called the patella, commonly known as the kneecap, rests on a groove on the front side of the femoral end. The fibula, another bone of the lower leg, forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in the smooth movement of the bones over one another. The meniscus, a soft crescent-shaped area of cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

How is Complex Total Knee Replacement Surgery Performed?

The procedure is mostly performed as open surgery since arthroscopic key-hole incisions may not be sufficient to remove the damaged or worn-out prosthesis from a previous knee-replacement surgery. The surgery is performed under regional or general anesthesia and involves the following steps:

  • After adequately sterilizing the surgical area, your surgeon makes a long vertical incision over the knee.
  • The supporting structures of the knee are gently moved aside to access the joint area.
  • Your surgeon will evaluate the joint area for any soft-tissue infection, joint damage, or prosthetic damage to determine which prosthetic parts have worn out or loosened or shifted out of position.
  • If the previous prosthesis is in a bad shape, then your surgeon will carefully remove the original prosthesis, taking care to preserve as much bone as possible and any bone cement from a previous knee replacement.
  • If the articulating bones have been damaged with severe arthritis or other conditions, then your surgeon will trim the damaged portions from the joint surfaces at appropriate angles to ensure a perfect fit of the new implant.
  • Once the original prosthesis is removed, your surgeon will prepare the bone surfaces appropriately to insert specifically sized new prosthetic components into your knee joint, to be secured with bone cement or screws.
  • In some cases, bone graft material may be used to aid in rebuilding the knee.
  • With the new components in place, the knee joint is tested through its range of motion.
  • All surrounding tissues and structures are restored to their normal anatomic positions.
  • Finally, the incision is closed with sutures and sterile dressings are applied.

What Does the Postoperative Care for Complex Total Knee Replacement Involve?

In general, postoperative care instructions and recovery after complex total knee replacement will involve the following:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
  • You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed.
  • You are advised to keep your leg elevated while resting to prevent swelling and pain.
  • You will be given assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking as it can negatively affect the healing process.
  • Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy protocol will be designed to help strengthen knee muscles and optimize knee function.
  • Most patients can resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

What are the Risks and Complications of Complex Total Knee Replacement?

Complex total knee replacement surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Failure to relieve pain
  • Blood clots
  • Infection
  • Bleeding
  • Anesthetic/allergic reactions
  • Injury to nerves and blood vessels
  • Implant wear and loosening
  • Failure of the graft
  • The need for revision surgery

For more information about our services or to schedule an appointment, call us at or click here to request an appointment online. We'll respond to you as soon as possible.

How Can You Reach CSOG Knee Center
  • Schedule An Appointment
  • Send a Referral
  • Send Medical Records
    Powershare Image Upload
  • Additional Inquires
Knee Center Specialists
Colorado Springs Locations
Orthopaedic Care Across Colorado Springs

Visit CSOG at convenient locations for specialty care, Express Care, imaging, therapy, and recovery support.

North Campus

4110 Briargate Parkway
Suite 300
Colorado Springs, CO 80920

Mon - Thu : 7:00 am to 5:00 pm
Fri : 7:00 am to 4:00 pm

Schedule an Appointment
South Campus

1655 Quail Lake Loop
Colorado Springs, CO 80906

Mon - Thu : 7:00 am to 5:00 pm
Fri : 7:00 am to 4:00 pm

Schedule an Appointment
East Campus

6140 Tutt Blvd
Suite 110
Colorado Springs, CO 80923

Mon - Fri : 7:00 am to 6:00 pm

Schedule an Appointment
Ready to Take the Next Step Toward Better Movement?

Whether you are dealing with a new injury, chronic pain, arthritis, or recovery after surgery, CSOG can help you find the right orthopaedic care path.

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516LCL Reconstruction/knee/lcl-reconstruction-orthopaedic-specialists-colorado-springs-co/151lcl-reconstruction1
517ACL Reconstruction/knee/acl-reconstruction-orthopaedic-specialists-colorado-springs-co/151acl-reconstruction1
518Revision Knee Replacement/knee/revision-knee-replacement-orthopaedic-specialists-colorado-springs-co/151revision-knee-replacement1
519Robotic Assisted Knee Replacement/knee/robotic-assisted-knee-replacement-orthopaedic-specialists-colorado-springs-co/151robotic-assisted-knee-replacement1
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557Knee Sprain/knee/knee-sprain-orthopaedic-specialists-colorado-springs-co/152knee-sprain1
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561Multiligament Instability/knee/multiligament-instability-orthopaedic-specialists-colorado-springs-co/152multiligament-instability1
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