Osteoarthritis is the most common form of knee arthritis. The cartilage that cushions your knee gradually wears away with age, weight, activity, or genetics, exposing the bone underneath. Movements become painful, the joint may swell, and you may hear crackling sounds. It is not an injury; it is degeneration. Most cases progress slowly, which is why we stage and manage at each stage rather than rushing to surgery.
Total Knee Replacement (TKR)
Robotic, conventional, and partial knee replacement at Max SMART Saket. 12,000+ knees done. 23+ years' experience.
Max SMART Saket
Mahajan's GK-1
Total Knee Replacement (TKR), also known as Total Knee Arthroplasty (TKA), is the surgical replacement of the worn cartilage and bone surfaces of the knee joint with implants tailored to your anatomy.
Total knee replacement is usually recommended for advanced knee arthritis when other treatments such as physiotherapy, medications, injections, or joint-preserving procedures are no longer providing adequate pain relief or function.
Dr. Ramneek Mahajan and his Joint Reconstruction team at Max Smart Super Speciality Hospital, Saket, perform total knee replacement using internationally trusted, high-performance implant systems, combined with an enhanced recovery programme designed for faster mobilisation and smoother rehabilitation. Most patients begin standing and walking within hours of surgery, guided by our simple Rule of 20: move, ice, rest, repeat.
Knee replacement is not just about replacing a joint, it is about helping you regain comfort, confidence, and quality of life.
Our aim is to help you return safely to the activities that matter most to you, whether that is walking without pain, spending time with family, travelling, social engagements, or returning to work. From the very first consultation, we believe in clear communication, personalised planning, and long-term support, with structured follow-up at 6 weeks, 3 months, 6 months, and annually thereafter.
Same knee. See what arthritis takes away.
Who is Total Knee Replacement for?
Total knee replacement is recommended for adults with advanced knee arthritis whose symptoms no longer improve with non-surgical treatment. In our practice, we follow a structured 4-stage approach to managing knee arthritis, ensuring that surgery is considered only when truly necessary.
Stage 1: Physiotherapy, lifestyle modifications, activity adjustment, and weight management.
Stage 2: Medications, intra-articular injections, and in carefully selected younger patients, joint-preserving procedures such as alignment correction surgery.
Stage 3: If the arthritis is limited to one part of the knee, a partial knee replacement may be considered.
Stage 4: Total knee replacement is recommended when arthritis affects the entire knee joint, daily activities remain significantly restricted despite earlier treatments, and pain begins to affect sleep, walking, and overall quality of life.
The patients we most commonly treat are those in their late fifties to eighties with osteoarthritis. We also care for younger patients who present with rheumatoid arthritis, post-traumatic arthritis, or other conditions causing early joint damage, as well as older individuals in otherwise good general health whose mobility and independence are being limited by knee pain.
Age alone is rarely the deciding factor - overall health and fitness for anaesthesia matter far more. Suitability for surgery is confirmed through weight-bearing X-rays, a detailed clinical examination to assess alignment and ligament stability, and a careful understanding of how the knee problem is affecting your day-to-day life.
Our philosophy is simple - total knee replacement should be recommended when the knee truly needs it, neither too early, nor later than necessary.
Real outcomes from real patients
These videos are published on Max Healthcare's official YouTube channel. Each patient's experience is unique - outcomes depend on individual health, disease characteristics, and clinical factors. These accounts are not a guarantee of results.
Meet Your Surgeon
How long is the hospital stay?
Hospital stay for a routine total knee replacement at Max Smart Saket is usually 24 to 48 hours, with most patients going home on the second day. The operation itself takes around 60 to 90 minutes for a single knee under spinal anaesthesia, supplemented with local nerve blocks so you stay comfortable through and after surgery. Most patients are mobilised with a walker within 2 hours of surgery, which is the cornerstone of the enhanced recovery pathway Dr Ramneek Mahajan has refined over more than 12,000 knees and more than 23 years of joint reconstruction practice.
Day 1 covers bedside sitting, chair sitting, commode use, supported standing, and the first short walks in the corridor with a physiotherapist alongside.
Physiotherapy starts the same day and continues twice daily during the stay; ice is applied around the knee to keep swelling down between sessions.
By discharge you are walking with a walker or single stick, managing stairs with one rail, taking care of basic self-care, and using the Rule of 20
The Rule of 20
20 minutes of activity, 20 minutes of icing, 20 minutes of rest - through your waking hours. You leave with a written recovery plan, contact numbers for the doctors, physiotherapists, dieticians, and administrative team on call, and a clear schedule for follow-up at Week 2 for stitch removal and Week 6 for the first review.
If both knees are being done together, the stay is 3 to 4 nights to allow safe early mobilisation of both legs.
What does recovery actually look like
Every patient goes home with 7 to 8 contact numbers - covering doctors, physiotherapist, dieticians, emergency services, and administrative staff. Nobody feels alone in the recovery.
Recovery after total knee replacement is steady and milestone-driven, not all at once. The Rule of 20 - 20 minutes of activity, 20 minutes of icing, 20 minutes of rest - runs through your waking hours from Day 1 in hospital through the early weeks at home, and shapes how the knee settles.
In Week 1, you walk inside the house with a walker or single stick, manage personal care, and start short walks outside. Daily chores like making your own tea, eating at the dining table, and sitting in the balcony are encouraged so the day feels normal.
By Week 2, the stitches are out, swelling is settling, and most patients are on a single stick around the house.
Between Weeks 4 and 6, you transition off walking aids if balance and strength allow. Driving typically returns at 6 to 8 weeks once you can react safely.
By the end of Month 1, the goal is roughly 4,000 steps a day, social activity outside the home, and a return to office or shop hours for those who feel ready. Stamina and confidence on stairs continue to improve through Months 2 and 3.
We see you back at six weeks, three months, six months, and one year, and we adjust your physiotherapy plan as you progress. Some days feel better than others, which is normal.
Signs that suggest TKR may be right
There are six signals that tell us a knee has crossed into Stage 4 and total replacement is now the right step.
The first is pain that no longer settles with painkillers, injections, or physiotherapy, and that now disturbs sleep or limits walking even on flat ground.
The second is loss of basic function - difficulty climbing stairs, getting up from a low chair, sitting cross-legged, or difficulty covering the distance you used to manage without thinking, especially when these affect work, social life, or independence at home.
The third is visible deformity - the leg starting to bow inwards or outwards (varus or valgus), or the knee no longer able to straighten completely because of a flexion contracture.
The fourth is grinding, locking, or giving way as the joint surfaces wear unevenly and the cartilage cushion is lost.
The fifth is X-ray evidence of advanced osteoarthritis with bone-on-bone contact, loss of joint space, marginal osteophytes, and sometimes subchondral cysts.
The sixth is occasional stress (insufficiency) fractures resulting from longstanding deformity such as severe varus or valgus malalignment.
Any one of these alone is rarely enough; it is the combination of severe symptoms, restricted day-to-day life, and X-ray findings that points to surgery.
We confirm with weight-bearing X-rays and a complete clinical assessment before we recommend total knee replacement.
What are the surgical options for this procedure, and how do I choose between them?
We perform three forms of knee replacement, and the right one depends on your knee - not on the technology being newer.
1. Conventional total knee replacement.
The full knee joint is replaced using manual jigs and instruments.
This is the most studied approach, with decades of long-term outcome data.
Suitable for most patients with end-stage osteoarthritis affecting all three compartments of the knee.
2. Robotic-assisted total knee replacement.
A CT scan made before surgery is used to plan implant size and positioning.
During surgery, a robotic arm guides bone cuts within a pre-planned safe boundary controlled by the surgeon.
Studies report fewer alignment outliers compared to manual instrumentation.
Suitable for the same patients as conventional total knee replacement, but often particularly helpful when the bone anatomy is unusual or distorted, making accurate alignment more challenging, as well as in some patients who have had previous surgery with implants already in place.
3. Partial knee replacement (UKA).
Only the worn-out compartment of the knee is replaced - the rest is preserved.
Suitable for patients with arthritis limited to one compartment, intact ligaments, and no significant deformity.
When performed for the right patient, partial knee replacement can deliver excellent long-term results, with modern implants showing approximately 90-95% survivorship at 10 years.
The choice is made together - based on your imaging, your knee anatomy, the compartments involved, and what you do with your knees day-to-day. We discuss all three options in consultation; the recommendation comes after examining you, not before.
What happens during the surgery itself
Total knee replacement typically takes 60-90 minutes per knee. Here is the broad sequence - without the graphic detail.
Step 1 • Pre-op setup.
You arrive in pre-op. Anaesthesia (usually spinal with sedation) is set up; the knee is positioned and prepped.
Step 2 • Incision and access.
A 6-8 inch vertical incision is made down the front of the knee. We reach the joint either through a medial parapatellar approach or an undervastus approach - the choice depends on which is kinder to the muscle and ligaments in your particular knee. In both, the kneecap is gently moved to the side, not cut.
Step 3 • Bone preparation.
The worn cartilage and a thin layer of damaged bone are precisely removed from the femur, tibia, and undersurface of the kneecap.
Step 4 • Implant fitting.
The new implant is fitted in three parts - femoral component, tibial component, and a polyethylene insert that acts as the new cartilage. The kneecap is resurfaced if clinically needed.
Step 5 • Closure and recovery.
Once balance and tracking are verified, the layers are closed. Closure is mostly sub-cuticular - the stitches sit under the skin, so there are no external sutures to be removed later. You move to recovery.
Specifics - incision style, implant choice, whether the kneecap is resurfaced - are decided in consultation based on your imaging and exam.
The implant we put in • how precisely it gets placed
Two things shape the outcome of a knee replacement - the implant we put in, and how precisely it gets placed.
The implant. We use internationally accepted, US FDA-approved implant systems with a well-proven track record in published literature and joint registry data. The metal part uses cobalt-chromium, the same alloy that has been standard in knee replacements for decades. The plastic part - which acts as the new cartilage between the bones - uses a modern, vitamin-E-treated polyethylene that wears down much more slowly than older versions.
When we use it: for most primary knee replacements at our practice. The systems we use have decades of long-term data behind them.
Precision - robotic assistance. Before surgery, a CT scan of your knee becomes a 3D plan. During surgery, a robotic arm guides each bone cut to match that plan exactly. The surgeon stays in full control; the arm just prevents the cut from straying. Studies show this approach reduces alignment errors compared to traditional surgery.
When we use it: when your knee anatomy is unusual, you have had prior knee surgery, or there is significant deformity - and for younger patients where small precision differences add up over decades of wear.
When robotics is not the right fit. For most straightforward knee replacements with standard anatomy, traditional surgery without the robot works just as well. Cost, surgery duration, or your own preference can point either way - we discuss this with you upfront.
Every surgery carries risk - we discuss yours
Every surgery carries risk. Knee replacement is no exception. We talk through these openly in consultation - honest discussion is part of how informed consent works.
Infection.
Reported in roughly 1-2% of total knee replacements in modern operating theatres. Risk is higher with poorly-controlled diabetes, obesity, smoking, or pre-existing skin conditions. We screen and optimise these before surgery; a sterile OR setup, prophylactic antibiotics, and meticulous wound closure further reduce risk.
Blood clots - DVT and pulmonary embolism.
Deep vein thrombosis (DVT) is a blood clot that can occasionally form in the leg after major surgery due to reduced mobility. Rarely, part of the clot can travel to the lungs (pulmonary embolism), which is more serious. To reduce this risk, we use pre-operative screening (including blood tests and venous Doppler where indicated), early mobilisation, blood thinners, and compression devices.
Stiffness or restricted range of motion.
Some patients heal with less flexion than they had before surgery. Pre-op physio + structured post-op rehab + our Rule of 20 protocol minimise this. If stiffness develops, manipulation under anaesthesia can usually recover function.
Wound healing problems.
Higher in smokers, patients on long-term steroids, and those with significant comorbidities. Smoking cessation 4-6 weeks before surgery materially reduces risk.
Implant longevity and revision.
Modern implants have 15-20 year survivorship in most patient profiles. Revision surgery - replacing a worn or loose implant - is a recognised care pathway, not a failure. We follow you long-term so this gets caught early.
Your personal risk profile depends on age, comorbidities, lifestyle, and bone quality. We discuss your specific picture in consultation before any recommendation.
Frequently Asked Questions (FAQs)
Can I safely wait?
The questions worth asking before you decide - and when waiting is the right call, and when it is not.
Before we meet
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What should I expect, step by step?
The whole path, stage by stage - getting ready, the day itself, recovery, physio, life after.
Patient journey
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Where did he train?
Fellowships, years in practice, and international experience
Credentials and experience
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