In the non-arthritic knee, these elements work in perfect harmony to move the joint. The lower end of the femur and the upper end of the tibia couple with each other, while the patella rides in a groove in the front of the femur. Nature has provided a self-lubricating system of healthy cartilage to cover the ends of these bones. It is this slippery, smooth surface that enables the knee to glide like a well-oiled machine with no rough spots to interfere with its precise rhythmic motion.
Arthritis of the knee is a disease that affects this cartilage surface of the joint. In the arthritic knee the cartilage is worn away and the surface of the knee becomes pitted, eroded, and uneven. The knee becomes painful, stiff, and unstable. Walking and maintaining balance becomes difficult. The patient experiences pain which may range from vague aches to severe discomfort - even when sleeping.
For patients suffering from advanced arthritis, knee replacement can offer a relief of these symptoms. For most patients, the arthritis affects the entire joint - so a total knee replacement is performed. On occasion, only a portion of the knee may be involved, and for those patients a partial knee replacement can be considered.
 Hospital for Special Surgery has been in the forefront of modern knee replacement since the operation's inception in the early 1970s. More knee replacements are performed here than in any other hospital in the United States. Advances in smaller incision surgery, new implant materials and design, and sophisticated instrumentation with which to perform the surgery have been - and continue to be - the areas of expertise of the surgeons who perform this surgery in the HSS Hip & Knee Service.
Regional anesthesia is used for most patients, avoiding the potential problems that may accompany a general anesthetic. These techniques have been developed by the Department of Anesthesiology at HSS, a world leader in this field. The surgery is performed in specially designed laminar flow enclosures with the surgeons wearing "space suits." These specialized environments in the OR have resulted in the infection rate for knee replacements at HSS being the lowest in the peer reviewed scientific literature. To complement these advances, teams of nurses, physician's assistants, and physical therapists are dedicated to the treatment of patients who have undergone knee replacement surgery.
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The normal knee bends and straightens over one hundred times a minute while walking. For most it is a brisk, easy stride; for those with advanced arthritis, it is a painful and tiring effort.
