About 267,000 reconstructive total knee replacement surgery operations are performed each year in the United States. Of those, about 20 percent - some 53,400 - will need to undergo a second reconstructive knee surgery within 10 years.

The most common reason for total knee replacement surgery in the United States is severe osteoarthritis of the knees, though it is also considered for people with other destructive diseases of the joint or trauma.

Reconstructive total knee replacement is major surgery, which usually involves a four to five day hospital stay and a rehabilitation period of about three months. People considering a reconstructive total knee replacement surgery should carefully weight the benefits and the risks before making a final knee replacement surgery decision.

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Because of the seriousness of this surgery, a total knee replacement surgery is typically considered only after all other options - anti-inflammatory medications, cortisone injections, physical therapy - fail to improve the situation. And because the replacement parts will also wear down, the surgery is generally saved for people over the age of 60.

Knee replacement surgery involves removing or resurfacing parts of the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) aitnd sometimes the kneecap and replacing the diseased bone or tissue with a prosthesis made of metal alloy and high-density plastic. Some implants are cemented into the bone while others fit into place so that bone grows into the implant.

The reconstructive total knee replacement surgery, performed by an orthopedic surgeon, usually lasts about two hours. The surgery can be performed with general anesthesia, epidural or spinal anesthesia, or a regional nerve block.

There are potential risks of knee replacement surgery. These include blood clots, infection and implant failure.

Blood clots in the large veins of the leg and pelvis are common after knee replacement surgery. These blood clots can travel to the lungs (pulmonary embolism) and can cause shortness of breath, chest pain, shock or death.

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Infection of a knee replacement is another very serious risk. Infections can occur immediately following surgery or years later. Some infections require removal of the implants, followed by weeks of IV antibiotics.

Implants eventually wear out and may loosen, requiring a replacement of the replacement. Most knee replacement prosthesis last an average of 20 years; some last less than 10 and some more than 30. About 20 percent of patients with total knee replacements require a second operation within ten years. Second total knee replacement surgery is generally more complicated and less successful than the first, which is why physicians often delay joint replacement surgery as long as possible.

Other risks include nausea and vomiting, chronic knee pain and stiffness, bleeding into the knee joint, nerve damage and blood vessel injury. You are left with about an eight inch incision over the front of the knee.

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