Total Knee Replacement Surgery

If you and Dr Jason Hockings decide that total knee replacement surgery is the right path for you, it’s natural to wonder what the journey will involve. This step-by-step guide explains exactly what to expect from your first appointment, through surgery, and into recovery using Dr Hockings’ advanced, patient-specific, kinematically aligned approach.

1. GP referral and your consultation with Dr Hockings

Your journey begins with a referral from your GP or another medical specialist. This is required to book your first appointment with Dr Hockings and ensures you receive the appropriate Medicare rebate.

During your initial consultation, Dr Hockings will:

• Review your medical history, symptoms, and how your knee is affecting daily life
• Examine your knee’s movement, strength, and alignment
• Review any previous imaging, such as X-rays
• Discuss your treatment options and whether surgery is appropriate

If total knee replacement is recommended, Dr Hockings will review the procedure with you, including the risks, benefits, and expected recovery. Once you’re confident and informed, you’ll sign a consent form. You’ll also receive advice on preparing your home and organising any support you may need after surgery.

2. Pre-operative planning with a CT scan and 3D mapping

After your initial consultation, you’ll receive a referral for a CT scan of your entire leg, from hip to ankle. This detailed scan captures the precise structure of your bones and joints and is used to create a highly accurate 3D digital model of your knee.

This 3D model becomes the foundation for your personalised surgical plan, and with the support of advanced software, Dr Hockings can, prior to your surgery:

• Assess your natural knee alignment, bone contours, and areas of joint wear
• Apply kinematic alignment principles to plan implant positioning that closely reflects the movement of your original, pre-arthritic knee
• Develop a customised surgical strategy tailored to your individual anatomy and biomechanics

Once Dr Hockings has finalised the plan, the data is securely transferred to a specialist manufacturing facility in Switzerland, where your patient-specific instruments (PSI) are created. These 3D-printed surgical cutting guides are designed to fit your knee precisely, then sterilised and delivered to the hospital in time for your operation.

Using PSI helps achieve a high level of surgical accuracy, supporting the preservation of your natural joint motion and contributing to a smoother, more confident recovery.

3. Surgical preparation and pre-operative steps

In the weeks leading up to surgery, you’ll receive support from Dr Hockings’ team to prepare, including:

• Hospital admission paperwork
• Education about fasting instructions and medications
• Prehabilitation physiotherapy (where appropriate)
• Information about home preparation and mobility aids

4. Anaesthesia consultation

Before your procedure, you’ll have a pre-operative consultation with the anaesthetic team, usually conducted over the phone. During this conversation, the anaesthetist will review your medical history, current medications, and any previous experiences with anaesthesia. This is an important step in ensuring your safety and comfort during surgery. Together, you’ll discuss the two main types of anaesthesia used in knee replacement surgery; spinal anaesthesia and general anaesthesia and determine which is most appropriate for you:

• Spinal anaesthesia involves injecting anaesthetic near the spinal cord to numb the lower half of your body. You may remain awake or be lightly sedated during the procedure. This option is commonly used and is often associated with fewer side effects, faster recovery from anaesthesia, and lower risk of complications such as nausea.
• General anaesthesia involves putting you into a temporary state of controlled unconsciousness. It may be recommended in specific situations or based on personal preference, underlying medical conditions, or surgical requirements.

The anaesthetist will explain the risks and benefits of each option and answer any questions you may have. Their goal is to create a personalised anaesthetic plan that prioritises your comfort, supports a smooth surgical experience, and promotes a safe recovery.

4. Hospital admission & the day of surgery

You will receive a phone call from the hospital’s triage or admissions team one to two days before your procedure. They will confirm your admission time, talk you through any last-minute instructions, and answer any final questions you may have.

On the day of surgery, you will arrive at the hospital a few hours before your scheduled procedure. After check-in, you’ll be guided to the pre-operative area, where a nurse will assist you in preparing for surgery. 

This typically includes:

• Changing into a hospital gown
• Removing jewellery, nail polish, and personal items
• Taking baseline observations such as blood pressure and temperature
• Reviewing your consent forms and ensuring all documentation is complete

You will also meet with your anaesthetic team, who will perform final safety checks and ensure everything is in place before you are transferred to the operating theatre. It’s completely natural to feel a little anxious, but please know that every member of our team is focused on keeping you safe, comfortable, and well-supported throughout the process.

5. The surgical procedure: What happens in the operating theatre

Your total knee replacement procedure is a carefully planned and highly technical operation designed to relieve pain, improve movement, and restore confidence in your daily activities. Here’s what to expect during the surgery itself.

Anaesthesia and surgical preparation

On arrival at the operating theatre, you will be greeted by the anaesthetic team. Your anaesthetist will review your medical history and ensure that your chosen anaesthesia method is safely administered. You will receive either:

• Spinal anaesthesia with light sedation, which numbs the lower half of your body while keeping you relaxed but awake, or
• General anaesthesia, where you’ll be fully asleep throughout the procedure.

The decision is made based on your medical history, preferences, and any discussion during your pre-operative anaesthesia consultation.

Once anaesthesia takes effect, your surgical leg will be carefully positioned to optimise access and precision. The skin will be cleaned thoroughly with an antiseptic solution to reduce the risk of infection, and sterile drapes will be applied to maintain a clean surgical field.

Surgical incision using the Subvastus Approach

Dr Hockings performs most knee replacements using the Subvastus Approach. Unlike traditional techniques that cut through the quadriceps tendon, the subvastus approach gently lifts the muscle to access the joint beneath it. This minimally invasive, muscle-sparing technique offers several potential benefits:

• Preserves important muscle strength
• May reduce post-operative pain
• Can support faster early-stage recovery and mobility

An incision is made along the front of your knee, carefully sized and positioned to allow optimal access to the joint while preserving surrounding tissues.

Exposure and assessment of the joint

With the knee joint now exposed, Dr Hockings will assess the extent of joint damage and confirm key measurements. He examines the worn cartilage, checks bone surfaces, and confirms the alignment and motion of the joint. At this stage, Patient-Specific Instrumentation (PSI) the custom-made cutting guides created from your CT scan are positioned on the femur (thigh bone) and tibia (shin bone). These guides allow precise bone cuts that match your 3D surgical plan and intended kinematic alignment.

Specialised callipers and measuring devices may also be used to:

• Confirm the thickness of bone to be removed
• Recreate your natural joint height and angles
• Ensure correct rotation and alignment

This step is critical to achieving a well-balanced, anatomically accurate reconstruction of your knee.

Bone preparation and use of MyKnee PSI

Using the MyKnee PSI guides, Dr Hockings removes the damaged bone and cartilage surfaces in a way that matches your unique anatomy. This allows:

• Accurate placement of the implant components
• Preservation of natural joint motion
• Minimal disruption to surrounding ligaments and soft tissues

The goal is to restore the natural movement and feeling of your knee, using a kinematically aligned approach rather than forcing the joint into a generic position.

Trial implants and soft tissue balancing

Before the final implants are inserted, trial components are placed onto the prepared bone surfaces. These temporary pieces allow Dr Hockings to assess:

• The balance and tension of surrounding ligaments
• The movement and stability of your knee throughout its range of motion
• The alignment and fit of the components

If adjustments are needed, they are made at this stage to ensure the final implants provide a smooth, stable, and functional result.

Insertion of the final implants

Once satisfied with the balance and alignment, Dr Hockings will implant the final components:

• A metal femoral component that caps the end of the thigh bone
• A tibial baseplate and polyethylene insert that recreate the surface of your shin bone
• A patellar button may be added to resurface the back of your kneecap, depending on your condition

Dr Hockings predominantly uses cementless (press-fit) fixation techniques, which are designed to allow your natural bone to grow into the surface of the implants over time. This approach is often preferred in patients with good bone quality and may offer advantages in long-term durability and biological integration. In certain cases, such as patients with softer bone or revision surgery, bone cement may be used to help secure one or more components. The choice of fixation method is based on your individual anatomy, bone strength, and overall surgical plan.

Advanced surgical technology, such as Augmented Reality (NextAR) or Robotic-Assisted techniques, may also be used in select cases. These tools enhance real-time visualisation and accuracy during implant positioning, supporting precise alignment and potentially improving long-term outcomes. Dr Hockings will determine whether these technologies are appropriate for your specific case during the planning phase.

Closing the incision

Once the final implants are secured and joint function is confirmed, the surgical area is irrigated and checked for stability. The incision is then closed in layers:

• Internal tissues are closed using dissolvable sutures
• The skin is closed with dissolvable sutures or surgical glue
• A sterile dressing is applied to protect the wound

You’ll then be transferred to the recovery unit, where your vital signs will be monitored and your post-operative journey will begin.

7. Hospital stay and immediate recovery

Once your surgery is complete, you’ll be monitored in a recovery area while the effects of anaesthesia wear off. You may experience some pain or swelling, but this will be carefully managed using medications and other strategies to keep you as comfortable as possible.

Getting out of bed and walking, with assistance, usually begins within 24 hours of surgery as moving early helps reduce the risk of complications such as blood clots and stiffness. You’ll be encouraged to wear your own clothes soon after surgery, an important step in regaining mobility and confidence.

This step-by-step process is designed to deliver a personalised, precise, and thoughtful surgical experience, restoring function, comfort, and quality of life through advanced knee replacement care.