Total Knee Replacement
Arthritis, total versus partial replacement, and what the operation actually does — plus how we diagnose it, how surgery is scheduled, and what the first twelve weeks look like.
Call 520-881-1394 Read the packetWho this is for
This page is for people whose knee arthritis is getting in the way of work, the things they enjoy, or sleep, especially if medications, physical therapy, bracing, or injections are no longer enough.
Surgery is not automatic. In 2025 Dr. Ward performed 87 total knee replacements and 44 partials. He, Olivia Sobojinski, PA, and Gabby Ventura, PA listen first and talk through options. There isn't one path that fits everyone.
What happens at your visit
You will usually have an X-ray in the office. We look at it together, talk about non-surgical options as well as surgery, and you decide on a timeline that fits your life.
If you later decide to schedule, that can happen in clinic with Dr. Ward, or you can call after you have already met.
"Dr. Ward was kind and caring with his knowledge about my knee. He helped on my first visit." — Google review
Understanding arthritis
Every joint is two bones that need to glide on each other. On top of each bone is a thin layer of cartilage, only a few millimeters thick. Dr. Ward describes it like icing on a cake: the icing is the cartilage, the cake is the bone. That icing is exceptionally smooth, so the joint moves with very little friction.
With age or injury the icing wears away. Bone is rough, more like sandpaper. Sandpaper on sandpaper means inflammation, swelling, and pain. That is arthritis. Cartilage cannot grow back. Treatment is about calming inflammation.
How we diagnose it
X-ray is the main test for osteoarthritis. Cartilage itself does not show on X-ray and is poorly seen on MRI. What we are looking for is the space between the bones.
On X-ray
Arthritis on X-ray is loss of space between the bones — the icing is gone. Extra signs can include bone spurs, sclerosis (the bone looking extra white and hard), subluxation, and deformity.
If the space is preserved, the cartilage is likely still there.
About MRI
MRI is useful for meniscus, muscles, and tendons. It does not show bone well, and it is a poor test for the cartilage surface itself.
For osteoarthritis, an X-ray in the office is usually enough. MRI or arthroscopy is sometimes used if the picture is not clear.
Total vs. partial
The knee has three compartments. Which operation fits depends on how many of them are worn and whether the ACL is intact.
Partial
Changes one compartment only. Keeps the ACL and PCL. Recovery is typically about six weeks. Many people say it feels more natural.
A partial may be an option if arthritis is in one compartment and the ACL is intact. An X-ray is usually enough to decide. Sometimes an MRI or arthroscopy is used to confirm the other compartments and the ACL.
The tradeoff: conversion of a partial to a total is uncommon, but the other compartments can still wear.
Total
Changes all three compartments: inner (medial), outer (lateral), and behind the kneecap (patellofemoral). Those ligaments are not kept. Recovery is about twelve weeks.
No arthritis is left in those compartments. If more than one compartment is involved, a total is usually the better fit. That decision is made together in clinic.
What the surgery actually is
People sometimes imagine the end of the thigh bone being amputated and swapped for metal. That is not what happens. About 9 mm from the femur and 4 mm from the tibia are trimmed so a smooth metal cap can sit on the bone.
Those caps glide against a polished plastic insert (polyethylene). Less friction means less pain and more motion. Arthritis is diagnosed mainly on X-ray; cartilage itself does not show up.
The implant is DePuy Attune — metal on the femur and tibia with a highly cross-linked polyethylene spacer.
Scheduling and Dr. Ward's approach
You can schedule in clinic with Dr. Ward, or call after you have already met. Leave a message. Dr. Ward or a PA will see you before surgery for leftover questions.
Dates and hospital
Alison Guerra, surgery scheduler, calls with dates. You pick. Surgery is at Oro Valley Hospital or Northwest Medical Center. You choose.
Insurance
A total knee is elective, but it is considered medically necessary after non-operative care has failed. The office works on pre-approval. Call your own plan for your deductible and what you will owe.
It is marketing for a quadriceps-sparing approach, not a special implant. The usual exposure splits the quad tendon and gives a clearer view; midvastus and subvastus spare it. All three have been used for years. If you want that exposure, Dr. Ward is happy to use it.
What to expect
Before
A preoperative visit to review labs, write down questions, go over a pain plan, and get a physical therapy referral. Testing can be done without an appointment at the hospital. Nothing to eat after midnight the night before.
Day of
Surgery averages 60–90 minutes. Dr. Ward generally recommends a nerve block and a spinal anesthetic, and he injects the knee. Many people go home the same day after 2–4 hours in phase-two recovery. He calls the person you designate when he is finished.
Recovery
Physical therapy about 7–10 days after surgery, sooner if you want. Packet goals: about 5° to 115° by six weeks and 0° to 125° by twelve weeks. Getting the knee fully straight matters as much as getting it to bend.
Before surgery
Most of the work happens before the operating room. Write questions down. Bring them to the preoperative visit.
Pre-op visit
- Labs and leftover questions
- Pain plan
- Physical therapy referral
- Walker prescription if you need one — most people borrow a walker or pick one up at a thrift store
Testing
No appointment is needed at Oro Valley Hospital or Northwest Hospital for:
- CBC, BMP, PT/INR
- Chest X-ray
- EKG
Medical clearance from your PCP is needed if you have lung, heart, or kidney problems. It is not needed for cholesterol or stable high blood pressure. If you see a cardiologist, anesthesia requires cardiology clearance as well.
Medications
- Stop aspirin 7 days before surgery
- Blood thinners are stopped only with guidance from your PCP or cardiologist (often about 3 days)
- Restart them the evening of the day after surgery unless you are told otherwise
Night before and morning of
- Nothing to eat after midnight. Eating means the case is canceled.
- A sip of water only for morning heart medications
- Shower the morning of surgery with regular over-the-counter soap. No special soap is needed.
- Stop lotion on the legs the day before
- Do not blade-shave the legs for 2 days. Clippers are fine the day before.
Prehab
Bike, elliptical, and water exercise are good. No impact. The goal is to build the thigh muscles before surgery.
Physical therapy starts about 7–10 days after surgery, sooner if you want.
Home setup
- Clear rugs and cords
- Sit with the knee straight. No pillow under the knee. A recliner is fine only if the knee is fully straight with air under it.
- A straight knee is needed to walk without a limp
- Stairs: up with the good leg, down with the surgical leg
Day of surgery
Bring
- Comfortable clothes and shoes
- Phone, ID, and insurance card
- A ride home
- Glasses (no contacts)
- Be ready to remove dentures
Leave at home
- Walker — have it waiting at home
- Ice machine
- Jewelry and rings
- Home medications
- Makeup
Anesthesia
A loved one can be with you in pre-op. Dr. Ward and anesthesia meet you there.
Anesthesia is usually a nerve block plus a spinal (like an epidural) so you wake up with less pain and less nausea. He also injects the knee. If you have a lot of back arthritis or prior back surgery, a spinal may not be possible.
Timing
- About 15–20 minutes to go to sleep
- Surgery 60–90 minutes
- Recovery room about 45–60 minutes. He calls the person you designate right after.
- Phase two is 2–4 hours: up with the nurses and physical therapy, then home. Overnight if needed.
Incision and dressings
The incision runs from two fingerbreadths above the kneecap down to the tibial tubercle. Absorbable sutures are under the skin. Nothing to remove.
- Ace wrap for 2 days for swelling
- Mepilex adhesive for 7 days — keep it dry
- Prineo mesh is glued on for about 2–3 weeks. Showers are fine. No soaking. Trim it as it peels.
Recovery
Stay ahead of the pain for the first three days. Sharp pain eases after 1–2 weeks. A night ache like a toothache is common around six weeks.
Pain, ice, swelling
- Ice 30–45 minutes every hour while you are resting
- Elevate foot above knee above hip
- Ankle pumps
- Bruising down to the ankle and swelling in the foot are common
Blood clots
Blood clots are uncommon, but the risk is higher after knee replacement. Movement is the best prevention. You will be on a blood thinner for a period as directed in clinic.
Physical therapy
Plan on about three months of physical therapy. Getting the knee fully straight is as important as getting it to bend. A straight knee is what lets you walk without a limp.
Driving
Not while you are on narcotics.
- Left knee: often sooner, if you have been off narcotics for 4 hours
- Right knee: off the walker, full weight, and able to slam the brake
Work
- Desk work: minimum about 2 weeks. Most people are more comfortable at 4.
- Standing jobs: minimum about 4 weeks. Most people need 6.
The other knee
If the other knee also needs surgery, wait until about the 3-month mark.
Common questions
These are the answers from the packet. If something still does not sit right, come in. Do not feel like you are wasting his time.
Why does the knee click?
That is metal on plastic. It is normal. It usually quiets down as scar tissue forms.
Why is the outside of the knee numb?
A midline incision cuts the infrapatellar branch of the saphenous nerve. That numbness is expected. It may shrink over time, or it may be permanent. It is not a strength problem.
Why is it so tight and swollen?
That is usually worst in the first two weeks. Ice, elevate, use anti-inflammatories as prescribed, and use compression if you can tolerate it.
It feels warm and a little red.
Extra blood flow can make the knee feel warm and look a little red for up to about three months. That can be normal healing.
There is a pimple on the incision.
That is often a suture abscess. It does not usually need antibiotics. It can pop like a pimple, or you can show Dr. Ward.
I see a fishing-wire suture.
That is suture spitting. You can clip it or leave it.
Will I set off airport scanners?
Many newer scanners do not set it off, but every airport is different. You do not need a card, and you do not have to show the scar.
Other joints hurt.
You are often favoring the surgical side. That usually settles as your gait normalizes.
My leg feels longer.
That is usually because a bow-leg or knock-knee was corrected to straight, not because length was added. About 9 mm is taken from the femur and 3–4 mm from the tibia, and the same amount is replaced.
Do I need antibiotics for the dentist?
Antibiotics before invasive dental work that may bleed. Not needed for a routine cleaning. Call the office.
Compression stockings?
Optional. Skip them if they are too tight or hard to put on.
When should I worry?
Infection can look like normal healing. Come in rather than wait. Do not feel like you are wasting his time.
Related resources
The packet covers the details: preparing for surgery, the day of, motion goals, and week-by-week recovery. This page is the short version. The PDF is the full one.
Read the packet (PDF)Schedule a visit
Call 520-881-1394 and we will find a time that works.
Call 520-881-13941521 E. Tangerine Rd, Suite 337
Oro Valley, AZ 85755 · (520) 901-6380
6130 N. La Cholla Blvd, Suite 135A
Tucson, AZ 85741 · (520) 881-1394