Once the anesthetic has been given and the patient prepared: the damaged joint surfaces are removed. An incision approximately eight inches in length is made on the front of the knee.

The damaged joint surfaces are removed from all 3 bones making up the knee joint. Sometimes, depending on the surgeon, the back of the knee cap is left intact if it is not badly affected by the arthritis. The surrounding muscles and most of the ligaments are preserved.

The lower end of the thigh bone (femur) is resurfaced with a metal cap.

The upper end of the leg bone (tibia) is replaced with a plastic and metal implant with cement and or screws.

The back of the kneecap (patella) is also resurfaced with an all-plastic implant. Highly specialized instruments are used that allow precision cutting of the bone so that the new joint fits perfectly. The type of implant used depends on surgeon's preference and patient requirements.)