4.Total Knee Replacement Procedure The procedure is designed to be performed with minimal local trauma The knee joint is exposed using a minimally invasive approach The damaged portions of the femur and tibia are then cut at the appropriate angles using a high tech intra-operative computerised navigation system Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. The patella (kneecap) will be resurfaced in most cases. 80% of the natural kneecap is retained The real components are then inserted with or without cement and the knee is again checked for implant fit, alignment and stability The knee is then carefully closed with dissolving sutures and skin glue. Sterile waterproof dressings and a compression bandage are applied. Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added. Custom implants are occasionally required.