A comprehensive pillar for patients considering knee arthroplasty
30 de minute, evaluare clinică, plan personalizat.
Short answer: Knee replacement is a surgery where the damaged joint surfaces of the femur and tibia are replaced with an implant made of metal and polyethylene. It's called total knee arthroplasty. It is indicated when chronic knee pain, usually caused by knee osteoarthritis, no longer responds to conservative treatment (medication, physical therapy, injections) and begins to significantly affect quality of life. The surgery takes 60–90 minutes, hospitalization is 3–5 days, and full recovery takes between 6 and 12 months.
The knee joint is formed by the lower end of the femur, the upper end of the tibia, and the patella (kneecap), connected by ligaments and covered with cartilage. Cartilage is the smooth tissue that allows bones to glide over each other without pain. When this cartilage wears down—a process called knee osteoarthritis—the bones rub directly against each other, and every step becomes painful.
A knee replacement doesn't 'heal' the joint. It replaces the faulty mechanism with an artificial one. Imagine an old, rusty hinge that creaks with every opening. You replace it with a new hinge. That's essentially what we do with the knee, but on a much more precise scale.
The implant has three components:
In some cases, we also replace the back surface of the patella with a polyethylene component.
There are two main types, chosen based on your situation:
Total Knee Arthroplasty (TKA): Replaces all three joint surfaces. It is the most common—over 90% of cases. Recommended for advanced osteoarthritis in all three compartments of the joint.
Unicompartmental Knee Arthroplasty (Partial Knee Replacement): Replaces only a part of the joint when only one compartment is affected. Advantage: smaller incision, faster recovery, better mobility. Disadvantage: if the wear extends to other compartments, a total replacement may be needed later.
The decision between the two is made based on X-rays and a clinical exam. During the consultation, I will explain specifically what would be indicated in your case.
This is where things get important, and it's time to be completely honest with each other.
Knee replacement is a serious operation. It permanently alters your anatomy, has real risks, and recovery requires discipline. It is by no means a 'simple fix.' That's why, before sending you to the operating table, I carefully evaluate if you are truly at the right moment.
The decision to operate is a conversation, not a decree. During the consultation, I lay all the cards on the table: what your X-ray shows, what the clinical exam says, what non-surgical alternatives are still reasonable, and what the real risks of the surgery are for you specifically. Then, you decide.
Many patient fears come from the unknown. Here's exactly what happens:
The evening before: Hospital admission. Fasting from the previous evening. A mild sedative for sleep if you need it. A visit from the anesthesiologist who will explain the type of anesthesia.
The morning of the surgery: Preparation—shower with antiseptic soap, changing into a special gown, IV line insertion. A brief chat with me—I'll answer any questions you have at that moment.
Total duration: 60–90 minutes for standard cases. Longer for complex cases (large deformities, previous surgeries).
Immediately after surgery: You will spend 1–2 hours in the recovery room, under monitoring. Then you will return to your ward room. Pain is controlled with intravenous and then oral analgesics.
On the first post-operative day (very important): you get out of bed, take your first steps with a walker, under the supervision of a physical therapist. This isn't 'rushing'—it's an integral part of the surgery's success. Prolonged immobilization increases the risk of thrombosis and joint stiffness.
Recovery after a knee replacement is a marathon, not a sprint. Patients who understand this from the beginning have the best results.
Week 1: you are still hospitalized (3–5 days) or at home with daily physical therapy; walking with a walker around the bed and in the hallways; passive and active assisted mobility exercises; anticoagulant treatment to prevent thrombosis; daily dressing changes, stitches removed at 14 days.
Weeks 2–4: continue walking with a walker, possibly crutches for short periods; physical therapy 3–5 times a week; knee mobility should reach 90° flexion by the end of week 4; we begin light muscle training; return to sedentary work (office job) at 2–4 weeks.
Weeks 5–8: transition to a cane; target mobility: 120° flexion; walking without support for short distances; resuming driving (at 6–8 weeks); the first 'I don't feel my knee anymore' moments appear—an excellent sign.
Months 3–6: complete independence in walking; light recreational activities: long walks, swimming, stationary bike; continued physical therapy 1–2 times/week for maintenance; muscle strength still rehabilitating.
Month 6 to 1 year: maximum recovery—90% of patients report a radical reduction in pain; final mobility: 120–135° flexion (a natural knee has 140°); resumption of low-impact sports (golf, hiking, swimming, cycling); permanently not recommended activities: running on pavement, repetitive jumping, impact sports (competitive soccer, basketball).
Every surgery has risks. Hiding this doesn't help you. Here are the real risks, with real incidences:
| Risk | Approximate Incidence | How We Prevent It |
|---|---|---|
| Post-operative infection | 1–2% | Prophylactic antibiotics, strict asepsis, controlled environment |
| Deep vein thrombosis (DVT) | 2–5% (with prophylaxis); 30%+ without | Anticoagulant for 4–6 weeks post-op, early mobilization |
| Pulmonary embolism | sub 1% | Same measures as for DVT |
| Reduced mobility (less than 90° flexion) | 5–10% | Aggressive physical therapy, manipulation under anesthesia if necessary |
| Residual pain | 10–15% (usually tolerable) | Correct patient selection, precise technique |
| Prosthesis wear/loosening | sub 1%/year, cumulativ | Correct technique, normal weight, avoiding impact sports |
| Need for revision surgery | ~5% at 10 years, ~15% at 20 years | Quality implant, long-term follow-up |
| Vascular/nerve damage | sub 0,5% | Careful technique, pre-operative planning |
Post-operative infection
Incidence: 1–2%
Prophylactic antibiotics, strict asepsis, controlled environment
Deep vein thrombosis (DVT)
Incidence: 2–5% (with prophylaxis); 30%+ without
Anticoagulant for 4–6 weeks post-op, early mobilization
Pulmonary embolism
Incidence: sub 1%
Same measures as for DVT
Reduced mobility (less than 90° flexion)
Incidence: 5–10%
Aggressive physical therapy, manipulation under anesthesia if necessary
Residual pain
Incidence: 10–15% (usually tolerable)
Correct patient selection, precise technique
Prosthesis wear/loosening
Incidence: sub 1%/year, cumulativ
Correct technique, normal weight, avoiding impact sports
Need for revision surgery
Incidence: ~5% at 10 years, ~15% at 20 years
Quality implant, long-term follow-up
Vascular/nerve damage
Incidence: sub 0,5%
Careful technique, pre-operative planning
These numbers are not meant to scare you. They are meant to show you that the risks are small, but real. The surgery remains one of the most effective orthopedic interventions in all of medicine—over 90% of patients report a radical reduction in pain and an increase in quality of life (Bourne RB et al., Clin Orthop Relat Res 2010).
I am honest with this information because patients have the right to know.
Knee replacement surgery is included in the National Endoprosthesis Program of the CNAS (National Health Insurance House). Patients who meet the criteria benefit from a fully reimbursed surgery, including the implant.
Steps for the CAS route: (1) orthopedic consultation (with a referral from the family doctor)—free with CAS; (2) investigations (X-ray, possibly MRI)—mostly reimbursed; (3) waiting list for inclusion in the National Program—varies between 3 and 12 months, depending on the hospital; (4) the surgery—at hospitals with a contract: Craiova County Clinical Emergency Hospital, MedLife Private Hospital Craiova (recently), hospitals in other counties; (5) recovery—free spa treatment voucher (reservations at partner resorts).
Advantages: zero cost for the patient. Disadvantages: waiting list; limited choice of implant.
Advantages — fast scheduling (usually within 2–4 weeks), choice of implant (you can opt for premium implants), private room, scheduling flexibility. Disadvantage: cost.
Indicative private costs (2026): orthopedic consultation 200–400 lei; hospitalization + operating room + standard implant + in-hospital recovery 18,000–35,000 lei (variable depending on the chosen implant and hospital); the hybrid option (CAS reimbursement for the surgery + private payment for a separate room) significantly reduces the total cost.
At my office, the consultation costs 360 lei. For a detailed surgery estimate, a full clinical evaluation is needed—I cannot give a price over the phone without seeing the case.
Honestly? It depends on you. If time is not a pressure and qualifying for CAS is clear, the public route offers equally good results from a surgical perspective—the procedure is internationally standardized. If you want a short timeline, choice of implant, or hotel-like comfort, private makes sense.
What I never do: convince you to go private when the CAS is a valid option for you. During the consultation, I explain both routes without an agenda.
I am Dr. Alexandru Florian Grecu, a senior consultant orthopedic and trauma surgeon with clinical practice in Craiova. I work at MedLife Private Hospital Craiova (2A Științei Street) for private consultations and surgeries, and at the Craiova County Clinical Emergency Hospital (1 Tabaci Street) for cases on the CAS route through the National Endoprosthesis Program.
My main specializations are hip and knee arthroplasty, knee arthroscopy, and regenerative therapy with PRP and hyaluronic acid. Besides my clinical work, I teach orthopedics at the University of Medicine and Pharmacy of Craiova, as a Senior Lecturer.
Orthopedics is a specialty where what matters is not just the day of the surgery, but also what happens 5, 10, or 20 years later. I choose the implants, the technique, and the timing of the intervention with this long-term perspective in mind. My patients are primarily people who want to regain their lost mobility—whether for work or to watch their grandchildren grow up.
For complete details about my professional background, see the About page.
If you've had knee pain for months or years and are wondering if surgery is necessary, the first consultation is non-binding. We'll review your X-rays, clinical exam, and discuss non-surgical and surgical options together. The decision remains yours. Appointments: 0251 960 (MedLife) or +40 787 210 391 Consultations: with National Health Insurance referral (cu bilet de trimitere) or private (360 lei). Monday–Friday, 08:00–18:00.
Programări: 0251 960
30 de minute, evaluare clinică, plan personalizat.
I have created a dedicated brochure for patients preparing for knee replacement surgery. It contains everything you need from the moment of the decision to operate onwards: necessary medical tests, what happens on the day of surgery, the recovery exercise program, warning signs, and a complete list of things to prepare.
📄 Download brochure: Patient's Guide to Knee Replacement (PDF)The brochure is designed to be read at home, in peace, and to answer all practical questions about the surgery and recovery. During the consultation, we will discuss and personalize this plan according to your situation.
Felson DT et al. — Weight loss reduces the risk of symptomatic knee osteoarthritis in women. Ann Intern Med. 1992;116(7):535-9.
For the rule 'losing 5 kg can reduce knee pain by 20-30%'.
Messier SP et al. — Effects of intensive diet and exercise on knee joint loads in adults with knee osteoarthritis. JAMA. 2013;310(11):1226-1235.
For the rule '1 kg of body weight = approximately 4 kg of pressure per knee with each step'.
Bourne RB et al. — Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63.
For the >90% satisfaction rate after knee replacement.
Swedish Hip Arthroplasty Register — Annual Report 2022.
For the long-term success rate of hip replacement.
Allen KD, Golightly YM — Epidemiology of osteoarthritis: state of the evidence. Curr Opin Rheumatol. 2015;27(3):276-83.
For the prevalence of knee osteoarthritis and risk factors (3-4 times more common in women).