Knee Replacement

At Mechnikov Hospital, knee replacement is part of a comprehensive approach to treating major joint diseases. We start with detailed diagnostics, safely perform the surgery, and support the patient throughout the recovery period. Our goal is not just to eliminate pain, but to help the person return to their normal rhythm of life without constant limitations.

State Program for Free Knee Replacement

At Mechnikov Hospital, knee replacement can be received free of charge under the state medical guarantees program. Our facility has a specialized department—the Center for Pathology and Arthroplasty of Large Joints—and is included in the list of hospitals funded by the National Health Service of Ukraine (NHSU). This means the patient receives a full cycle of treatment in accordance with approved state standards.

What Exactly the State Covers

The state program covers all the main stages of treatment related to knee replacement.

The cost of the endoprosthesis is fully covered by the state. Implants are purchased centrally through the Ministry of Health (MoH),so the patient bears no financial costs and does not independently choose the class, type, or manufacturer of the prosthesis. This ensures equal access to surgical treatment regardless of financial capabilities.

The surgical intervention is funded within the NHSU package, which includes:

• the work of the entire surgical team (orthopedic traumatologists, assistants, operating nurses);
• the work of the anesthesiology team;
• performing the surgery in a fully equipped operating room, observing all safety requirements.

The hospital stay after the surgery is also paid for by the NHSU. Throughout the entire hospitalization period, the patient receives free of charge:

• a bed in a ward;
• care from medical staff;
• hospital meals;
• postoperative medical monitoring.

Who Can Benefit from the Program

Free knee replacement is available to patients aged 18 and older with clear medical indications. If the disease is in its early stages and does not cause a significant impairment of joint function, surgical treatment is not indicated.

Absolute contraindications include active infectious processes, severe decompensated diseases of the heart, lungs, or kidneys, uncontrolled diabetes mellitus, blood clotting disorders, and severe vascular lesions of the limb scheduled for surgery. The state program also does not provide the option of installing a specific "branded" implant at the patient's request and does not apply to stateless persons or those without the necessary documents.

Procedure for Enrolling in the State Free Knee Replacement Program

To undergo knee replacement under the state program, it is important to follow a clear sequence of steps. This algorithm allows the patient to be officially registered in the NHSU system and ensures transparent and fair access to treatment.

Step 1. Consulting a Family Doctor

The first step is a visit to your family doctor or general practitioner at your place of residence.

At this stage, it is necessary to:

• discuss your current complaints and the results of previous examinations;
• obtain an electronic referral for a consultation with an orthopedic traumatologist.

This step is mandatory. Without an official e-referral, we cannot register the consultation in the NHSU system as part of the state program, and therefore, we cannot include the patient in the further pathway for free treatment.

Step 2. Consultation at the Mechnikov Hospital Polyclinic

With the electronic referral, the patient schedules an appointment at the consultative polyclinic of Mechnikov Hospital through the registry.

During the consultation:

• the orthopedic traumatologist conducts a clinical examination;
• analyzes X-rays and other examinations;
• determines the exact diagnosis and the presence of indications for knee replacement.

It is at this stage that the medical rationale for further consideration of the case is formed.

Step 3. Medical Advisory Commission (MAC)

After the initial examination, the patient's case is reviewed by the Medical Advisory Commission. It includes the traumatologist from the consultative polyclinic, the head of the specialized department, and, if necessary, allied specialists.

The commission confirms:

• the presence of persistent impairment of knee joint function;
• the feasibility and necessity of joint replacement;
• the absence of medical contraindications for surgery.

The MAC's decision is recorded as an official conclusion in the patient's outpatient record.

Step 4. Entry into the Registry (Waiting List)

Following a positive decision by the Medical Advisory Commission, the patient's data is entered into the official waiting list—an electronic queue for free knee replacement.

The queue is transparent and formed according to approved state rules. The call for surgery occurs in order of priority, taking into account the availability of implants and medical priorities.

What Documents Are Required to Participate in the State Program

For a patient to be officially enrolled in the state free knee replacement program, a standard package of documents must be prepared. This is necessary for correct registration in the electronic system and to confirm the right to receive state-funded assistance.

Basic Patient Documents

To formalize participation in the program, you must provide:

• a copy of a citizen of Ukraine passport;
• a copy of the taxpayer identification card (TIN);
• a copy of the extract on the place of residence;
• information about the specific joint requiring replacement (right or left knee).

Documents Confirming a Preferential Category (if applicable)

If the patient belongs to a preferential category, copies of the corresponding supporting documents must also be submitted. These categories include:

• individuals who have special merits to the Motherland, as well as members of their families (spouse, minor children);
• persons with war-related disabilities;
• combat veterans;
• war participants;
• family members of deceased (perished) war veterans;
• family members of deceased (perished) Defenders of Ukraine.

Veterans of various services are highlighted separately, in particular:

• military service veterans;
• veterans of internal affairs agencies;
• veterans of the National Police of Ukraine;
• tax police veterans;
• veterans of the Economic Security Bureau of Ukraine;
• state fire department veterans;
• veterans of the State Criminal Executive Service of Ukraine;
• civil protection service veterans;
• veterans of the State Service of Special Communications and Information Protection of Ukraine.

Preferential categories also include:

• children from large families;
• medical and pharmaceutical workers;
• victims of the Chornobyl disaster, including persons with disabilities among the liquidators and Category 1 victims, as well as children with disabilities related to the Chornobyl disaster.

Contact Details

For communication and organization of subsequent stages of treatment, you must provide:

• patient's contact details (phone number, email);
• contact details of a designated related person (full name and phone number).

We always help patients check the completeness of their document package and advise on what exactly needs to be prepared so that the process of inclusion in the state program occurs without delay.

Which Prostheses Are Used Under the State Program and When the State Does Not Cover the Surgery

Within the state free knee replacement program at Mechnikov Hospital, we use endoprostheses purchased centrally with state funds. Currently, these are AK Medical knee endoprostheses (manufactured in China),specifically the A3 GT model with cement fixation.

Cement fixation means that the implant is securely anchored to the bone tissue using special medical cement. This option is well-suited for patients with reduced bone density and allows for stable joint fixation immediately after surgery. All implants used under the state program are certified in Ukraine and approved for clinical use.

At the same time, it is important to understand in which situations the state program does not cover knee replacement. Primarily, this applies to cases where the patient wishes to install an endoprosthesis not included in the MoH procurement list. Choosing a specific "branded" implant or a different type of prosthesis is only possible through paid treatment.

State funding also does not extend to additional services not included in the Medical Guarantees Program. This refers to, among other things, superior comfort wards, private nursing care, or additional examinations beyond the approved protocols.

Organizational limitations should be considered separately. If the facility temporarily lacks available endoprostheses due to the exhaustion of limits or while awaiting a new delivery, the patient may be offered the choice of waiting in the queue or opting for a paid surgery with an implant purchased at their own expense.

Paid Knee Replacement

In addition to participating in the state program, patients at Mechnikov Hospital have the option to undergo knee replacement on a paid basis. This treatment format expands the choice of implants and allows for the selection of an optimal solution tailored to lifestyle, physical activity level, and individual anatomical features.

What Endoprostheses Are Available at the Patient's Expense

In the paid format, more advanced knee endoprostheses from leading European and American manufacturers are used. Depending on the clinical situation, the patient may be offered:

• total knee endoprostheses with various fixation types;
• partial (unicompartmental) endoprostheses, used when only one part of the joint is affected;
• revision endoprostheses for complex cases or the replacement of previously installed implants.

This category includes premium models featuring innovative materials, increased wear resistance, and designs adapted for active patients. Such implants can provide greater movement comfort and a longer service life, particularly for working-age individuals.

Choosing an Implant Together with the Doctor

In the case of paid joint replacement, the patient is an active participant in the implant selection process. The final decision is made jointly with the operating orthopedic traumatologist after a detailed examination.

During the consultation, the doctor considers:

• the nature and extent of knee joint damage;
• the patient's anatomical features;
• age, physical activity level, and desires for future lifestyle.

This personalized approach makes it possible to select an endoprosthesis that best meets the specific needs of the individual and ensures a predictable treatment outcome.

Indications for Knee Replacement

Knee replacement is considered in cases where the joint has undergone significant destruction and can no longer provide painless movement and support. Most often, the surgery is necessitated by the following conditions:

• stage III–IV osteoarthritis of the knee (gonarthrosis);
• rheumatoid arthritis and other inflammatory arthropathies;
• post-traumatic changes following fractures, ligament, or meniscus injuries;
• osteonecrosis of the femoral or tibial condyles;
• severe knee deformities and congenital anomalies;
• consequences of previous joint infections, following complete sanitation.

The most common indication is stage III–IV gonarthrosis. At this stage, the articular cartilage is almost completely destroyed, and the bone surfaces begin to rub against each other. This is accompanied by persistent pain poorly controlled by medications, significant restriction of knee movement, and visible leg deformity. Often, varus or valgus limb deviations develop, along with a flexion contracture, making it difficult to fully straighten the leg.

In rheumatoid arthritis and other inflammatory joint diseases, destruction occurs due to chronic inflammation. The immune system attacks the joint's own tissues, gradually leading to a loss of stability and function. When the knee becomes a constant source of pain and prevents normal walking, replacement surgery offers a chance to restore mobility and reduce inflammatory pain.

Post-traumatic changes can develop years after severe knee injuries. Intra-articular fractures, ligament, or meniscus tears alter joint anatomy, disrupt load distribution, and eventually lead to secondary osteoarthritis. In such cases, pain and instability increase gradually but relentlessly.

Osteonecrosis of the femoral or tibial condyles arises from impaired blood supply to the bone tissue. The bone loses strength, deforms, and can no longer withstand stress, which rapidly leads to joint destruction and the onset of severe pain.

Surgery may also be indicated for severe deformities or congenital knee anomalies. An incorrect limb axis causes uneven loading, causing the joint to wear out much faster. In some patients, the consequences of previous knee joint infections become an indication—provided that the infectious process is completely eradicated and the condition has stabilized.

Symptoms Indicating the Need for Knee Replacement

The decision to undergo surgery rarely arises suddenly. Most often, the patient lives with knee pain for a long time, gradually adapting to limitations and decreased activity. However, there are clear symptoms indicating that the joint is no longer coping with its function and conservative treatment no longer yields the expected effect.

The most alarming signs are:

• constant or nocturnal knee pain that does not subside even at rest;
• the need for regular intake of painkillers, particularly non-steroidal anti-inflammatory drugs or stronger analgesics;
• difficulty walking, when pain appears after walking just 100–200 meters, forcing a stop;
• limping, a feeling of instability, or the knee "giving way";
• inability to perform usual work or basic self-care tasks;
• a significant decline in the quality of life, when pain and limited movement affect sleep, mood, and daily activities.

Constant knee pain, especially at night, often indicates pronounced destruction of the joint surfaces. In such cases, the person cannot find a comfortable position for the leg, sleep becomes superficial, and severe stiffness is felt in the morning. Regular intake of painkillers ceases to provide a lasting effect and can lead to gastrointestinal, cardiovascular, and renal side effects.

Limited walking and the onset of limping mean the joint is losing stability and proper biomechanics. Even short walks or household chores become a trial, and the person involuntarily reduces activity, avoiding stairs, going outside, and physical exertion.

When knee pain and instability interfere with work, self-care, or performing usual daily routines, it is a crucial signal not to postpone a consultation with an orthopedic traumatologist. Timely examination allows for assessing the joint's condition and determining whether knee replacement is the optimal solution for your specific case.

Diagnostics Before Knee Replacement

Before elective knee replacement surgery, the patient undergoes the following examinations:

• X-ray of the knee joint in two projections with weight-bearing and special markers. This is a basic examination that allows assessing the degree of joint destruction, limb alignment, and properly planning the implant placement.
• General clinical laboratory tests: complete blood count, urinalysis, and coagulogram. These are necessary to evaluate blood clotting, the presence of inflammatory processes, and the overall condition of the body.
• Biochemical blood test and glucose levels, which help detect metabolic disorders and correct concomitant conditions prior to surgery.
• Ultrasound (Doppler) of the lower limb blood vessels to assess venous circulation and prevent thrombosis in the postoperative period.
• Electrocardiogram (ECG) to evaluate heart function.
• Echocardiography (EchoCG) and a cardiologist consultation, and if necessary, an endocrinologist, nephrologist, or other specialists.
• Examination by a general practitioner or family doctor, and a mandatory consultation with an anesthesiologist, who assesses the patient's overall health and selects the safest form of anesthesia.

In certain clinical situations, the list of examinations may be expanded. Computed tomography (CT) is used for complex deformities and significant anatomical changes.

The multidisciplinary Mechnikov Hospital can perform a full range of preoperative examinations at its own polyclinic during the pre-hospitalization stage. This is convenient for the patient, as all necessary tests and consultations can be completed in one facility, avoiding unnecessary travel and wasted time.

Modern Equipment for Precise Surgical Planning

Precise planning is one of the key factors for successful knee replacement. At this stage, the doctor determines the optimal size and position of the implant, corrects the limb axis, and predicts the course of the surgery. At Mechnikov Hospital, we use modern diagnostic equipment for this purpose, which minimizes risks and helps achieve the desired outcome.

For preoperative planning, our specialists utilize digital radiography. It provides high-definition images with precise calibration capabilities. This allows for preoperative "templating"—selecting the optimal size and configuration of the endoprosthesis before the surgery begins. Thanks to this, the surgeon understands in advance which implant is best suited for the specific patient and can accurately plan all stages of the intervention.

In complex clinical cases, multispiral computed tomography (MSCT) is used. This examination allows creating a 3D model of the knee joint and thoroughly assessing the condition of the bone structures. MSCT is especially important for pronounced deformities, post-traumatic changes, or when planning revision knee replacement. This approach enables the surgeon to thoroughly understand bone architecture and plan the positioning of the endoprosthesis components with maximum precision.

Preparation for Surgery

Medication Adjustment Before Surgery

Before knee replacement, adjusting medication therapy is mandatory. At Mechnikov Hospital, we adhere to strict safety protocols, and final decisions regarding medications are made after consulting with the anesthesiologist and allied specialists.

Usually, blood thinners (anticoagulants and antiplatelet agents) are temporarily discontinued a few days before surgery to reduce the risk of blood loss. If necessary, the patient is switched to controlled "bridge therapy." Non-steroidal anti-inflammatory drugs are also stopped on the eve of the intervention, as they affect blood clotting.

Medications for diabetes control are individually adjusted to avoid complications during anesthesia. Hormonal drugs in women may require a temporary pause due to an increased risk of blood clots. Blood pressure and heart medications are generally not canceled and are taken even on the day of surgery, subject to the doctor's approval.

During hospitalization, the patient must bring their outpatient medical record so that the medical team can review their entire medical history.

Nutrition, Activity, and Home Preparation Before Surgery

Preparation for knee replacement begins before hospitalization. Proper nutrition and basic preparatory steps help the body endure the surgery more easily and recover faster.

Two to three weeks before the intervention, it is recommended to increase protein intake—meat, fish, eggs, and dairy products. Protein is the main "building block" for tissue healing and muscle recovery. It is also important to include foods rich in iron and vitamin C to support hemoglobin levels and reduce the risk of postoperative weakness.

If there is excess weight, even a small weight loss before surgery reduces the strain on the new joint and cardiovascular system. A mandatory preparation step is the sanitation of infection sources: dental treatment, and consultations with an ENT specialist, gynecologist, or urologist. Any hidden infection can become a source of complications after the endoprosthesis placement, making this step extremely crucial.

The Course of Knee Replacement Surgery

For most patients, it is important to understand exactly how the surgery goes, how long it takes, and what to expect afterward. We always explain these points in detail during the preparation phase to reduce anxiety and give a sense of control over the situation.

What Type of Anesthesia Is Used

In 90–95% of cases during knee replacement, we use spinal (regional) anesthesia. With this type of anesthesia, the patient is conscious or in a state of light medical sleep but completely lacks sensation in the lower limbs. This method is considered safer for the heart, lungs, and brain, especially in older patients.

Spinal anesthesia reduces blood loss during surgery, lowers the risk of thromboembolic complications, and avoids difficult recovery from general anesthesia. General anesthesia is used only in exceptional cases—when there are contraindications to spinal anesthesia, such as blood clotting disorders or severe spinal deformities. The final choice of anesthesia method is always made by the anesthesiologist after examining the patient.

Duration of Surgery

A standard primary knee replacement performed by our surgeons takes an average of 45 to 90 minutes. The duration may vary depending on the severity of the deformity, the condition of the bone tissue, and the anatomical features of the joint.

Operating Room Equipment

The operating rooms at Mechnikov Hospital are equipped in accordance with European standards. During the procedure, a C-arm (fluoroscope) is used, allowing real-time monitoring of the endoprosthesis components' positioning. Modern instruments from leading global manufacturers are also utilized, ensuring bone preparation accuracy down to the millimeter.

After surgery, the patient remains in the hospital under medical supervision and immediately transitions to early mobilization and rehabilitation.

Postoperative Period Following Knee Replacement

After the surgery, an equally important stage begins for the patient—recovery. It is during this period that a proper gait is formed, pain diminishes, and confidence in movement gradually returns. At Mechnikov Hospital, we work according to the principles of rapid and safe rehabilitation so that the patient can return to an active life as early as possible.

When You Can Start Walking

We follow Fast Track Surgery protocols, which involve early mobilization. Already on the day following the surgery, the patient begins to sit up in bed and stand on their feet. The first steps are taken under the supervision of the attending physician or medical staff, usually within the ward. This approach reduces the risk of complications and promotes faster recovery.

Are Crutches or Walkers Needed

The use of mobility aids is a mandatory safety element during the postoperative period.

• Walkers are recommended in the first few days post-surgery, especially for older patients, as they provide maximum stability.
• Crutches are typically used for 4–6 weeks after discharge. They are needed not so much for support as for preventing falls and developing a correct gait without a limp.

When Discharge Occurs

The standard hospital stay after a knee replacement is about 14 days. The patient is discharged after the stitches are removed, provided their overall condition is stable and there are no complications in the postoperative period.

Restrictions in the First Weeks

During the first weeks following surgery, it is important to observe certain restrictions to avoid complications and ensure proper healing:

• avoid sudden movements and twisting of the knee joint;
• do not sit or stand motionless for long periods;
• strictly adhere to the antithrombotic regimen, including wearing elastic stockings and taking anticoagulants as prescribed.

Rehabilitation After Knee Replacement

Rehabilitation is an integral part of successful joint replacement. It not only restores knee movement but also helps form a correct gait, recover muscle strength, and regain confidence in daily movements. At Mechnikov Hospital, this stage takes place under the supervision of a specialized team.

Rehabilitation Department of Mechnikov Hospital

Our hospital has a robust physiotherapy and rehabilitation department that works closely with orthopedic traumatologists. This allows recovery to begin in the early stages and the rehabilitation program to be adjusted based on the patient's condition.

What Rehabilitation Methods Are Used

The foundation of recovery is physical therapy (PT). Exercises specifically help restore joint mobility, strengthen thigh and calf muscles, and prevent the formation of contractures. Sessions are conducted gradually under the supervision of an instructor, taking the recovery stage into account.

Physiotherapy is used to reduce pain and postoperative swelling. It improves blood circulation in the intervention area, accelerates tissue healing, and makes rehabilitation more comfortable for the patient.

In the first few weeks, mechanotherapy is actively employed, particularly CPM therapy. These are special devices for continuous passive motion of the knee joint: the leg is secured in a motorized splint that slowly and effortlessly bends and straightens the knee without exertion from the patient. This approach prevents the formation of adhesions and joint stiffness.

Duration of Rehabilitation

Recovery following a knee replacement occurs in stages. The early stage lasts approximately 4–6 weeks and is aimed at reducing pain, restoring basic movements, and developing a correct gait. A full return to daily household activities usually takes 2–3 months. Most patients can return to low- or moderate-intensity sports 3–6 months after the surgery.

When Return to Full Walking is Possible

Walking with the support of crutches or a walker starts on the second day after surgery and typically lasts 6–8 weeks. The transition to a cane occurs after roughly 1.5–2 months, with the cane held in the hand opposite the operated leg. Most patients begin walking without any aid after 2.5–3 months, while fully restoring a limp-free gait can take 6 to 12 months until the muscles are completely strengthened.

Physical Activity and Sports

Following a knee replacement, movement is recommended, but with reasonable limitations. After about 3 months, swimming, cycling (initially on a stationary bike),racewalking, and Nordic walking are permitted. These types of activities support the joint without overloading the implant.

At the same time, certain strains are permanently contraindicated. Running, jumping, contact sports, and alpine skiing create excessive impact loads and significantly increase the risk of rapid component wear or endoprosthesis loosening.

We support the patient at every stage of rehabilitation, explain what should and should not be done, and help them safely return to an active, fulfilling life.

Results of Knee Replacement

Mechnikov Hospital has one of the strongest histories of major joint replacement in Ukraine. It was at our facility in 1991 that the country's first specialized Center for Pathology and Arthroplasty of Large Joints was opened. Since then, we have been continuously developing this field, combining accumulated experience with modern surgical approaches.

Over 30 years of work signify not only the number of surgeries performed but also a deep understanding of disease progression, potential complications, and ways to prevent them. During this time, our specialists have evolved from the earliest endoprosthesis models to modern minimally invasive techniques, and have trained multiple generations of orthopedic traumatologists. Today, we rely on a vast clinical base and consistent treatment outcomes.

Lifespan of Endoprostheses

The modern knee endoprostheses used in our hospital are designed for an average of 10–15 years of active service. According to international registries, 90–95% of endoprostheses function successfully 10 years post-implantation. For many patients, especially those with a moderate physical activity level and normal body weight, the artificial joint lasts 15 years or more without requiring revision surgery.

The lifespan of the endoprosthesis depends not only on its quality but also on the patient's lifestyle, weight management, and adherence to loading recommendations.

Recovery and Quality of Life

Over 90–95% of patients post-surgery demonstrate a significant improvement in knee joint function. Our goal is to achieve the so-called "Forgotten Joint" effect, where 6–12 months after surgery, the person stops feeling limitations and no longer thinks about the presence of the implant.

Following recovery, patients return to daily life and can:

• work, including performing physical labor with reasonable limitations;
• drive a car;
• engage in favorite hobbies—gardening, fishing, traveling;
• maintain a fulfilling intimate life free from pain and stiffness.

Potential Complications and Their Prevention

Thanks to modern technologies and the extensive experience of the surgeons at Mechnikov Hospital, serious complications after joint replacement are rare. We pay special attention to their prevention at all stages of treatment.

To prevent infectious complications, strict sterility is maintained in the operating room, intervention time is optimized, and standard antibiotic prophylaxis is administered. Thrombosis prevention includes the use of modern anticoagulants, compression hosiery, or pneumatic compression, and early mobilization of the patient from the very first day post-surgery.

The risk of instability or loosening of the endoprosthesis is minimized through proper implant selection and surgical technique, as well as weight control in the postoperative period. To prevent joint rigidity, an early start of physical therapy and adequate pain relief are essential.

Breakage of the implant itself is extremely rare—occurring in less than 0.01% of cases, as modern titanium and cobalt-chromium alloys possess exceptionally high strength. Prosthesis rejection is also an isolated occurrence, since the materials from which endoprostheses are made are bioinert and highly compatible with body tissues.

What We Consider a "Successful Outcome"

For us, a successful knee replacement is not just a properly performed surgery, but real changes in the patient's daily life.

• Reduction or complete disappearance of pain. The patient no longer requires constant intake of painkillers and can move freely without fear of every step.
• Restoration of mobility. Knee range of motion returns, enabling the ability to walk unassisted, stand up independently, move around, and practice self-care.
• Improvement in quality of life. The individual returns to active social life, work, household chores, and leisure activities that were previously inaccessible due to pain and limitations.

It is precisely this result that we consider the primary goal of our work and the guiding principle in the treatment of every patient!