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Key Takeaways
- During a total knee replacement, the damaged menisci are usually removed along with the worn joint cartilage.
- A durable plastic insert between the metal components provides a smooth, low-friction, load-bearing surface in the artificial knee.
- You can support the long-term function of your knee replacement through physiotherapy, low-impact activity, fall prevention, weight management and regular follow-up.
Have you been told that you may need a total knee replacement and wondered what happens to the meniscus in your knee? If the meniscus acts as the knee’s natural shock absorber, is it left in place, repaired or removed during surgery? And if it is removed, what supports your new joint when you walk, climb stairs and return to daily activities?
Knowing how the procedure changes the structures inside your knee can help you prepare for discussions with your orthopaedic specialist. This article explains what happens to the meniscus during total knee replacement, why it is usually removed and how the knee implant supports smooth, stable movement afterwards.
What is the meniscus and what does it do in your knee?
The meniscus is a pair of C-shaped wedges of cartilage that sit between your thigh bone (femur) and shin bone (tibia). You have a medial meniscus on the inner side of the knee and a lateral meniscus on the outer side.
In a healthy knee, the menisci help to:
- Absorb shock during walking, running and jumping
- Spread weight more evenly across the knee joint
- Reduce pressure on the joint surfaces
- Improve joint stability and congruency
- Support smooth movement between the femur and tibia
The meniscus works alongside the articular cartilage, ligaments, muscles and synovial fluid to help your knee move comfortably. However, a meniscus can tear after a twisting injury or gradually degenerate as osteoarthritis progresses.
What happens to the meniscus during total knee replacement surgery?
During a standard total knee replacement, your surgeon removes the menisci, damaged cartilage and a small amount of bone to prepare the joint for the implant. This is necessary because total knee arthroplasty replaces the worn joint surfaces rather than repairing individual structures within a severely arthritic knee.orthoinfo.
A total knee replacement is sometimes better described as a knee-resurfacing operation. Your surgeon removes damaged cartilage and a small amount of bone from the end of the femur and top of the tibia. Metal components are then fitted over these prepared bone surfaces.
A medical-grade plastic insert, usually made from highly durable polyethylene, is placed between the metal components. This plastic spacer creates a smooth, low-friction surface for the new joint to move on.
In simple terms
Your natural meniscus is removed, but its cushioning role is addressed by the new knee implant system, particularly the plastic tibial insert between the metal surfaces.
The operation does not involve transplanting a new meniscus. Meniscal transplant surgery and total knee replacement are very different procedures. A meniscal transplant may be considered for selected people with a missing or severely damaged meniscus but relatively preserved knee joint surfaces; it is not generally part of a total knee replacement.
Why is the meniscus removed in total knee replacement?
By the time you need total knee replacement, the meniscus may be worn, torn or affected by advanced osteoarthritis. The surgeon removes it to prepare the joint surfaces, create space for the implant and balance the surrounding soft tissues.
The metal components and plastic insert are designed to work together as a new joint surface. Leaving the original meniscus in place could interfere with implant positioning and movement.
Knee replacement is generally considered for severe arthritis that causes ongoing pain, stiffness or difficulty with daily activities despite suitable non-surgical treatment. It is not usually the first treatment for an isolated meniscus tear.
A surgeon examines the knee during total knee replacement to assess the joint and remove damaged tissue, including the meniscus.
Does the plastic insert replace the meniscus after knee replacement?
The plastic insert does not biologically replace your meniscus, but it performs several of its mechanical functions. It sits between the metal femoral and tibial components to provide a smooth gliding surface and distribute forces through the artificial knee.orthoinfo.
However, it is not identical to a natural meniscus. Your original meniscus is living tissue with sensory, stabilising and load-distributing roles. The artificial knee is an engineered system designed primarily to reduce pain and restore practical movement when the natural joint is badly damaged.
After surgery, your knee may therefore feel different from your original knee. You may notice:
- Clicking or clunking sensations when bending the knee
- Numbness around the scar
- Mild stiffness, particularly with deep bending
- Discomfort when kneeling
- A different sensation during stairs, squatting or prolonged walking
These experiences can be normal, but new, worsening or persistent symptoms should be discussed with your orthopaedic surgeon.
Can the meniscus be preserved in a partial knee replacement?
A partial knee replacement treats arthritis affecting only one compartment of your knee. The knee has three main compartments:
- The medial compartment on the inner side
- The lateral compartment on the outer side
- The patellofemoral compartment between the kneecap and thigh bone
During a standard partial knee replacement, the damaged cartilage, a small amount of bone and the meniscus in the treated compartment are usually removed. Meniscal tissue in the unaffected compartment may remain if it is healthy.
Partial knee replacement is suitable only for selected people. Your surgeon will assess the location and extent of arthritis, knee alignment, ligament stability, range of motion and the health of the remaining joint surfaces.
Will you have problems living without a meniscus after TKR?
The effects of meniscus removal differ after total knee replacement from after a meniscectomy in a natural knee.
In a natural knee, losing meniscal tissue can increase pressure on the cartilage that remains. During total knee replacement, the damaged cartilage and menisci have already been removed and replaced with artificial joint surfaces. Your outcome is therefore more influenced by factors such as implant positioning, muscle strength, rehabilitation, activity level and overall health.
Most people have meaningful pain relief and improved daily function after knee replacement. However, an artificial knee does not fully reproduce the movement or sensation of a healthy natural knee.
What should you expect after total knee replacement surgery?
After total knee replacement, you will begin recovery under the guidance of your surgical and rehabilitation team. Early movement, safe pain control and physiotherapy are central to regaining function.
In the first days and weeks, it is common to experience swelling, bruising, stiffness and pain around the operated knee. You may use a walker, crutches or a cane temporarily while you build strength and confidence.
Your recovery plan may include:
- Prescribed pain-relief medicines
- Blood-clot prevention measures, such as medication or compression devices
- Ankle pumps and early walking to improve circulation
- Range-of-motion exercises
- Quadriceps and leg-strengthening exercises
- Wound-care instructions
- Gradually increasing your walking distance and daily activity
Many people gradually resume more daily activities over the following weeks, but the pace of recovery varies considerably. Regaining strength, balance and confidence can take months. Your recovery should be based on your surgeon’s advice, your physiotherapist’s plan and your individual progress—not a fixed timetable.
How can you protect your new knee replacement?
You can help protect your knee replacement by following your rehabilitation plan, staying active safely and avoiding activities that place excessive stress on the joint.
- Do your physiotherapy exercises to build strength, improve movement and support the new joint.
- Choose low-impact activities such as walking, swimming or cycling rather than running, jumping or contact sports.
- Maintain a healthy weight for you to reduce pressure on the knee implant.
- Use a walking aid for as long as your surgeon or physiotherapist recommends, and avoid twisting or pivoting on the operated leg in early recovery.
- Prevent falls by removing loose rugs and clutter, wearing non-slip footwear and using handrails where needed.
- Keep your surgical wound clean and contact your care team promptly if you develop increasing redness, swelling, discharge, fever or worsening pain.
- Attend follow-up appointments so your orthopaedic surgeon can monitor your recovery and the condition of the implant.
Frequently asked questions
In standard total knee replacement surgery, the menisci are generally removed to make space for the artificial components and enable correct joint balancing. The specific surgical approach can vary, so ask your surgeon to explain the plan for your knee.
You should not feel the meniscus being removed during surgery because knee replacement is performed under anaesthesia. Pain after surgery relates to the overall surgical procedure and healing process, and your medical team will provide a pain-management plan.
Yes. Many meniscus tears do not require total knee replacement. Treatment may include activity modification, physiotherapy, pain-relief measures, injections in selected cases, meniscus repair or partial meniscectomy, depending on the tear and the condition of the rest of your knee. Total knee replacement is generally reserved for severe joint damage or arthritis with significant symptoms.
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Disclaimer
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition. For decisions about your health or treatment, speak with a qualified doctor who knows your situation. An…
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