The knee is a joint composed of the femur (thigh bone), the tibia (leg bone) and the patella. The femur is held in place on the tibia by ligaments and muscles. In order for the femur and tibia to slide together smoothly, they are covered with a very smooth layer of tissue: cartilage. Menisci (soft and mobile cartilage) interpose to adapt the surfaces of the femur to those of the tibia.


Osteoarthritis of the knee is the loss of articular cartilage. Osteoarthritis is sometimes the consequence of an accident but it is most often associated with the aging of the cartilage. It is not currently possible to regenerate cartilage. When osteoarthritis makes the knee too painful and surgery becomes necessary, the surfaces of the joint are replaced by a prosthesis made of metal and polyethylene (high density plastic) implants.

Normal knee

Knee with severe wear

The Duval Clinic surgeons specialize in knee joint replacement. Below you will find many answers to your questions and how we can give you back your quality of life. You certainly have many questions on the subject, consult the following tabs where we offer you brief answers. Our surgeons will be happy to elaborate more in detail with you during a consultation.

When the protective joint surfaces layers (cartilage) are damaged, they are rough and do not slide well together. The result is pain, stiffness and inflammation. This is called joint degeneration or osteoarthritis.

Causes :
Most people with this condition complain of knee, calf or thigh pain and may even experience back pain.

Presence of pain

  • at rest; increases with walking; inconvenient to sleep;
  • in the groin, buttock, thigh, knee or back;
  • can be accompanied by stiffness and lameness.

Limitation of movements

  • difficulty squatting, going up and down stairs, putting on socks.

Knee joint degeneration is a progressive disease that can take several months or years to significantly limit your activities and quality of life. In the early stages of the disease, the vast majority of people with degenerative joint disease can improve their condition by taking anti-inflammatory medication and using a cane, by losing weight when necessary and by limiting certain activities. When the condition has not improved satisfactorily with non-surgical treatments and :

  • You are having difficulty or can no longer work;
  • Your quality of life is diminished;
  • You have frequent pain;

A knee joint replacement is a solution to consider. Knee joint replacement aims to improve your quality of life, relieve your pain and allow you to return to an active life.

There is no minimum age to benefit from a knee joint replacement. Your degree of pain and disability is the best indicator. In general, knee replacements are performed on people 65 years of age or older for whom conservative treatments are no longer effective. However, if you are younger and severely affected by wear and tear on your knee, improvements in prosthesis materials and surgical techniques allow most patients to have a good quality of life and to keep their prosthesis for the rest of their lives (see this article on the subject in the prestigious Lancet journal). We will be happy to evaluate your condition and advise you on the best treatment options for your.

There is no maximum weight, but all the general complications associated with knee replacement surgery are increased: wound healing problems, infection, reoperation, etc. This is why it is best to lose weight before surgery. However, the surgeons at the Clinic regularly perform joint replacements on overweight patients. We use prostheses with cementless fixation, which have been shown to be more durable in obese patients (see our results with cementless prostheses).

There is no age limit for knee replacement surgery. However, your overall health must be good enough for the surgery to proceed without major medical problems, and your expected function after surgery must be good enough to enjoy a significant improvement in your quality of life. Patients over the age of 80 can have surgery at the clinic.

Two types of surgery are possible:

Total knee prosthesis (figures 1): consists of replacing the articular surfaces of the knee, both internal and external. In addition, the surface of the patella is replaced according to its degree of wear.

The unicompartmental knee prosthesis consists of replacing only the worn cartilage surfaces of a single portion of the knee: either medial or lateral (Figures 2).

Figures 1

Figures 2

Yes, robotic assisted knee replacement surgery is now available in Canada. We are proud to announce that on Monday, February 1, 2021, we successfully performed our first two total knee replacements with a surgical robot. In fact, Clinique Duval has acquired the ROSA surgical robot from Zimmer. The addition of the ROSA robot to our palette of technological tools is another key to ensuring that each of our patients receives impeccable care. The ROSA Knee System is a tool that accompanies the surgeon during a knee replacement operation and allows him to perform the surgery with superior precision (click this link to see it in action). Dr. Massé, a specialist practicing at the Duval Clinic, has extensive expertise in robotics. He reminds his patients that “the robotic tool is not there to replace the surgeon, who remains in control of the operation, but rather to transmit information that will allow him to make better decisions and perform gestures with greater precision.» While robotic instruments are an important development in technology and medicine, Dr. Massé says, “the experience and dexterity of the clinic’s surgeons remain the most important elements in a procedure.»

Clinique Duval has always made sure to offer the latest technological tools to ensure an optimal level of care and precision. “The various studies on this subject currently show a simpler and faster recovery with less postoperative pain,” says Dr. Massé. “Satisfaction levels appear to be higher in patients who have undergone surgery with a robotic device.»

Dr. Kiss using the ROSA robot during a total knee replacement.

Knee arthroplasty is a highly effective procedure, despite the fact that it is affected by significant rates of residual symptoms and complications. Unsatisfactory clinical outcomes are primarily due to the neglect of each individual’s unique joint anatomy and kinematics. Systematic joint replacement techniques were originally designed to simplify implantation and make it more reliable in the hands of the surgeon. However, the precision and accuracy of implantation has improved dramatically with the use of technological tools (e.g., computer-assisted or robotic surgery). This has allowed the development of a more personalized philosophy of arthroplasty.

The Clinic’s surgeons are international leaders in the application of the personalized anatomical/kinematic alignment technique. This technique aims to reproduce the patient’s native anatomy and physiological joint laxity, thus improving knee prosthesis kinematics and functional results (see this text on the subject). One of our surgeons, Dr. Pascal-André Vendittoli, is the president and founder of the Personalized Arthroplasty Society:

Knee joint replacement is a very effective surgery with a high satisfaction rate for patients with joint degeneration. The majority of patients who undergo surgery experience a significant reduction in pain and are able to resume many of the activities they have neglected since the beginning of their disease. However, it should be noted that the full benefit of the surgery is often not achieved until 6 to 12 months after the operation, although after 2 to 3 months, the level of activity can already be greatly increased.

It is important to know that the operated knee rarely feels like a natural knee. The contact of the surfaces of the prosthesis can make noise. The range of motion of your knee will be reduced compared to a healthy knee. Some permanent restrictions are associated with knee joint replacement: difficulty squatting and kneeling. In addition, it would be best to avoid heavy work requiring lifting of more than 25 kg or climbing ladders and scaffolding. Sports with jumps or sudden stops should be resumed after surgery.

  • 1-2 weeks after your surgery you can start using a stationary bike.
  • 3 to 4 weeks after surgery, you can return to the pool for some water walking or gentle swimming. It is important that the wound is well sealed;
  • During the first 3 months, you should avoid regular and intense sports;
  • From 3 to 5 months after your surgery (depending on your condition), you can do social dancing, skating, skiing, hiking, bowling, golfing.
  • It is generally not recommended to practice activities with repeated impacts and pivots such as: jumping, jogging, volleyball, soccer, basketball, mogul skiing, aerobic dance, contact field hockey, snowshoeing, running, yoga, karate, etc. Talk to your surgeon at the Clinic for recommendations specific to your condition.

The Duval Clinic has 14 individual hospitalization rooms if your condition requires a short stay. The length of stay varies from one patient to another between 1 and 3 days. However, the advancement of operative techniques, optimization of postoperative pain control, better organization of home care, as well as effective multidisciplinary collaboration have made it possible to offer you the possibilitý to spend less than 24 hours in the clinic after your surgery and have an organized and safe discharge. Your surgeon and attending team will inform you if you are eligible for this accelerated recovery protocol (day surgery).

Personalized total knee replacement with computer navigation (surgeon P-A Vendittoli)