During this procedure, the orthopaedic surgeon builds an artificial knee in the patient. 

1. The surgeon makes an incision on the front of the knee to gain access to the patella. The incision is usually about 8 to 10 inches long.

2. The patella is the first part of your knee that is exposed. The surgeon rotates the patella outside of the knee area in order to gain access to the rest of the knee. 

3. The first bone that the surgeon will resurface is the femur. The surgeon will carefully measure and make percise cuts using special intruments. The damaged bone and cartilage is cut away. The end of your femur is cut and resurfaced to fit the first part of the artificial knee, the femoral component.

4. The surgeon attaches the metal femoral component to the end of your femur and uses bone cement to seal it into place.

5. The surgeon will now resurface the tibia. The surgeon removes damaged bone and cartilage from the top of the tibia and then shapes the bone to fit the metal and plastic tibial components.

6. The bottom portion of the implant, called the tibial tray, is fitted to the tibia and secured into place using bone cement. Once the tray is in place, the surgeon will snap in a polyethylene (medical-grade plastic) insert to sit between the tibial tray and the femoral component, and act as a kind of buffer. This insert will provide support for your body as you bend and flex your knee. 

7. Before returning the patella to its normal position, the surgeon might need to flatten the patella and fit it with an additional plastic component in order to ensure a proper fit with the rest of your implant. The plastic piece, if needed, is cemented to underlying bone.

8. The surgeon will bend and flex the knee to ensure that the implant is working correctly, and that alignment, sizing, and positioning is suitable. To complete the procedure, the surgeon will close the incision with stitches or staples, and then bandage it and prep you for recovery.