Tokuda Hospital Sofia


Knee Replacement

Joint Prosthesis

Our orthopedics and traumatology department performs joint replacement surgery in accord with the latest globally recognized medical standards.

Our surgeons are very experienced especially in endoprothesis of the major joints such as the hip, knee, elbow, shoulders, as well as for smaller joint structures located in the hands and wrists.   

Our patients in need of joint/hip replacement, knee, ankle, or shoulder surgeries can expect a dramatically reduced post-operation recovery time due to the minimally invasive surgical procedures we provide. Additionally, we offer the latest generation high-quality medical implants. 

Our orthopedic specialists offer computer based surgical navigation during joint replacement procedures.

Our computer navigation system uses infra-red cameras, tracking devices and 3-D imaging systems. The system provides very precise images and measurements of the patient’s skeletal structures with very sensitive sensors, which allows our medical team to implant artificial joints with maximum precision.

 “Navigation is a key benefit for the patient, because with the systems capabilities the implanted artificial joints have a longer effective life”, commented department chief Dr. Yablanski. He added that the system enables our surgeons’ precision to be maximized during endoprosthesis procedures.

Our computer navigation systems have numerous patient benefits including: smaller surgical incisions, dramatically reduced patient recovery time, and less operative trauma, which reduces the risk of post procedural embolisms and reduces post procedural complications.

You can email your inquiries to our orthopedic medical team directly at the following address:

What is a knee endoprothesis?

A knee endoprothesis or implant consists of several components made of metal and polyethylene which are designed to replace the damaged ends of the bones making up the knee joint to allow free and painless movement.

Types of knee joint implants:

1.Total knee joint replacement implants are those which replace all the knee joint surfaces as shown in the x-ray images below:










2.Partial knee joint implants are those which replace only a damaged portion of the knee joint as shown below:



For approximately 95% of knee joint implants the components are fixated with surgical cement. For the remainder of procedures, cement-less fixation is performed using components with a specialized porous surface to allow bone to grow on them to secure the implant.

Reasons to recommend a knee implant procedure

The reasons behind undergoing a knee implant are most commonly related to osteoarthrosis  defined as wear of the bone cartilage, which leads to pain, joint deformation, and limitation on the joint’s movement.

Additionally wear of the knee joint leading to the need of knee joint replacement can also be caused by specific arthrosises including rheumatoid (autoimmune), gout related, and/or due to traumas or infections of the joint.

When and why should I undergo a knee replacement procedure?

Reasons for a person to decide to undergo this surgical procedure are:

  • Knee pain during periods of activity and persistent pain during periods of rest especially at night time
  • Lack of results for knee pain relief using medication therapies and/or injection therapies  
  • Loss of knee joint mobility, joint stamina, and/or a changed way of walking to shift the body weight on to other joints  
  • Knee joint mobility limitations which affect performing normal everyday activities
  • Decreasing ability to participate in normal life habits, meeting with friends, playing sports, walking, shopping, etc…

The health status of your knee joint can be fully examined with an x-ray and the exam results and your treatment options can be fully discussed with your treating physician.

Procedure planning, preparation, in-patient admittance, and hospital stay

How is the planning, preparation, in-patient admittance, and hospital stay organized for patients whom need knee implants?  

The decision to undergo a knee joint implant procedure is made by the patient after discussing the treatment options with an orthopedic specialist. This procedure is a planned operation therefore the admission date and surgery is scheduled in advance. A series of clinical tests and specialist examinations are prescribed before the procedure. Typically specialist examinations are related to concurrent diseases and sometimes require additional tests or preparation before the knee joint procedure. Especially important are any indications of infections such as tooth infections and/or kidney infections which can cause complications if not treated before having this procedure done.

Hospital in-patient admission

We advise our patients to come to our hopsital on the day of their planned admission with the required test results. Upon admittance into our in-patient ward, we conduct additional tests per our orthopedic standard operating procedures including specialized x-ray tests, which are mandatory to plan the surgical procedure. 


The surgical operation is typically carried on the day following admission. During the early post-procedural period a preplanned schedule of pain relief medications are administered. The drainage tubes are removed from the operated joint and physical therapy rehabilitation begins approximately 24 hours after the operation.

Hospital stay

The hospital stay is typically around 7 days. During this period the operative wound healing is monitored and physical therapy of the operated joint is performed and managed by a physical therapist. The entire recovery process is supervised by the treating medical team. 

What to expect during the surgery?

This type of operation is classified as a major surgical intervention, which is routinely performed in our hospital. The intervention process has been described below as follows:


The types of anesthesia recommended for this type of surgery is localized (only for the lower limbs) or general anesthesia. The decision as which specific type of anesthesia used depends on the overall patient condition and is fully discussed during a patient consultation with the treating anesthesiologist. 


On average the knee replacement/implant surgery lasts for approximately 1.5 hours. Often the surgery results in a small amount of blood loss, and in a small portion of patients blood transfusions are needed post-operatively. We offer universal and affordable systems to save the patient’s own blood before the procedure to be administered if needed after the procedure.

Modern medical equipment

We have the equipment capability to offer this type of surgery under computer control termed computer navigation with our specialized software, equipment and instruments to maximize precision and improve clinical outcomes.

Postoperative period

Post-procedural rehabilitation

During the hospital stay in the orthopedic in-patient ward our patients are given a physical therapy rehabilitation program for the operated joint managed by a rehabilitation specialist. During this early recovery period, we administer pain relief medications and cold compresses during the rehab exercises to maximize comfort. We also use specialized rehab equipment to precisely exercise and move the knee joint.  

Rehabilitation is a critical recovery element to ensure knee joint mobility, restore knee extension and flexion function, and to help the muscles of the operated limb to recover from the operation.

Rehabilitation after hospital discharge

Rehabilitation therapy should continue after discharge from our orthopedic department. We offer specialized out-patient rehab services in our Physical Therapy and Rehabilitation department to support the recovery process post knee replacement/implant surgeries. The healing journey to being able to fully load and normally use the operated knee joint occurs gradually. Typically, approximately 60 days post-procedurally one can expect to walk normally without walking aids.

Note: After the procedure one may feel a warming sensation in their operated knee joint when moving it. This normal symptom typically lasts for approximately 6 months after the procedure and isn’t a cause for concern. 

What are the procedure's possible risks and complications?

Venous thrombosis

To prevent venous thrombosis (blood clots), we provide a proven medication therapy program based on orthopedic good medical practices and standards which lasts for approximately 45 days post operatively. The specific medication dosage and route of administration is determined by the treating medical team based on the patient profile. 


To prevent infections in the operative area, antibiotics courses are administered before and after the knee joint procedure.

To reduce the risk of infections occurring around or in the implanted knee joint, we do the following: 

  1. Prepare the patient to screen for and resolve any indications of infections  
  2. To prevent any conditions conducive to developing future infections. The patient is instructed to inform their doctor about their knee implant, before undergoing future treatments to avoid infections

Complications related to infections of the operated joint are serious and require immediate consultation with an orthopedist. Sometimes treating an infection of an infected knee joint implant requires a new surgical intervention and a prolonged course of antibiotic treatment.

Knee joint loosening

Knee joint loosening is when there is independent movement between the knee implants and the bone structures. This condition can lead to pain and swelling in the operated knee. Loosening can be caused by a variety of factors including: not following the instructions to not fully load the operated joint, excess body weight (over 20% of the norm), a change in the health of the bone tissue due to developing new diseases or taking certain medications.

Treatments for knee joint loosening typically require a repeat surgical procedure and implantation of new specialized implants: see below. The key to effective treatment is by following a strict schedule of check-up exams to detect knee joint loosening as early as possible. By discovering the condition in its earliest stages, bone tissue damage can be avoided and repeat treatments are most effective.  

Specialized knee implant for corrective secondary procedure










Life with a knee implant

The majority of patients whom have undergone the knee replacement implant surgery are typically over the age of 65. However, patients of a much younger age also have medical indications to undergo the surgery.   

The useful life of a knee joint implant is typically around 20 years. According to published reports: approximately 90% of patients have good to excellent results from the prosthesis procedure, knee joint patient is reduced in 80-95% percent of cases, and patients report significant improvements in the range of knee joint motion after the procedure.  

After the procedure, patients can enjoy the ability to perform normal everyday activities and play a number of sports including swimming, bike riding, and golf.

General post knee implant procedure recommendations:

1. Maintain a normal body weight

2. Avoid extreme stress and loading of the artificial knee joint

3. Always inform your dentist and treating physician that you have an implant to take precautions to avoid any knee implant infections.

4. Avoid sports that are dangerous for the operated knee joint such as skiing, contact sports, jumping, etc…

5. Follow your check-up exam and rehab schedules


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Hospital location

51B "Nikola I. Vaptsarov" blvd. (if you drive, the entrance is from "At. Dukov" str.), "Hladilnika" distr., 1407 "Lozenets".

The hospital has a parking lot. The first 30 min. are free of charge, then a fee of 3 bgn/hours applies.

Public transport:
Buses: №88, 120
Shuttle bus: 32

Subway: Getting off at "James Bourchier" station, after that walking through "Lozenets" distr., or tram №10, taking off at "Nikola I. Vaptsarov" stop. or a bus №88, taking ff at "Tokuda Hospital" stop.


From the Central Railway Station

Bus line №305 getting off at "Romanian embassy" stop
From "Romanian embassy" stop – Bus line №120 getting off at "Tokuda Hospital" stop.
(after the traffic lights at "Atanas Dukov" str.

With a subway, from "Central Railway Station" station, getting off at "James Bourchier" station, after that walking through "Lozenets" distr., or tram №10, taking off at "Nikola I. Vaptsarov" stop. or a bus №88, taking ff at "Tokuda Hospital" stop.