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Revision Knee Replacement

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Home > Orthopedic Surgery > Knee Replacement > Revision Knee Replacement

OVERVIEW

Revision knee replacement


Introduction
Why does a knee replacement needs to be revised?
Pre-operation
Day of your surgery
Surgical procedure
Post-operation course
Risks and complications
Summary

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Introduction

Revision Knee Replacement means that part or all of your previous knee replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone. The typical knee replacement, replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).
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Why does a Knee need to be revised ?

Pain is the primary reason for revision. Usually the cause is clear but not always. Those knees without an obvious cause for pain in general do not do as well after surgery.

Plastic (polyethylene) wear. This is one of the easier revisions where only the plastic insert is changed

Instability which means the knee is not stable and may be giving way or not feel safe when you walk

Loosening of either the femoral, tibial or patella component. This usually presents as pain but may be asymptomatic. It is for this reason why you must have your joint followed up for life as there can be changes on X-ray that indicate that the knee should be revised despite having no symptoms.

Infection- usually presents as pain but may present as swelling or an acute fever.

Osteolysis (bone loss). This can occur due to particles being released into the knee joint which result in bone being destroyed

Stiffness- this is difficult to improve with revision but can help in the right indications
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Pre-operation

  • Your surgeon will send you for routine blood tests and any other.
  • investigations required prior to your surgery.
  • You will asked to undertake a general medical check-up with a physician.
  • You should have any other medical, surgical or dental problems attended to prior to your surgery.
  • Make arrangements around the house prior to surgery.
  • Cease aspirin or anti-inflammatory medications 10 days prior to surgery.
  • as they can cause bleeding.
  • Cease any naturopathic or herbal medications 10 days before surgery.
  • Stop smoking as long as possible prior to surgery.
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Day of your surgery

  • You will be admitted to hospital usually on the day of your surgery or a day prior.
  • Further tests may be required on admission.
  • You will meet the nurses and answer some questions for the hospital records.
  • You will meet your anaesthetist, who will ask you a few questions.
  • You will be given hospital clothes to change into and have a shower prior to surgery.
  • The operation site will be shaved and cleaned.
  • Approximately 30 mins prior to surgery, you will be transferred to the operating theatre.
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Surgical procedure

Each knee is individual and knee replacements take this into account by having different sizes for you knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.

Surgery is performed under sterile conditions in the operating theatre under spinal or general anaesthesia. You will be on you back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes about two hours .

The Patient is positioned on the operating table and the leg prepped and draped.

A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilising solution.

An incision around 7cm is made to expose the knee joint.

The bone ends of the femur and tibia are prepared using a saw or a burr.

Trial components are then inserted to make sure they fit properly.

The real components (Femoral & Tibial) are then put into place with or without cement.

The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.

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Post-operation coursee

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain called Patient Controlled Analgesia (PCA).

Once stable, you will be taken to the ward. The post-op protocol is surgeon dependant, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post of day to make movement easier. Your rehabilitation and mobilization will be supervised by a physiotherapist.

To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.

Your orthopaedic surgeon will use one or more measures to minimize blood clots in you legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section.

A lot of the long term results of knee replacements depend on how much work you put into it following your operation.

Usually you will be in hospital for 3-5 days and then either go home or to a rehabilitation facility depending on your needs. You will need physiotherapy on your knee following surgery.

You will be discharged on a walking aid either on frame or crutches and usually progress to a walking stick at six weeks.

Your sutures are sometimes dissolvable but if not are removed at approx 10 days.

Bending you knee is variable, but by 6 weeks should be to 90 degrees. The aim is to get 110-115 degrees of movement.

Once the wound is healed, you can take a shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks.

More physical activities, such as sports previously discussed may take 3 months to be able to do comfortably.

When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements especially if they are up a lot of stairs.

You will usually have a 6 weeks check up with your GP who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray.

You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee.

If you ever have any unexplained pain, swelling, redness or if you feel unwell you should see your doctor as soon as possible.


This 82 year lady required a tibial tubercle osteotomy to gain access to the knee and proceed with the revision total knee replacement.


Knee Replacement Surgeon, Knee Pain, Total Knee Replacement


This 82 year lady required a tibial tubercle osteotomy to gain access to the knee and proceed with the revision total knee replacement.






What happens if my knee replacement gets infected ?

Fortunately infection of a total knee replacement is quite rare. The infection rate for primary total knee replacement is less than 2%. Infection of a knee prosthesis is a serious issue. Very occasionally the infection can be treated with wound debridement (removal of non viable tissue around the knee joint) and antibiotics.

In the majority of cases however the presence of the total knee replacement prevents the elimination of the bacteria causing the infection and removal of the implant is required in order to have a chance of curing the infection.

After the components have been removed a antibiotic loaded articulating spacer can be used so that the patient has reasonable knee function whilst the infection is being treated with antibiotics.

Sometimes more than one debridement may be required to eliminate the infection.

When there is good evidence (blood tests and aspiration of the knee joint testing for bacteria) that the infection has been removed an attempt can be made at re-introducing a new revision total knee replacement. In the majority of cases the time to re-implantation is about 3 months but this time varies from patient to patient.

This 71 year old gentleman had an infected total knee replacement. He was treated with a two stage revision. Antibiotic loaded spacers where used after the knee replacement was removed. 3 months later after the infection had settled a new revision total knee replacement was performed.


Knee Replacement Surgeon, Knee Pain, Total Knee Replacement Surgery Risks


This 71 year old gentleman had an infected total knee replacement. He was treated with a two stage revision. Antibiotic loaded spacers where used after the knee replacement was removed. 3 months later after the infection had settled a new revision total knee replacement was performed.


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Risks and complications

- As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

- It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or local complications specific to the Knee.

Medical complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include

  • Allergic reactions to medications.
  • Blood loss requiring transfusion with its low risk of disease transmission.
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections.
  • Complications from nerve blocks such as infection or nerve damage.
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death.



Local complications

Infection : - Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%, if it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Blood clots (Deep Venous Thrombosis) : - These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.

Fractures or breaks in the bone : - can occur during surgery or afterwards if you fall. To fix these, you may require surgery.

Stiffness in the knee : - Ideally your knee should bend beyond 100 degrees but on occasion the knee may not bend as well as expected. Sometimes manipulations are required, this means going to theatre and under anaesthetic the knee is bent for you.

Wear : - the plastic liner eventually wears out over time, usually 10 to 15 years and may need to be changed.

Wound irritation or breakdown : - The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this.

Occasionally, you can get reactions to the sutures or a wound breakdown which may require antibiotics or rarely further surgery.

Cosmetic Appearance : - The knee may look different than it was because it is put into the correct alignment to allow proper function.

Leg length inequality : - This is also due to the fact that a corrected knee is more straight and is unavoidable.

Dislocation : - An extremely rare condition where the ends of the knee joint loose contact with each other or the plastic insert can lose contact with the tibia (shinbone) or the femur (thigh bone).

Patella problems : - Patella (knee cap) can dislocate that is, it moves out of place and it can break or loosen.

Ligament injuries : - There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem.

Damage to nerves and Blood vessels : - Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

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Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of there prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.


Revision Knee Replacement FAQ

What is a Revision Knee Replacement procedure?

A Revision Knee Replacement (also known as a Revision Knee Arthroplasty) is a complex and major procedure, which is performed when an original prosthetic knee joint begins to fail.


Why is a Revision Knee Replacement procedure performed?

A Revision Knee Replacement is performed when primary knee replacement prosthesis has become problematic. Although modern day knee prosthetics are typically very hard and long wearing they can occasionally require replacement after becoming worn, loosened, dislocated or infected.


How is Revision Knee Replacement surgery carried out?

A Revision Knee Replacement can be performed under General Anaesthetic (you will be asleep) or Spinal/Epidural Anaesthetic (you will be awake, but sedated). The procedure usually takes around two hours to complete and is performed with a patient positioned on their back on the operating table throughout the procedure.

An incision is then made along the original knee joint surface, although it is common for this incision to be lengthened slightly beyond its original scar. The damaged or failing prosthesis is then carefully removed with every effort made to avoid any additional trauma to the existing bone and original joint surface.

Revision knee surgery is a technically challenging procedure and should only be carried out by an expert knee surgeon, as this procedure often requires additional bone grafting material to help repair the knee surface and secure the new replacement prosthesis.

Following the insertion of the new replacement prosthesis the wound is usually closed with absorbable stitches and a surgical drain is inserted to minimise the risk of any developing blood clots.


What is the recovery after Revision Knee Replacement surgery like?

Once a patient is fully recovered from the effects of anaesthetic they are normally encouraged to be as gently active and mobile as possible to avoid complications such as Deep Vein Thrombosis (DVT) from developing. It is therefore normal for patients to be encouraged to take a few steps with the support of a walking frame and guidance from a physiotherapist 24 hours after surgery.

Following a progressive improvement of mobility and pain control patients are normally discharged home 7-10 days following their surgery. By the time the required level of recovery is achieved for discharge, patients are normally free of drains, wearing a simple wound dressing, eating and drinking normally, walking with just the aid of a stick and taking only mild analgesia (pain killers).

Over the next 6 weeks patients will be expected to work on improving their own mobility and range of joint movement through dedicated and progressive physiotherapy and by increasing their daily activity and walking distances.

Your Consultant Surgeon will then assess your joints range of movement after 6 weeks and then again after three months to evaluate how successful your Revision Knee Replacement operation has been. Patients who are in employment should not resume work until after their first consultation and dependant on the physical nature of their job may be advised to take longer off work.

Patients should expect a continuous and full physical recovery to take up to one year to achieve.


Are there any risks associated with Revision Knee Replacement surgery?

Although Revision Knee Replacement surgery is regularly performed without any complications, it is very important that all candidates are fully aware of both the benefits and risks of undertaking this type of specialist surgery.

All surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation with an expert in Knee Revision surgery to discuss your condition in relation to these risks cannot be over emphasised.


do I find out if I am a suitable candidate for Revision Knee Replacement surgery?

Surgical Advisor will be delighted to help you find a leading expert in knee surgery to consult with. Your surgeon will carry out a thorough evaluation of your condition and provide you with a comprehensive explanation of the most appropriate surgical solution.

Our Expert Consultant Orthopaedic Surgeons are most carefully selected and recommended because they understand the importance of the decision you are making when contemplating Revision Knee Replacement surgery and because of their specialist lower limb surgery expertise. Throughout your consultation you will therefore be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any recommended treatment.

To ensure that all patients are comfortable with any recommendations or advice given in their consultation, all patients are asked to go away after a consultation and think through all the information they have received. If for whatever reason you are still not sure about the best course of action and wish to have further dialogue with your surgeon, you will not be expected to pay for a second consultation appointment.


How do I make a consultation appointment?

For further advice on how to make an appointment to consult with an expert revision knee surgeon:



The list of of Knee Joint Replacement Hospitals in India is as follows : -


Apollo Hospitals Bangalore Apollo Hospitals, Bangalore, India
Apollo Hospital Chennai Apollo Hospital, Chennai, India
Apollo Hospitals Hyderabad Apollo Hospitals, Hyderabad, India
Apollo Hospitals Delhi Indraprastha Apollo Hospital, Delhi, India
Apollo Hospitals Kolkata Apollo Gleneagles Hospital, Kolkata, India
Apollo Hospital, Goa, India Apollo Hospital, Goa, India
Wockhardt Hospital Bangalore India Wockhardt Hospital, Bangalore India
Wockhardt Hospital hyderabad, India Wockhardt Hospital, hyderabad, India
Wockhardt Hospital Mumbai, India Wockhardt Hospital, Mumbai, India
Fortis Hospital, Delhi, India Fortis Hospital, Delhi, India
Fortis Hospital Mohali, India Fortis Hospital, Mohali, India
Fortis Hospital Noida, India Fortis Hospital, Noida, India
Manipal Hospital, Bangalore, India Manipal Hospital, Bangalore, India
MIOT Hospital, Chennai, India MIOT Hospital, Chennai, India
Sparsh Hospital, Bangalore, India Sparsh Hospital, Bangalore, India
Artemis Hospital, Gurgaon ( Delhi ) , India Artemis Hospital, Gurgaon ( Delhi ) , India
Max Devki Devi Heart and Vascular  hospital,  Delhi, India Max Devki Devi Heart and Vascular hospital, Delhi, India
BGS Global Hospital Bangalore, India BGS Global Hospital, Bangalore, India
BGS Global Hospital Chennai, India BGS Global Hospital, Chennai, India
BGS Global Hospital Hyderabad, India BGS Global Hospital, Hyderabad, India



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