Revision knee Replacement

Introduction:

Knee replacement is a common procedure performed worldwide with a very good success rate. While many patients experience significant improvement in their quality of life after a knee replacement, some may require a second surgery known as revision knee replacement.

What is Knee replacement:

It is a surgical procedure that involves removing damaged or worn parts of the knee joint and replacing them with artificial components. It's mainly performed to relieve pain and restore function in individuals with severe knee arthritis.

What is Revision knee replacement:

Revision knee replacement is done when the primary knee fails or wears out. There are several reasons for this:

• Implant wear and tear over time leading to pain, instability and reduced function.
• Infection of the artificial joint which may need removal and replacement of the prosthesis.
• Instability of the knee joint due to implant wear, ligament damage and other issues.
• Loosening of the components over time causing pain and reduced function
• Periprosthetic fracture
• Component malalignment

The Procedure:

Revision knee replacement is a complex surgery that involves removing the failed components and replacing them with a new prosthesis. Here's an overview of the procedure:

1. Preparation: The patient is mainly under regional anesthesia, like Spinal and epidural combination or general anesthesia, if the patient is not fit for regional anesthesia.
2. Accessing the knee Joint: The surgeon makes an incision and gains access to the knee joint, often needing to remove the scar tissue from the initial surgery.
3. Removal Components: The surgeon removes the old implant, which may involve some bone loss. This can be replaced with bone grafts or augments.
4. Implant Placement: New implants are inserted and secured to the bone with stems and cement. The choice of components would be a constrained or highly constrained rotating hinge prosthesis, depending upon the ligament status.
5. Closure: After confirming the knee stability and range of motion, the incision is closed in layers.

Recovery and Rehabilitation:

Recovery from revision knee replacement can be more challenging than primary knee replacement due to the complexity of the surgery. Rehabilitation is crucial and should be done meticulously. It typically involves the following:

1. Hospital Stay: Patients may need to stay a few days (5 to 7 days) in the hospital after surgery to monitor their condition and wound care.
2. Physical Therapy: It is vital to regain strength and range of motion. It may begin soon after surgery and continue for a few days.
3. Pain Management: Managing post-operative pain is crucial. Patients may require injectable as well as nerve blocks to control pain for an initial few days and then switch to oral pain therapy.
4. Home Care: Patients will need to follow specific instructions for wound care and take precautions to avoid any complications.
5. Weight-bearing: Weight-bearing may be restricted initially, and a crutch or walker may be necessary for a few days.

Potential Complications:

Revision knee replacement comes with some increased risk of complications, which include:

1. Infection: The risk of infection is higher in revision surgery due to the presence of scar tissue and multiple procedures.
2. Blood Clots: The immobility after surgery increases the risk of deep vein thrombosis.
3. Stiffness: Regaining full range of motion can be more challenging in revision surgery.
4. Nerve or damage to blood vessels: Due to the complexity of the procedure, there is an increased risk of nerve or blood vessel damage 
5. Persistent Pain: Some patients may continue to experience pain even after revision surgery.
6. Pulmonary Embolism can be a fatal complication associated with revision surgery.

Conclusion:

Revision knee replacement is a complex and challenging procedure, but it can provide pain relief and improved function to patients whose initial knee replacement has failed. For any patient who needs a revision knee replacement, it's crucial to have a thorough discussion with your orthopedic surgeon to understand the risks, benefits, and expectations.

It's important to remember that each patient's case is unique, and the decision to undergo revision knee replacement should be made after careful evaluation by an experienced Joint replacement surgeon. While it's a significant surgery, it can offer a new lease on life for those who have been dealing with the complications of a failed knee replacement.

The blog has been authored by Dr. Ponnanna Machaiah. The content is for informational purposes only and should not be taken as professional medical advice. More about the author