Revision Knee Replacement Surgery

Introduction

Revision Knee Replacement means that part or all of your previous knee replacement needs to be revised. This operation varies from 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).

Why does a knee replacement need to be revised?

Pain is the primary reason for revision. Usually, the cause is clear but not always. 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 – This 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 that results in bone being destroyed.

Stiffness- This is difficult to improve with revision but can help in the right indications.

Pre-Operation

  • Your surgeon will send you for routine blood tests and any other
  • Investigations required prior to your surgery
  • You will be 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 for help 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

Day of Surgery

  • You will be admitted to the hospital usually on the day of your surgery
  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • Anesthetist will ask you a few questions
  • Attendant will give you hospital clothes to change into and have a shower prior to surgery
  • The operation site will be shaved and cleaned
  • Approximately 30 minutes prior to surgery, you will be transferred to the operating room

Surgical Procedure

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

In any surgical operation, you will be under sterile conditions, spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours.

Your leg’s position is prepped and draped on the operating table.

Your leg is prepared for the surgery with a sterilizing solution with a tourniquet to the upper thigh.

It will expose your knee joint by 7cm incision.

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.

Post-operation Course

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 medication through a machine called PCA machine (Patient Controlled Analgesia).

Your surgeon will take you to the ward when you get stabled.The post-op protocol is surgeon dependent, but in general, your drain will come out at 24 hours and you will sit out of bed and start moving your knee and walking on it within a day or two of surgery. Movement gets easier on the 2nd post-op day as dressing reduces a bit. Your physical therapist will supervise your rehabilitation and mobilization process.

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

To minimize blood clots in your legs, you can use one or more measures 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 a hospital for 3-5 days and then either go home or to a rehabilitation facility depending on your needs. You will need physical therapy for your knee following surgery.

Your surgeon will discharge you on a walker or crutches and usually progress to a cane at six weeks.

Home Care

Remove sutures at approximately 10 days if it doesn’t dissolve naturally.

Bending your knee is variable, but by 6 weeks it should bend to 90 degrees. The goal is to get 110-115 degrees of movement.

Take a bath when wound dries up. 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 can install rails in your bathroom or modify your sleeping arrangements especially if they are up a lot of stairs.

Usually, you need to have a 6-week check-up with your surgeon 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.

You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the bloodstream 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.

Risks and Complications

  • Major surgery involves risk but it outweighs the potential disadvantages
  • Inform yourself 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 anesthetic 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%. Antibiotics can treat it but may require further surgery. Hip removal eradicates the 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 afterward if you fall. To repair 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 require you to take it while going to the operating room.

Wear

You don’t need to change the plastic liner as it eventually wears out over time, usually 10 to 15 years.

Wound Irritation or Breakdown

Surgery 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 that may require antibiotics or rarely further surgery.

Cosmetic Appearance

Surgery puts your knee into the correct alignment to allow proper function so it may look different than it was.

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 lose contact with each other or the plastic insert can lose contact with the tibia (shinbone) or the femur (thigh bone).

Patella Problems

The Patella (knee cap) can dislocate. This means it moves out of place and it can break or loosen.

Ligament Injuries

There are a number of ligaments surrounding the knee. Surgery corrects torn ligaments, broken out or injured.

Damage to nerves and Blood Vessels

Damages on nerve and vessels require a second operation. 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.

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 restores function to your damaged joints as well as relieve pain. You may regard it as part of your treatment plan.

Doctors offer surgery only once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision for 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 these prior to making a decision. Wait until you are sure this is the best procedure for you.

Revision Knee Replacement Case Studies

Why choose Dr. Kakare?

As a top joint replacement specialist in New York City, Dr. Karkare has extensive experience in revision knee replacements, ensuring patients have the broadest array of safe and effective treatment options to relieve pain and other symptoms.

Doctor Karkare performs an in-depth evaluation of each patient to determine if an anterior approach would be a good choice or if another approach might be preferred before any procedure is performed.

This enables every patient to make an informed, educated decision so they can feel confident in their care every step of the way.

To schedule your evaluation, call (212)951-0182 or use our online contact form to learn more.

 

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