A typical knee replacement will use plastic to replace the ends of the thigh bone (femur) and shin bone (tibia), inserting the plastic between them and the knee cap (patella)
Reasons for a Revision Knee Surgery
The main reason a patient will need revision knee replacement surgery is because this person is experiencing knee-related pain. Sometimes, depending on your individual case, the cause is clear. However, if the cause of your pain is not immediately obvious, your knee may not do as well after your surgery.
Polyethylene (or Plastic) Wear – This revision is often easier than other types of revisions and involves only replacing the plastic insert in your knee.
Knee Instability – If you have knee instability, this means that your knee doesn’t feel like it is supporting you or gives way when you walk.
Femoral, Tibial or Patella Loosening Component Loosening – The main symptom of femoral, tibial or patella component loosening is usually pain, but depending on your case, you may not have any symptoms. That’s why it is important that you maintain follow-up care after your replacement surgery for the rest of your life. Regular X-rays can show changes that develop in time, indicating that your knee should be revised.
Infection – Symptoms of infection can include pain but may also manifest as a fever or just feeling unwell.
Osteolysis, or Bone Loss – Bone loss can occur when particles, or “wear debris,” exist in the knee joint. This debris can cause inflammation and break down of bone.
Stiffness – This symptom is not easy to improve through knee revision but surgery can sometimes help.
Before Revision Knee Replacement Your Surgery
There are several things that your surgeon will have you do before your revision knee replacement, including:
- Routine blood tests, as well as any other investigations necessary before your surgery
- A check-up with your regular physician, to make sure you are healthy before surgery
- Attend to any other physical issues before your revision knee replacement, such as medical, dental or surgical issues
- Arrange for home help during your recovery time
- Ten days before surgery, stop taking any anti-inflammatories or aspirin, since they can cause or worsen bleeding
- Ten days before surgery, stop taking any herbal or naturopathic medications
- Quit smoking as long before your surgery as you can
Knee Revision Surgery Day
- You will arrive at the hospital and be admitted, usually on the same day as your surgery
- Any last-minute tests may be performed before your surgery
- You will be asked questions by the nursing staff, who will make sure your hospital records are up-to-date
- You will meet your anesthesiologist, who will ask you further questions
- You will change into a hospital gown and shower before your surgery
- The site of your operation will be cleaned and shaved
- You will be moved to the operating room about 30 minutes before your surgery begins
The Surgical Procedure
Since each knee is unique, during your surgery, the doctor will have different sizes of knee replacement equipment available. If you have excess bone loss, sometimes the doctor will add extra pieces of metal or bone.
Like other surgeries, revision knee replacement takes place under sterile, operating room conditions, and you will be under general or spinal anesthesia. You will be positioned on your back, with a tourniquet applied to your upper thigh to mitigate blood loss. The surgery will take about two hours.
The operating room staff will position your leg on the operating table, drape it, and prep you for the surgery with a sterilizing solution and the tourniquet.
During the revision knee replacement surgery, your knee joint will be exposed through a 7 cm incision and both ends of the thigh bone and shin bone will be prepared using a saw or a burr.
The surgeon will then use trial replacement components to check for a good fit. Once the fit is established, the actual components are put into place and fixed, either with or without cementing.
The surgeon then closes the knee area and will insert drains before dressing and bandaging the area.
When you wake in the recovery room, your vitals, such as blood pressure, oxygen saturation, temperature, and pulse, will be monitored. There will be a dressing at the site of your surgery and drains coming out of the wound site. You will have an IV drip in your arm, usually with a button to press that will administer pain medication (a PCA machine, or Patient Controlled Analgesia). You will also likely have a catheter (tube) in your bladder.
You will be taken back to your room after you wake up and the nurses verify that your vital signs are stable.
Usually, one-day post-surgery, your drains will be removed. You may then be encouraged to sit in a chair or walk, moving your knee, depending on your doctor’s orders, within a day or two after your surgery. Movement may be difficult at first but typically eases after the second day, when your wound dressing will be reduced. Your physical therapist will give you exercises to help you recover and gain mobility.
After surgery, it is important to breath very deeply, coughing out any phlegm you may have, to avoid congestion of the lungs.
Blood clots are sometimes an issue post-surgery, but the use of compression stockings, inflatable leg coverings or abdominal injections of blood thinner will mitigate the risk of blood clots or Deep Vein Thrombosis (DVT). For more information on blood clots, see the Complications section.
Much of the success of your knee replacement revision depends on how hard you work post-surgery to regain movement and increase mobility.
If you have adequate help at home post-surgery, you may be discharged in three to five days. If not, you will be discharged to a hospital for rehabilitation. You will require physical therapy following surgery.
You will need to use a walker or crutches for at least two weeks after your surgery and will need a cane in the four weeks following.
Post Knee Revision Surgery Home Care
After you have completed knee revision surgery and are sent home the healing process begins. Your sutures will most likely dissolve on their own, but if dissolvable stitches are not used, regular stitches will be removed in around 10 days.
Your progress may vary, but by six weeks post-op, you should be trying to bend your knee 90 degrees. Your objective should be to bend your knee 110-115 degrees.
Avoid taking a bath until your wound heals. You may drive after six weeks of recovery, if you can control your leg sufficiently. By six weeks, you should be able to walk with a reasonable amount of comfort. Returning to any sports you may have played before your surgery, however, could take up to three months.
Safety at home after your surgery is important. For example, sleeping on a main floor instead of in an upstairs bedroom or installing hand rails in your bathroom will help you avoid accidents that could impede your recovery.
Your post-operative check-up with the surgeon is usually scheduled for six weeks after your surgery. For the rest of your life, however, it is important to receive regular follow-up care and x-rays, to ensure that your knee replacement is functioning correctly and is not exhibiting signs of wear.
Because of the risk of infection after surgery, you should take an antibiotic before and after any dental work or additional surgeries. Your doctor or dentist will be able to prescribe those for you.
Be alert for signs of infection. For example, if your wound increasingly looks red or swollen, or you have a temperature over 100.5 degrees, you should contact your doctor.
Possible Risks or Complications
As with any major surgery, there is always a possibility of risk or complication. While the benefits of knee revision surgery outweigh these possibilities, it is important to be informed of any risks before your surgery.
Surgery complications can be general (medical), or specific to your knee.
Medical complications may be related to anesthesia or your overall well-being, and may include almost any type of condition, so the list below is not complete. However, complications may include:
- An allergic reaction to a medication
- Loss of blood, requiring a transfusion (which carries a low risk of disease transmission)
- A heart attack, stroke, pneumonia, failure of the kidneys, or bladder infection
- Nerve block complications, which can include nerve damage or infection
- Possibly life-threatening medical conditions that may lead to ongoing health issues, a longer hospital stay, or in rare cases, death
Complications specific to your knee may include:
Infection is a risk that occurs after any type of operation. When located in the knee, an infection can be either superficial or deep. Rates of infections are around 1%. Antibiotics can sometimes be used to treat infection, but you may require further surgery to resolve the infection.
Blood Clots, or Deep Vein Thrombosis
Blood clots can form in the calf muscles and move to the lung, resulting in a pulmonary embolism. Pulmonary embolisms can be serious or life-threatening. If you experience pain in your calf or shortness of breath at any point, notify your surgeon immediately.
Fractures or Breaks in the Bone
Fractures are rare but can occur sometimes during or after knee revision surgery. In some cases, this can prolong your recovery or cause you to need additional surgery.
Your results may vary, but the objective of knee surgery is to allow your knee to bend 100-115 degrees. However, sometimes that progress can be inhibited by stiffness.
Joints will all eventually experience wear. If you are an active person, this wear can occur more quickly. The typical survival of a knee replacement liner is 15 years.
Irritation of the Wound
You may experience some sensitivity or numbness around your scar. This numbness or sensitivity usually decreases in time and does not cause any problems with your knee function. If you experience minor aches around the wound area, you can use Vitamin E cream and massage the joint.
Rarely, reactions to sutures or wound breakdowns occur. Antibiotics, and in a small percentage of cases, further surgery, may be required.
Your knee may not appear the same as it did prior to your surgery, since the alignment has been altered for proper functioning.
Unequal Leg Length
Knee replacement revision involves straightening the joint, therefore altering the leg length.
Dislocation is very rare but occurs when contact is lost between the ends of the knee joint—either with each other, or with the plastic insert placed during surgery.
Occasionally, your knee cap (patella) can become dislocated, meaning it either moves out of place or loosens.
Injuries to the Ligaments
Surgery can correct broken, torn or injured ligaments surrounding your knee.
Nerve or Blood Vessel Damage
Damage to the nerves or blood vessels may lead to loss of sensation or movement in the lower part of your leg. This complication is rare but can be permanent.
If you have concerns before your surgery, discuss them thoroughly with your Orthopedic surgeon.
While surgery is a last choice for most people, if you have arthritis, surgery could mean the difference between you living with debilitating suffering or enjoying a normal, active life. Surgery can often be an effective part of your treatment plan, helping to relieve your pain and bring back function to your damaged joints.
Surgery is offered only by doctors after other non-operative treatments have failed. Consult with your family, surgeon and doctor, so that you can be as informed as possible before making this important decision.
In most cases, knee replacement revision surgeries are very effective, however, as with any surgery, complications can occur, and you should take these into consideration when making your decision. Be sure to take your time and consider all your options before you decide that this surgery is right for you.
Why choose Dr. Karkare?
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 enable every patient to make an informed, educated decision, and feel confident in their care every step of the way.
To schedule your evaluation, call (516) 735-4032 or use our online contact form to learn more.