Knee Revision Surgery
Knee revision surgery is a procedure that is performed when an initial knee replacement no longer functions as intended. During the procedure, the previous knee prosthetic implant is replaced with a new one with the goal of restoring function to the knee and alleviating any pain and instability.
The procedure is done by attaching a metal or plastic prosthetic capped at the ends of the bones that join the knee, hence allowing them to move against each other. The knee revision can either be a total replacement where the prosthesis is completely replaced or partially done by replacing only one implant.
Normally, a total knee replacement is meant to last for many years. In most cases, a knee revision surgery is performed on younger patients to clean the surface of the bone and reattach the initial prosthesis or replace it with a new one.
Causes and Risk Factors that May Lead to Knee Revision Surgery
A knee revision surgery is recommended when the total knee replacement pauses the following risks:
Infection may occur soon after the total knee replacement surgery or years later. This could be as a result of several factors including bacteria around the prosthesis or wound. The joint infected may swell or have fluid leakage.
An aspiration procedure is carried out to remove the fluid around the prosthesis. The fluid taken out of the wound is then examined in the lab to analyze the type of infection and determine if the revision is the most appropriate procedure to be taken.
Wear and tear
Over time the prosthesis can wear off tiny particles thus breaking or loosening the connection between the implant and the bone.
A failure of the implant known as Aseptic loosening causes pain and instability because the bond between the prosthetic and the bone tends to disintegrate as the body absorbs the particles in a process known as osteolysis attacking the healthy bone. This fracture weakens the bones as a result of mechanical loss of fixation over a period of time or improper installation of the total replacement.
A knee implant that was not balanced or became injured during or after the knee replacement surgery, is likely to cause pain, loosen or become unstable. This injury or imbalance causes the soft tissues to not function as intended, thus the instability.
Diagnosis for a Knee Revision Surgery
During your consultation with the Orthopedic surgeon, an evaluation will be done on the knee replacement complications, so as to identify if the revision knee surgery is the best option. Physical examination along with imaging tests such as a CT scan or MRI and the prior details of the surgery will also be evaluated.
Pain and discomfort in the leg below the knee or in the thigh area may indicate that the metal prosthesis attached to thigh bone or shin bone has loosened. If the pain is in the whole knee, it may be a sign of the prosthesis having loosened or the joint being infected.
The aim of a knee revision surgery is mainly to minimize pain and resume the functionality of the knee. The revision is however more detailed and complex than the total knee replacement and takes a longer time to perform the procedure.
Risks Involved in a Knee Revision Surgery
Just like any other surgical procedure, there are risks involved in a knee revision surgery, and are similar to those of a knee replacement. These include:
- Increase in loss of bone tissues at the joint
- An indifference in leg length due to the implant
- Fracture or dislocation caused by force during operation
- Infection in the new implant if not treated well in the revision surgery
- Implant loosening as a result of being overweight.
Post-operative Care of Knee Revision Surgery
After the knee revision surgery procedure, the patient is expected to undergo physiotherapy for an estimated 3 months. Pain medication and blood thinners will be prescribed to prevent blood clots from occurring. A walking device is also issued to assist the patient in mobility.
Additionally, one is required to try moving, that is, walking or standing, so that the resistance or compression caused can enable the bone to grow. The recovery for knee revision surgery takes a longer period compared to the original knee replacement surgery. The only way to ensure a seamless recovery is going for check ups after every 3-6 months, or as recommended by your doctor.
Artificial joints start to deteriorate as you age or if you lead an active life making it necessary to have a subsequent procedure, knee revision surgery to fix this. The goal of knee revision surgery is to completely or partially replace your old knee prosthesis with a new one. Primary joint replacement refers to the surgical procedure when a joint is first replaced with an artificial one.
Anyone whose prosthetic knee implant fails due to fractures or wear (indicated by loosening of the prosthetic components) may need to undergo a revision procedure. Newly developing knee pain and swelling may be an indicator of a loose and unstable prosthetic component or an infection. In some cases, the knee may develop an excessive amount of scar tissue, which limits how much the joint can move. This causes stiffness, which is an indication you need the surgery.
The implant needs to be taken out first then, bone grafts that can be either allograft or autograft are used to fill in the gaps if there has been severe bone loss. Metal screws or wires may sometimes be utilized to reinforce the bone and ultimately specialized revision knee implants are placed.
The severity of the knee problem determines whether an alternative such as Arthrodesis (knee fusion) can be considered to knee revision surgery. Arthrodesis is the medical term for the fusing of two or more bones within a joint. Knee fusion leaves the joint stable but immobile and eradicates the pain that instability causes.
Since the original implant must be removed as it would have assimilated into the bone during the initial knee replacement surgery, the revision process is often more difficult than the primary one. The operation takes longer to complete and involves more planning, specialized equipment, and higher surgical expertise.
The average lifespan of implants used in knee replacement and revision surgery is 20 years. The longevity of a replacement prosthesis might vary depending on several factors. For example, the implant’s lifetime might be impacted by the quality of the bone and how it is fixed.
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