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Revision Total Knee Replacement

Dr. Lingaraju A P - Consultant Orthopaedic & Joint Replacement

What is Revision Knee Replacement surgery?

Is a surgical procedure that involves the replacement of prosthetic implants with a new implant in a person who previously had a Total Knee Replacement.

Total Knee Replacement is one of the most successful procedures in all of medicine. Although most Total Knee Replacements are very successful, over time problems such as implant wear and loosening may require a revision procedure to replace the original components.

When do you require Revision Knee Replacement surgery?

If you are suffering from severe knee pain while standing, walking and stair climbing, instability in the knee (lack of control in the knee) and discharging pus from the knee joint in a previous Total Knee Replacement. You will require revision knee replacement surgery.

revision total knee arthroplasty

 

What are the common conditions requiring Revision Total Knee Replacement Surgery?
  1. Implant Loosening and Wear: The common causes for implant loosening are high-impact activities, excessive body weight, and wear of the plastic spacer (osteolysis) between the two metal components.

Patients who are younger when they undergo the initial primary knee replacement may “outlive” the life expectancy of their artificial knee beyond 20years.

  1. Infection: Infection is a potential complication in any surgical procedure. Infection may occur immediately after your primary Total Knee Replacement or some years later. You will start noticing fever, pain, swelling, stiffness and pus drainage from the knee.
  1. Instability: Instability can be due to improperly balanced ligaments during primary surgery or implant loosening over a period of time. You may experience pain, recurrent swelling and sense of “giving way.”  Mild knee instability can be treated through knee bracing and physical therapy.
  1. Fracture: Fractures around the components of a Total Knee Replacement can happen due to fall.
Any age limit to undergo Revision Total Knee Replacement Surgery?

No age bar to undergo this surgery. Your physical fitness and medical conditions are important. We have done revision surgeries even at the age of 90 years.

How the Revision Total Knee Replacement surgery done?

To begin with the knee joint will be opened through the line of the incision made during your primary Total Knee Replacement. All the original implants along with cement are removed with preserving as much bone as possible. The bone surfaces for the revision implant are prepared. All bony defects assessed. New implants with added extra-long rods and augments are refixed to the bone with cement.  An ultra-high molecular weight polyethylene insert is inserted between the metal components to create a smooth gliding surface. Now your knee joint moves in a normal way.

How the Revision Total Knee Replacement surgery done in presence of infection?

Revision Total Knee Replacement surgery for infection can be done in one of two ways, depending on the type of bacteria, how long the infection has been present, the degree of infection, and patient preferences.

Debridement: In early and mild infections, the bacteria can be washed out, the plastic spacer can be exchanged, and the metal implants can be left in place.

Staged surgery. In severe long-standing infections revision surgery is performed through two separate surgeries. In the first surgery, all the implants will be removed along with cement and a temporary antibiotic spacer will be inserted to control the infection. This spacer will remain in the knee for several weeks. During this time, you will also receive intravenous antibiotics. When the infection has been cleared, a second surgery is done to remove the antibiotic spacer and new implants with added extra-long rods and augments are re-fixed to the bone with cement.  An ultra-high molecular weight polyethylene insert is inserted between the metal components to create a smooth gliding surface. Now your knee joint moves in a normal way. 

For Best Advice and Consultation reach out to Doctor for Orthopedics in Jayanagar

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