Dr Ray Randle: 07 5598 0094
Dr David Liu: 07 5598 0205
Dr Haig Lennox: 07 5598 0531

Revision Knee Replacement

Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and requires a second, revision surgery. Revision knee replacements are complex operations involving replacing part or all of the previous knee prosthesis with a new prosthesis. These operations require skill and experience.

Indications

Revision knee replacement surgery may be advised to patients if they have one or more of the following conditions:

  • Increased pain in the affected total knee replacement
  • Recurrent or persistent swelling
  • Worn out polyethylene insert
  • Knee instability or a feeling of giving way while walking
  • Loosening of the prosthesis
  • Infection in the prosthetic joint
  • Weakening of bone around the knee replacement, a process known as osteolysis (bone loss)
  • Stiffness in the knee
  • Leg length discrepancy or angular deformity
  • Fracture around the prosthesis
  • Breakage of the implant

Surgical procedure

  • Revision knee replacement surgery is performed under anaesthesia
  • An incision is made over the knee to expose theknee joint. Often the site of the old incision is used. More extensive release of the quadriceps tendon or patella tendon may be required
  • The components of the old knee prosthesis that are causing a problem are removed together with diseased tissue and cement if present
  • Complex techniques to rebuild missing bone and stabilise the new prosthesis are used. e.g. Bone graft, bone substitutes, metal augments and sleaves, custom implants, long stemmed implants, wires and screws are used to rebuild a new stable knee replacement. In the event of ligament instability or severe bone loss, rotating hinge or tumour prostheses are used. These are intrinsically stable
  • The muscles and tendons around the new joint are repaired and the incision is closed
  • On occasions biological or synthetic material is required to repair soft tissue

Goals and outcome

Revision TKR’s are successful operations when performed well. Eradication of pain, return of pain free functional movement and a stable, aligned knee is the goal. Recovery periods are usually longer than first time TKR’s. Outcomes are however not as predictable as the first knee replacement. Current literature suggests that approximately 10% of patients may have a poor outcome despite a well-performedrevision TKR with a good X-ray.

As part of the preparation for surgery, the better informed and prepared the patient is, the better the likely outcome. Signing an informed consent is a vital part of preparing for surgery. Attending a preadmission clinic is helpful. Many steps and actions are taken to reduce the risks of surgery and to aid in an uneventful full post-operative recovery.

Post-Operative care

Post-Operative pathway usually include:

  • The patient beingmonitored regularly
  • Pain will be managed in a multi-modality style
  • Drugs will be administered to avoid blood clots, prevent infections and prevent bleeding
  • Urinary catheters usually remain in for 1-2 days
  • Patients usually stay 3-5 days in the acute care ward
  • Patients will be given specific instructions regarding exercises and activity. Starting on the day of surgery. Mobilising will be guided by the physiotherapist
  • Continuous Passive Motion (CPM) may be used
  • Knee and leg swelling is common after knee surgery. Ice and elevation of the leg are recommended to minimize swelling and pain
  • Foot or calf pumps, early mobilising and hydration will be utilised to prevent calf and lung clots
  • If progress is slow, a referred to in or out patient rehabilitation will be arranged
  • Eating a healthy diet and not smoking will promote healing

Risks and complications

As with any major surgery, possible risks and complications associated with revision TKR surgery include, but are not limited to:

  • Knee pain
  • Wound breakdown and oozing
  • Knee stiffness
  • Infection, superficial and deep
  • Blood clots (deep vein thrombosis, pulmonary embolus)
  • Fractures around the knee joint
  • Nerve and blood vessel damage
  • Numbness around the scar
  • Instability and ligament injury
  • Clicking
  • Patella (kneecap) dislocation
  • Plastic liner wears out
  • Loosening of the implant
  • Bone loss from wear debris

The patient is a very important part of the pathway pre and post surgery. Patients need to be responsible for there own health and follow instructions. Informing the doctor or appropriate professional if there is a concern. Early diagnosis and treatment of complications will improve the success of treatment.

Revision Knee Replacement

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