Knee revision surgery, which is also known as revision total knee arthroplasty, is a procedure in which the surgeon removes a previously implanted artificial knee joint or prosthesis and replaces it with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from another donor.

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

Surgical Procedure

Revision total knee replacement is more complex and takes longer to perform than primary total knee replacement. In most cases, the surgery takes from 2-3 hours. To begin, your doctor will follow the line of the incision made during your primary total knee replacement. The incision may be longer than the original, however to allow the old components to be removed. Once the incision is made, the doctor will move the kneecap and tendons to the side to reveal your knee joint. Your doctor will examine the soft tissues in your knee to make sure that they are free from infection. He or she will assess all the metal and/or plastic parts of the prosthesis to determine which parts have become worn or loose or shifted out of position.
Your doctor will remove the original implant very carefully to preserve as much bone as possible. If cement was used in the primary total knee replacement, this is removed, as well. Removing this cement from the bone is a time-consuming process that adds to the complexity and length of the revision surgery. After removing the original implant, the doctor will prepare the bone surfaces for the revision implant. In some cases, there may be significant bone loss around the knee. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits. Rarely, the bone graft material may be used to help rebuild the knee. The graft may come from your own bone (autograft) or from a donor (autograft). Finally, the doctor inserts the specialized revision implant, repairs any surrounding soft tissues that are damaged and carefully tests the movement of the joint. A drain may be placed in your knee to collect any fluid or blood that may remain after surgery. After surgery, you will be moved to the recovery room where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

Post-Surgical Care

You will wake up in the recovery ward where you will be closely monitored until you are ready to return to your ward. Here you will continue to be observed until you are fully awake. Usually, you will spend the first postoperative day in bed. A physiotherapist will visit you to give you breathing exercises for your chest as well as exercises for your leg that can be performed whilst in bed. An x-ray of your knee will be taken to confirm optimal placement of the prosthesis. Blood-thinning medications will be administered daily to reduce the risk of blood clots (DVT) forming in your legs. In addition, you will be given special stockings (TEDs) to wear on both of your legs. For the first 24 hours after your operation, an inflatable sleeve will intermittently compress your calves to prevent stagnation of blood flow. You will receive intravenous antibiotics after your surgery for a designated period of time depending on the complexity of the operation. This will help to decrease the risk of infection. Your bandages will be removed at 48 hours after the operation. A new dressing will be placed over the incision. Your knee will be quite swollen and usually has areas of bruising around it. This is normal. You will be under the daily supervision of a physiotherapist until you are discharged from the hospital. The aims of these visits are to optimize motion in the knee, regain ambulation, improve muscle strength and control knee swelling. Once you are mobilizing safely, have regained appropriate motion in your knee and your pain is controlled by tablets, you will be able to go home. Some patients require further inpatient care and are transferred to a rehabilitation unit for a short time.

Rehabilitation & Recovery

Your rehabilitation will continue after you leave the hospital to initially maintain and improve on what you have already achieved. This will take the form of a home exercise program and outpatient physiotherapy visits, which usually last 3-6 months. An appointment will be made to see your surgeon six weeks after the operation. The goals of your revision knee replacement surgery are to be able to walk independently, to be able to bend your knee and to reduce the pain you were experiencing prior to your surgery. Your therapist will work with you to help keep your revised knee joint healthy for as long as possible. This may require that you adjust your activity choices to keep from putting too much strain on your revised knee joint. Heavy sports that require running, jumping, quick stopping and starting and cutting are discouraged. Patients may need to consider alternate jobs to avoid work activities that require heavy lifting, crawling, and climbing. The therapist's goal is to help you maximize strength, walk normally and improve your ability to do your activities. When you are well under way, regular visits to the therapist's office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.

Long-Term Outcomes

The vast majority of patients who have revision surgery experience favorable long-term outcomes, including relief from pain and increased stability and function. Complete pain relief and restoration of function are not always achievable, however some patients may still experience pain or knee stiffness following revision surgery.

About Medinovita

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