Revision Total Knee Replacement

A revision total knee replacement is a surgical procedure performed to address problems with an existing knee replacement prosthesis

This may be necessary for one or more of several reasons, including:

• Artificial knee joint has suffered from wear, loosening and related problems.
• Osteolysis – this is where small chips originating from wear of plastic insert in the artificial knee joint are attacked by the immune system, which then also attacks the healthy bone around the artificial components.
• Prosthetic Joint Infection.
• Knee ligament injury.
• Subsequent injury (e.g. a fall which may cause other bone fractures or dislocations).
• Arthritis has spread to other compartments in the knee (in the case of a previous Unicompartmental or partial knee replacement procedure).

Complex primary and Revision total knee replacements are a significant part of Dr Reddy’s Practice. This involves timely and skilled assessment of challenging knee problems including valgus deformities, post-traumatic deformities, ligament imbalances, infected joint replacements and failed knee replacements. He strongly believes that problem-focussed, patient-centric and empathic care form the foundation of treatment of these difficult conditions to achieve the best possible outcome.

Procedure

A revision total knee replacement is more complex than the initial knee replacement procedure. This is because previous artificial joint components must be removed and more bone may needs to be removed from the shin bone and/or thigh bone before new components can be attached. As part of this process, bone grafts or components called ‘metal augments’ or ‘platform blocks’ may be necessary to maintain limb alignment, ligament balance, and proper functioning of the knee joint.

As with a standard total knee replacement procedure, an incision is made (generally along the original scar line) and the kneecap and tendons are moved to one side to expose the knee joint. At this point, Dr Sunil Reddy will assess all existing components for wear and will check surrounding tissue for infection.

Components that need to be removed will be removed carefully along with any bone cement residue to preserve as much healthy bone as possible. The remaining bone will then be prepared for the new components and, if necessary, augments, blocks, or in some cases a bone graft.

For infected primary knee replacement, a two-stage procedure can be required. In this case, the first procedure involves the removal of the existing knee joint components and the insertion of an ‘antibiotic spacer’. In the second procedure, the spacer is removed and the new components are implanted.

Postoperative recovery and rehabilitation

The postoperative recovery is similar to total knee replacement surgery, although recovery can take longer in the case of revision surgery – with crutches or other forms of support necessary for a slightly longer duration.

Risks and complications of revision total knee replacement are higher in severity and incidence when compared to primary knee replacement. This could be due to increased complexity and duration of revision surgery as well as involvement of technically demanding surgical steps, ostoetomies and prosthesis requiring stem and augment components.