Knee Revisions

What Are Knee Revisions?

Knee and hip replacement surgeries are highly successful procedures that improve the lives of millions of people every year by relieving pain and increasing mobility. However, in some cases, knee and hip replacements fail, causing pain and loss of movement.

If your original knee or hip replacement prosthetic needs new parts or total replacement, we can carry out revision surgery to remove the sections causing the problem and fit new parts.

Knee and hip revision surgeries are more complex than the original procedure, requiring an exceptional level of orthopedic surgical expertise. Our orthopedic surgeon is an outstanding orthopedic surgeon with many years of experience in carrying out successful knee and hip revisions and is ideally qualified to perform your operation.

Why Would My Original Knee Replacement Fail?

Most people live long and happy lives with their knee replacements, but occasionally something can go wrong and they feel knee pain again, most often due to causes such as:

• Taking part in high-impact activities
• Obesity
• Degeneration of the plastic spacer in the prosthesis
• Having knee replacement surgery at a young age
• Infection
• Fractures
• Excess scar tissue around the implant
• Ligament damage causing instability

Some patients develop osteolysis, which develops when the immune system responds to the presence of tiny particles in the prosthesis by attacking the foreign matter. The attack also damages bones connected to the implant causing them to deteriorate, resulting in a loose joint.

How Is Knee Revision Surgery Carried Out?

It takes 2-3 hours to carry out knee revision surgery. First, we identify and remove the faulty parts of your original prosthesis from your knee and check the surrounding tissues for any sign of infection.

We then remove any bone cement remaining from the original procedure and prepare the surfaces of the bones for the new implant, which can be a painstaking process. We then insert the revision implant and repair the soft tissues.

Reasons for a revision

Short-term revisions: infection, implant loosening from the failed procedure, or a mechanical failure

An infection will usually present itself within days or weeks of surgery. However, infection can also occur many years after surgery.

Infection following knee replacement can cause severe complications. It’s generally caused by bacteria that settle around the wound or within the device. Infection can be introduced by contaminated instruments or by people or other items within the operating room.

Because of extreme precautions taken in the operating room, infection rarely occurs. However, if an infection takes place, it can lead to a buildup of fluids and potentially a revision.

If you notice any unusual swelling, tenderness, or fluid leakage, contact your surgeon immediately. If your surgeon suspects that there’s a problem with your existing artificial knee, you’ll be asked to undergo an examination and assessment. This involves X-rays and possibly other imaging diagnostics such as a CT or MRI scan. The latter can provide important clues about bone loss and determine whether you’re a suitable candidate for a revision.

People who experience fluid buildup around their artificial knee usually undergo an aspiration procedure to remove the fluid. The doctor sends the fluid to a lab to determine the type of infection and whether a revision surgery or other treatment steps are in order.

Long-term revisions: pain, stiffness, loosening due to wear of mechanical components, dislocation

Long-term wear and loosening of the implant can occur over years.

Various sources have published statistics on the long-term revision rates for knee replacement. According to the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), and by observing TKR patients over an eight-year period ending in 2003, the long-term revision rate is 2 percent for five or more years.

Based on a meta-analysis of worldwide joint registry databases, published in 2011, the revision rate is 6 percent after five years and 12 percent after ten years.

Healthline’s analysis of approximately 1.8 million Medicare and private pay records found that the rate of revision for all age groups within five years from surgery is about 7.7 percent. The rate increases to 10 percent for those age 65 and older.

The data on long-term revision rates varies and depends on numerous factors, including the ages of those observed. The chances for a revision are lower for younger people. You can reduce future problems by maintaining your weight and avoiding activities that place undue stress on the joint, such as running, jumping, court sports, and high-impact aerobics.

During a process called aseptic loosening, the bond between the bone and the implant breaks down as the body attempts to digest the particles. When this event takes place, the body also begins to digest bone, which is known as osteolysis. This can lead to a weakened bone, fracture, or problems with the original implant. Aseptic loosening doesn’t involve an infection.

Revision surgery for infection

Typically, a revision required because of infection involves two separate operations: Initially, the orthopedist removes the old prosthesis and inserts a polyethylene and cement block known as a spacer that has been treated with antibiotics. Occasionally, they’ll make cement molds like the original prosthesis and insert antibiotics in that, and implant it as the first stage.

During the second procedure, the surgeon removes the spacer or molds, reshapes and resurfaces the knee, and then implants the new knee device. The two procedures usually take place about six weeks apart. Inserting the new device typically requires 2 to 3 hours in surgery, compared to 1 1/2 hours for a primary knee replacement.

If you require a bone graft, the surgeon will either take bone from another part of your own body or use bone from a donor, usually obtained through a bone bank. The surgeon might also install metal pieces such as wedges, wires, or screws to reinforce the bone for the implant or fasten the implant to the bone. A revision requires the surgeon to use a specialized prosthetic device.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family, and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.