Revision Knee Replacement Surgery

If you're looking for a successful procedure in orthopedic medicine, look no further than a total knee replacement! This is because a knee replacement can help you feel so much better and get you back to doing the things you love again!

Newer implant designs and improved surgical techniques have greatly increased the success rate of total knee replacement surgery. In fact, you can expect a total knee replacement to last at least 15 to 20 years in more than 85% to 90% of patients.

It's important to remember that even the best knee replacement can fail over time for a number of reasons. When this happens, your knee can become quite painful and swollen. It may also feel stiff or unstable, which can make it difficult to do the everyday things you love.

In this comprehensive guide, we will dive deeper into knee revision surgery, its causes, the associated complications, and recovery. 

What is a Knee Revision Surgery?

A revision knee replacement is replacing a failed total knee replacement with a new prosthesis. In simple terms, it is the replacement of a total knee replacement (or "second knee replacement").

Revision knee surgeries are complex surgeries requiring extensive preoperative planning, specialized implants and instrumentation, extended surgical time, and proficiency in difficult surgical techniques.

What Can Cause a Knee Implant to Fail?

There are five main reasons why knee implants fail. The primary causes are: wear and loosening, infection, instability, leg fractures, or stiffness.

• Wear and Implant loosening. 

A total knee replacement only works properly if the implant is firmly attached to the bone. The implant was either cemented into the bone or press-fit during the initial surgery to allow the bone to grow onto the surface of the implant. In both cases, the implant was firmly attached. However, an implant can become loose from the underlying bone over time, causing pain in the knee.

The cause of loosening is not well understood, although it can be related to impact activity, excess body weight, and wear of the plastic spacer between the two metal components of the implant. In addition, patients who are younger at the time of their first knee replacement may "outlive" the life expectancy of their artificial knee. These patients may have a higher long-term risk of revision surgery due to loosening or wear.

In some cases, tiny particles that wear off the plastic spacer build up around the joint. These particles are attacked by the body's immune system. This immune response will also attack the healthy bone around the implant, leading to a condition known as osteolysis. Osteolysis is the deterioration of the bone around the implant, causing the implant to become loose or unstable. Advances in material science and plastic quality have made osteolysis less common today than in previous decades.

• Infection. 

It's important to remember that infection is a risk with any surgical procedure, including total knee replacement. It's possible you might get an infection while you're in the hospital or even after you go home. And it could even happen years later. 

If an artificial joint becomes infected, the joint can become stiff and painful to use. It is possible that the implant will begin to lose its attachment to the bone. Even if the implant remains properly attached to the bone, the pain, swelling, and drainage from the infection will usually require revision surgery. 

Depending on the type of bacteria, how long the infection has been present, the severity of the infection, and the patient's preferences, revision surgery for infection can be performed in one of two ways. 

1. Debridement and implant retention. In this case, the surgeon washes out the bacteria and replaces the plastic spacer. The implant is left in place.
2. Staged surgery. In this case, the implant will be removed, the joint will be washed out, and a temporary cement spacer will be placed in your knee. During this time, you will also be given an intravenous course of antibiotics. When the infection is gone, your doctor will perform a second surgery to remove the antibiotic spacer and insert a new prosthesis.

The best option for you will be discussed with your doctor. Removing the implant has a higher chance of curing the infection. However, it will take longer to heal.

• Instability. 

Your knee can become unstable if the ligaments around your knee are damaged or out of balance. Because most implants are designed to work with the patient's existing ligaments, any changes to these ligaments can interfere with an implant's ability to work properly. You may have recurring swelling and a feeling that your knee is "going out of joint. If knee instability cannot be treated with non-surgical measures such as bracing and physical therapy, revision surgery may be required.

• Fractures.

Periprosthetic fractures are bone fractures that occur around total knee replacement components. These fractures are most commonly caused by falling and usually require revision surgery. Your doctor will consider several factors in determining the extent of revision needed, including the quality of the remaining bone, the type and location of the fracture, and whether the implant is loose. If the bone is fractured or weakened by osteoporosis, the damaged section of the bone may need to be completely replaced with a larger revision component.

• Stiffness.

In some cases, a total knee replacement may not be able to help you achieve the range of motion you need to perform everyday activities. This can be the case if there is an excessive amount of scar tissue around the knee joint. If this happens, your doctor may try "manipulation under anesthesia". 

In this procedure, you will be given anesthesia so that you will not feel any pain. Then, your doctor will try to break up the scar tissue by bending your knee. This procedure improves the range of motion in most cases. However, sometimes the knee remains stiff. Revision surgery may be necessary if extensive scar tissue or the position of the components in your knee limits your range of motion.

What are the Signs of a Knee Replacement Failure?

Pain, decreased joint function, knee instability, and swelling or stiffness in the knee joint are the most common symptoms of a failed knee implant. Persistent pain and swelling may indicate loosening, wear, or infection. The location of the pain may be throughout the knee (generalized) or in a specific area (localized). A decline in knee function may result in limping, stiffness, or instability. Patients who experience these symptoms and signs may require revision knee surgery.

What to Expect during a Knee Revision?

The first step is to remove the old implant, preserve as much bone as possible, and, if necessary, use bone grafts to fill the gaps where the bone has been destroyed. The new prosthesis is then placed. Most revision knee surgeries take longer than primary surgeries (about two to three hours).

What are the Complications? 

There are risks associated with revision total knee replacement surgery, as with any surgical procedure. The risk of complications is higher because the procedure is longer and more complex than a primary total knee replacement.

Prior to your surgery, your doctor will discuss each of these risks with you and will take specific steps to help you avoid any potential complications. Revision surgery may include the following risks:

• Bleeding
• Wound or new prosthesis infection
• Poor healing of the wound
• Nerve or blood vessel damage
• Clots in the legs that can travel to the lungs (pulmonary embolism)
• Fracture of a bone during surgery

What does Recovery Look Like?

It's so important to feel informed and prepared for what's to come after surgery. You may need some extra help at home for a few days, a few weeks, or even a few months after you leave the hospital. It's a good idea to have a friend, family member, or caregiver ready to lend a hand. You might need a walker, a cane, or even crutches for a few days or weeks, until you're feeling better and walking without assistance.

Conclusion 

Although total knee replacement surgery is highly successful in the majority of patients, some procedures fail. Certain signs and symptoms, such as increased pain or decreased knee function, may indicate joint failure. The majority of patients who undergo revision surgery experience positive long-term results, including pain relief and increased stability and function. 

Contact Turkey Luxury Clinics and our team of doctors and surgeons will be ready to provide you with the best consultation and evaluation to meet your individual needs.