Overview
Revision Knee Replacement
Revision total knee replacement is performed when the original primary total knee replacement has worn out or loosened in the bone. Revisions are also carried out if the primary knee replacement fails due to recurrent dislocation, infection, fracture or very rarely, ongoing pain and significant leg length discrepancy.
The revision total knee replacement is a more complex procedure, often because there is a
reduced amount of bone to place the new total knee into. Extra bone may be required and
this is usually received from a bone bank. Bone bank (allograft bone) is safe and has been irradiated to eliminate any chance of disease transmission. There are also artificial bone
substitutes that may be used. Revision total knee replacement takes longer than a standard total knee replacement and has a slightly higher complication rate. The prosthesis may also not last as long as a primary
knee replacement , Surgery is usually performed through the same incision but may need some extension. The risks and complications are similar to standard knee replacement surgery.
Complications
Anaesthesia complications
As anybody undergoes general or regional anesthesia (epidural anesthesia) there are always
risks associated with it. The risks of course are magnified if you have abnormal general medical conditions in addition to your older age, which may have affected the functions of your vital organs such as heart, lungs and kidneys. Therefore a complete evaluation of those systems has to be performed before you are taken to the Operating theatre.
Specific complications relating to knee replacement surgery include the following:
Deep vein thrombosis: This is prevented by giving blood thinners and if it occurs it is treated with specific blood thinners, usually Warfarin.
Infection: The risk of infection is less than 1% and pre-operative antibiotics are given to prevent this from happening.
Stiffness: Occasionally knee replacement may stiffen up particularly in patients who are significantly overweight or have diabetes. Occasionally one will require a manipulation under an anaesthetic should this occur.
Nerve and vessel damage: It is unlikely that any major nerve or vessel will be damaged. It is unlikely that any major nerve or vessel will be damaged. It is, however, very common to have a small area of numbness over the other side of your knee where a superficial skin nerve is always cut during the surgery. This little numb patch is of no significance.
Prosthesis failure: The prosthesis may fail due to the plastic wearing out and it may require revision.
Reflex sympathetic dystrophy: Very rarely a condition can occur where the leg becomes stiff, hypersensitive and painful. This requires specific treatment with a pain management specialist.
Excessive bleeding around the joint: This usually settles but may require drainage.
Excessive scarring: Some skin will scar up significantly (keloid).
Fluid build-up in the knee joint: Occasionally this may occur and require drainage. It is usual for knees to be a little swollen and a little warm.
Risks
The complications that may follow knee revision surgery are similar to those for knee replacement.
They include:
- Deep vein thrombosis.
- Infection in the new prosthesis.
- Loosening of the new prosthesis. The risk of this complication is increased considerably if the patient is overweight.
- Formation of heterotopic bone. Heterotopic bone is bone that develops at the lower end of the femur following knee replacement or knee revision surgery. Patients who have had an infection in the joint have an increased risk of heterotopic bone formation.
- Bone fractures during the operation. These are caused by the force or pressure that the surgeon must sometimes apply to remove the old prosthesis and the cement that may be attached to it.
- Dislocation of the new prosthesis. The risk of dislocation is twice as great for revision surgery as for TKR.
- Difference in leg length resulting from shortening of the leg with the prosthesis.
- Additional or more rapid loss of bone tissue.
Normal results
Normal results of knee revision surgery are quite similar to those for TKR. Patients have less pain and greater mobility in the affected knee, but not complete restoration of the function of a normal knee. Between 5% and 20% of patients report some pain following either TKR or revision surgery for several years after their operation. Most patients, however, have considerably less discomfort in the knee after surgery than they did before the procedure. A recent British study found that revision knee surgery patients had the same positive results at six-month follow-up as patients who had had primary knee replacement surgery.
Aftercare
Aftercare following knee revision surgery is essentially the same as for knee replacement, consisting of a combination of physical therapy, rehabilitation exercises, pain medication when necessary, and a period of home health care or assistance.
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