Revision Total Knee
Replacement
Total knee replacements can wear or loosen with time, resulting
in increasing pain or stiffness. Occasionally, infection can occur in the
artificial joint, and this in itself may cause pain and stiffness, and may lead
on to loosening of the components.
If your artificial knee joint, which has worked well for some
time, starts to become increasingly painful or stiff, you should see your
surgeon who will arrange for some xrays to see if the
joint is loose or worn, and some other tests to rule out an infection. If
appropriate, it may be necessary to consider revision total knee replacement
surgery.
Revision total knee replacement surgery can be performed under
either general or regional anaesthesia, and these options can be discussed with
your anaesthetist prior to surgery.
Once the anaesthetic has been administered, an incision is made
down the front of the knee, usually in the same line as the scar from your
original operation. The loose or worn out components of the artificial knee
joint are removed and replaced by revision components, which are fixed with
bone cement and may incorporate metal stems or augments to make them more
secure.
Although the scar usually heals nicely, it may be more
conspicuous than the original scar and will probably be a little longer. After
a short period of observation in the recovery area you will be transferred back
to the ward.
If the revision total knee replacement is being performed for
infection, it is possible to do the operation in one sitting as described
above, although sometimes the surgery needs to be performed in two stages.
The first stage involves removing the old knee replacement, bone
cement and all infected material, and replacing it with a temporary knee
replacement which delivers antibiotics into the knee to treat the infection.
Patients can then return home for 6-8 weeks while the infection settles, and
during this time can walk using crutches or a Zimmer frame, although the
temporary knee replacement is not strong enough to bear full weight.
Once the infection has settled, the second stage of surgery can
take place. This involves re-operating on the knee to remove the temporary knee
and replace it with the definitive knee replacement components.
Revision Total Knee Replacement
BEFORE SURGERY
Revision Total Knee Replacement
AFTER SURGERY
Revision total knee replacement is a major operation and some
patients may need to go to a high dependency or intensive care unit for a few
days afterwards. However, once you have recovered and are back on the
orthopaedic ward, your progress will be similar to that after your original
total knee replacement. The medical and nursing staff will ensure that your
pain is well-controlled, and will get you out of bed to start standing and
walking as soon as possible after your operation.
You will start with a walking frame under the supervision of a
physiotherapist, who will give you instructions and show you exercises that you
should continue once you return home. It is very important in the early stages
to work hard to get the knee bending as much as possible, and you should expect
to regain more than 90 degrees of knee bend within the first couple of weeks.
You will have an X-ray taken of the knee, which you can look at and discuss
with your surgeon, and by the time you are discharged (about five days after
surgery) you will be walking comfortably and safely with two sticks or crutches
which you should continue with for the next six weeks. You should be able to go
up and down stairs one at a time, get yourself to the lavatory and on and off
the bed independently, although you may need some help with shopping and other
domestic tasks.
If you live alone and are worried about how you will manage
after your operation you should discuss this at your initial consultation so
that arrangements can be put in place.
You will be reviewed by your surgeon at six weeks, and as long
as there are no problems you will be encouraged to start walking without sticks
or crutches, and should be able to return to driving.
You may gradually increase your level of activity and should be
able to return to normal activities within the next six to nine months,
although vigorous activities and impact sports might cause the knee to wear out
more quickly and should really be avoided.
The results of a revision total knee replacement are generally
not as good as those of the primary operation, although the majority of
patients will get excellent pain relief and should
regain a range of movement that is similar to that of the original knee
replacement. Two stage operations for infection have a more than 80% chance of
success, and at least 75% of revised knee replacements will be functioning well
after 10 years.