Revision Joint Replacement Surgery

Information for Revision Knee Replacement

Procedure: As you will be aware your knee joint has already undergone a knee replacement either partial or complete. Unfortunately the knee replacement which has already been carried out is no longer working satisfactorily. As a result after evaluation and discussion with Dr Aman Dua / Dr Dharmesh Khatri you have decided that revision knee surgery is now are required. This involves removal of the original knee replacement implants, which is no longer functioning well and exchange / replace that with a further Revision knee replacement implant. Removal of prefixed implants may result in damage to the surrounding bone, removal of some extra bone may be required to provide a stable base into which the revision knee replacement can be cemented to bone. The new revision implant is usually more complex and constrained in order to improve your knee function and provide stability. Additional long stems inside the bones, metal augments, cones or sleeves may be required to enhace fixation of implants and to cover for bone loss.

Sometimes in order to gain sufficient access in tight joints or in severe scarring, surgeons may need to release the extensor mechanism. This is repaird at the end of the procedure but can make the power of straightening the knee weak. Sometimes the under surface of the knee cap also requires replacement or exchange of the original knee cap replacement. When Surgeons are happy with the position and movements of the knee, the tissue and skin can be closed.

Knee revision is usually performed when the pain from your original knee replacement is sufficiently severe for you to say that you are unable to manage given your ongoing symptoms. On occasions knee revision is required because the loosening of the original components are causing damage to the surrounding structures and on occasions because there is significant risk of infection in the joint. Usually in the case of infection the revision surgery would be carried out in 2 stages. The 1st to remove the infected implants debride the joint and replace it with antibiotic cement spacer. After stage 1 patient is followed up regularly with blood markers for infection and the 2nd stage is carried out some months later once the infection has been eradicated. Incase stage 1 procedure fails to eradicate infection, redebridement and cement spacer implantation may be required multiple times till infection is erdicated before going to stage 2. Dr Aman Dua / Dr Dharmesh Khatri has already decided for you based on your symptoms and investigations if a single stage revision can be carried out, however, there is always a possibility that when the knee replacement is opened surgically there is evidence of deep infection which may require conversion to a 2 stage revision.

Alternative Procedure: Other alternatives to surgery include living with your symptoms and taking pain killers until the level of your symptoms warrant revision surgery. In the case of proven infection sometimes antibiotic suppression may be a possibility. Sometimes the use of a knee brace may be sufficient to keep your symptoms under control. Some of these alternatives may not be appropriate for you however you should discuss all possibilities with surgeons.

Risks and complications

The detailed risks and complications are provided as part of the consent for total knee replacement, but, Extensive exposure, longer duration of procedure, poor soft tissue, difficulty in removing the older components, poor bone quality and bone loss may increase the risk of complications like wound problems, Infection, early loosening, fractures during surgery, Instability, decreased range of motion and need for braces and walking aids. The period of recovery in typically longer than in primary knee replacement and you may be advised non-weight bearing mobilization for initial few months.

Detailed consent form for Total Knee Replacement is provided at the time of consultation.