Knee revision surgery is also referred as revision total knee arthroplasty. It is the procedure to remove the pre implanted prosthesis or knee joint made artificially and replacing it with the new one. The procedure also involves usage of grafts of bone. This bone graft also could be an autograft, a bone that is taken from the same patient, but from another site. The bone graft can also be an allograft, a bone tissue donated by a donor.
Need and Purpose
Knee revision surgery is performed majorly for three purposes.
- To relive the pain from the affected hip
- To restore the mobility of the patient
- To remove the loose or damaged prosthesis to ensure irreversible harm is happened to the joint
Loosening of the prosthesis can happen for various reasons. The first reason is mechanical facts and the second one is inflammation development in the joint of the knee. In case the prosthesis is damaged, infected or possibly dislocated completely, has to be removed and a new one must be replaced to ensure that the patient’s knee is not permanently damaged.
Diagnosis is done to ensure that the revision of the knee replacement is necessary. The diagnosis includes stiffness, increase of pain, diffusing pain, pain felt in the whole knee along with tissue fluid, pain felt in part of the leg or lower thigh.
Preparation according to the Risk Factors
Surgeons consider six important factors, to ensure the need for the revision of the knee surgery.
- Age, as younger patients are more active usually
- Any kind of arthritis
- A long stay in hospital comparatively for the originally done knee surgery
- Surgical complications occurred during the first operation of the knee
- First knee operation that has been performed in the urban hospital
- Concurrent disorders or diseases
Knee revision surgeries are similar to the other knee replacement surgeries and usually take three hours of time. The procedure starts with the anesthesia given to the patient. The knee joint is opened then by cutting the joint capsule. The first step in this surgery is to remove the old femoral component present in the knee prosthesis. The metal shell is then removed. The bone that is damaged is scrapped off at the end of the femur and later the femur will be reshaped. In the cases that the bone is found to be weak, cavities might be filled into the femur taking some bone grafts. Sometimes metal wedges are also used for the attachment to be strengthened for the new femoral component and to glue in the right place using the cement. Old implant present in the tibia is then removed. In order to receive and fit the new implant, the bone is reshaped accordingly. Depending on the condition of the older implant, necessary processes are performed accordingly.
In the case the revision is required because of the infection in the knee, there would be two operations performed separately. The first operation is performed to remove the old prosthesis and then insertion of block of polyethylene cement, which is also known as spacer block into the joint. The spacer block is then given antibiotics for fighting with the infection. Then the incision will be closed and the same is remained in the knee of the patient for about six weeks. For these six weeks, intravenous antibiotics are given to the patient. After ensuring that the infection gets cleared, another operation is performed to implant the new revision prosthesis.
The risks associated are the following.
- Infection developed in the new prosthesis
- Deep vein thrombosis
- New prosthesis loosening
- Heterotopic bone forming
- Possible bone fractures, occurring during the operation
- New prosthesis dislocation
- Varied lengths of leg
- Loss of tissue of bone, rapidly
Aftercare for the revision of the knee replacement is usually the same just like the original knee replacement. So, the aftercare includes the physical therapy, medication for the pain, whenever necessary, exercises for rehabilitation and total period of the assistance or healthcare at home.
Cost of Revision of Knee Replacement Surgery
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