Revision Knee Replacement

Primary knee left, revision knee right

Primary knee left, revision knee right

WHAT IS REVISION KNEE REPLACeMENT SURGERY?

A revision knee replacement operation is any surgery in which parts of a previously performed total knee replacement are redone or replaced. This can be anything from a relatively minor change of the plastic liner, to a major operation involving replacing the entire prosthesis and managing defects in the surrounding bone.

WHY IS A REVISION TOTAL KNEE REPLACeMENT PERFORMED?

There are many reasons why a revision knee replacement may be required. These include loosening or wear of the old implants, infection, instability, fracture and patellofemoral pain. Follow this link to learn more about the reasons for revision knee replacement.

What does revision knee surgery involve?

ATTUNE REVISION KNEE SYSTEM 866x866.jpg

As with primary knee replacement surgery, most of the time the operation is done under spinal anaesthetic. This involves a small injection in your back that will make the lower half of your body completely numb for around four hours. You can have a general anasthetic if you prefer to be asleep for the operation. After the anaesthetic is administered, your leg will be cleaned with antiseptic liquid and covered with sterile surgical drapes. Revision knee replacement is more complex and takes longer to perform than a first time knee replacement. The operation can take anything from 90 minutes to four hours or more.

The old scar (incision) is opened and the worn or problematic old implants are removed. Any implants which are still in good condition are left alone. Often the previous implants, or old bone cement can be stuck firmly to your bone. These need to be removed very carefully to preserve as much bone as possible. Once the old implants are removed, the bone is cleaned thoroughly and prepared to receive the new implants. The implants used for revision surgery are specially designed to accommodate for bone loss, and are often much larger and more complex to insert than the original prosthesis. Sometimes additional metal implants called cones and sleeves, or donated bone graft are required to build up areas where there has been significant bone loss. The final construct is tested, and the skin is then closed with dissolving stitches. Dressings are put on, including paper stitches (steri-strips) and a waterproof dressing. You will be moved onto a comfortable bed and taken to the recovery area to wake up. While you are in the recovery area an x-ray will be taken of your new knee joint.

WHAT IS THE RECOVERY AFTER SURGERY?

Much of the initial recovery after revision knee surgery is the same as for primary (first time) knee replacement. After surgery is complete, you will be taken to the ward in another part of the hospital. If you have had a spinal anaesthetic your legs will stay numb for another 2-3 hours. You can eat and drink normally as soon as you feel ready. Your nurse will monitor your pulse, blood pressure and oxygen levels. They will also provide you with pain relief and anti-nausea medication as required. It is better to keep on top of pain instead of letting it build up. You will have foot pumps on your feet to help keep your circulation moving and prevent blood clots in your legs. Moving your feet regularly yourself also helps to prevent clots.

As revision surgery is often longer and more complex than your first knee replacement the recovery may take longer. You will need to stay in hospital for between 2-7 nights after surgery. Mr Gormack will check on you each day while you are in hospital. If there was major bone loss, there may be restrictions on the amount of weight you are allowed to take on your leg. Some patients are able to get out of bed and even walk a few steps on the day after their revision surgery. A physiotherapist will see you daily; they will teach you how to walk with a frame or crutches, and give you exercises to do yourself. Once you are confident and safe to walk around and do your daily activities independently, you will be cleared by the physiotherapist to go home. Before you leave hospital you will also be taught exercises to do at home. You will be given prescriptions for pain relief medication by your anaesthetist before being discharged.

Full recovery from surgery will likely take several months. You will be able to gradually increase walking distance and duration over this time. You should keep using crutches for the first six weeks after surgery, unless otherwise instructed. You will need to have your wound checked 10 – 14 days after surgery. This can be done at Mr Gormack’s clinic or by your own GP, depending on what is most convenient. Your pain levels will steadily decrease over time. You will have an appointment booked to see Mr Gormack six weeks post-surgery. If there are any concerns earlier, please call or email the clinic.

WHAT ARE THE RESULTS OF REVISION KNEE REPLACEMENT?

The majority of patients who undergo revision surgery experience favourable long-term outcomes, including relief from pain and better function. If your original problem was an infection, this can be solved in around 90% of cases. Due to the nature of the surgery, a revision knee replacement is often never quite as good as the first one. Complete pain relief and restoration of function are not always achievable, and some patients may still experience some pain or dysfunction.

WHAT ARE THE RISKS OF SURGERY?

As with any surgical procedure, there are risks associated with revision total knee replacement. Because the procedure is longer and more complex than primary total knee replacement, the risk of complications is higher. Before your surgery, Mr Gormack will discuss each of the risks with you and will take specific measures to help avoid potential complications.

The possible risks and complications of revision surgery include:

  • Infection

  • Bleeding

  • Nerve or artery damage

  • Blood clots in the legs or lungs (DVT / PE)

  • Instability

  • Fracture

  • Stiffness

  • Tendon or ligament damage

  • Medical events after surgery such as heart attack, kidney injury, stroke, pneumonia.

WHEN CAN I DRIVE AND WHEN CAN I RETURN TO WORK?

Revision knee replacement surgery is much more varied than primary knee replacement. As such, any recommendation regarding returning to activities will require an individual assessment of your circumstances, and is based on what is found during your surgery. As a rough guide, return to driving and working will take at least six weeks; longer in many cases.