Revision total knee replacement
In the clear majority of cases, total knee replacement enables people to live richer, more active lives, free of chronic knee pain. Over time, however, a knee replacement may fail for a variety of reasons. In a revision total knee replacement, we remove some or all the parts of the original prosthesis and replace them with new ones.
Revision total knee replacement is a longer, more complex procedure that requires extensive planning, and specialised implants and tools to achieve a good result.
Damage to the bone may make it difficult for us to use standard total knee implants for revision knee replacement. In most cases, we will use specialised implants with longer, thicker stems that fit deeper inside the bone for extra support.
We will recommend that you have a revision total knee replacement if you have any of the below -
- Implant loosening and wear
- Infection
- Instability
- Stiffness
- Fractures
Revision total knee replacement is usually performed under general anaesthesia. In most cases, the surgery takes from 2-3 hours. The incision may be longer than the original to allow the old components to be removed.
Once the incision is made, we will move the patella and tendons to the side to reveal your knee joint. Then, we will examine the soft tissues in your knee to make sure that they are free from infection. We will assess all the metal and/or plastic parts of the prosthesis to determine which parts have become worn or loose or shifted out of position. The original implants are removed very carefully to preserve as much bone as possible. If cement was used in the primary total knee replacement, this is removed as well. Removing this cement from the bone is a time-consuming process that adds to the complexity and length of the revision surgery.
After removing the original implant, we will prepare the bone surfaces for the revision implant. In some cases, there may be significant bone loss around the knee. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits. Rarely, bone graft material may be used to help rebuild the knee. The graft may come from your own bone (autograft) or from a donor (allograft).
Finally, we insert the specialised revision implant, repair any surrounding soft tissues that are damaged, and carefully test the motion of the joint.
Following surgery, you will be moved to the recovery room, where you will remain for several hours. Here, your recovery from anaesthesia is monitored. After waking up, you will be taken to your hospital room where you will most likely stay for several days.
Although recovery after revision surgery is usually slower than recovery after primary total knee replacement, the type of care you will receive is very similar.
Because the procedure is longer and more complex than primary total knee replacement, it has a greater risk of complications. The possible risks and complications of revision surgery include:
- Poor wound healing
- Reduced range of motion or stiffness in the knee
- Infection in the wound or the new prosthesis
- Bleeding
- Blood clots
- Bone fracture during surgery
- Damage to nerves or blood vessels
- Pulmonary embolism
Most patients who have revision surgery experience favourable long-term outcomes, including relief from pain and increased stability and function. However, complete pain relief and restoration of function is not always achievable and some patients may still experience pain or knee stiffness following revision surgery.
