• Knee
    Arthroscopy
  • ACL
    Reconstruction
  • ACL Reconstruction with
    Allografts and LARS Ligaments
  • Acute
    Knee Injury Clinic
  • Partial
    Knee Replacement
  • Knee
    Replacement
  • Hip Replacement &
    Resurfacing
  • Skiing and
    Snowsports
  • Revision Knee
    Replacement
  • Revision Hip
    Replacement
  • Anterior Minimally
    Invasive Hip Replacement
  • Computer
    Assisted Surgery

Revision Knee Replacement

Introduction

Revision Knee Replacement means that part or all of your previous knee replacement needs to be revised. This operation varies from very minor adjustments to larger operations replacing all of the previous implants. The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).

Why does a knee replacement needs to be revised?

Plastic (polyethylene) wear – This is one of the easier revisions where only the plastic insert is changed.

Instability – This means the knee is not stable and may be giving way or not feel safe when you walk.

Loosening of either the femoral, tibial or patella component – If the implants lose their attachment to the bone there is micromotion that causes pain. Revision is required.

Infection- usually presents as pain but may present as swelling or an acute fever.

Osteolysis (bone loss). This can occur due to particles being released into the knee joint that result in bony erosion and loosening of the implants.

Stiffness- This is difficult to improve with revision but can help in the right indications.

Pre-Operation

  • I will organise routine blood tests and any other investigations required prior to your surgery
  • You may be asked to undertake a general medical check-up with a physician
  • You should have any other medical, surgical or dental problems attended to prior to your surgery
  • Make arrangements for help around the house prior to surgery
  • Cease anticoagulants such as aspirin, Cartia, Plavix, warfarin, Xarelto etc 7 days prior to surgery as they can cause bleeding
  • Cease any naturopathic or herbal medications 10 days before surgery
  • Stop smoking as long as possible prior to surgery

Day of Surgery

  • You will be admitted to the hospital usually on the day of your surgery
  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your anaesthetist, who will ask you a few questions
  • You will be given hospital clothes to change into and have a shower prior to surgery
  • The operation site will be shaved and cleaned
  • Approximately 30 minutes prior to surgery, you will be transferred to the operating room

Surgical Procedure

Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.

Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss.

 

 

The length of the procedure will depend on the complexity of the job that is required.

Post-operation Course

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain medication through a machine (Patient Controlled Analgesia or PCA).

Once stable, you will be taken to the ward. The post-op protocol is tailored to the specific surgery that you have had. In general  you will sit out of bed and start moving you knee and walking on it within a day of surgery. The dressing will be reduced usually on the 1st post-op day to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist.

To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.

I employ several measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings, early moblisation and blood thinning injections.

The ultimate function of your revision knee replacement will largely depend on how much work you put into it following your operation.

Usually you will be in hospital for 3-5 days and then either go home or to a rehabilitation facility depending on your needs. You will need physical therapy on your knee following surgery.

You will be discharged on a walker or crutches and usually progress to a walking stick at 2-3 weeks.

Your skin sutures will dissolve and will not need removal. The sterile waterproof dressing should remain intact for 2 weeks. It is safe to shower and attend for hydrotherapy with the waterproof dressing intact.

You are encouraged to put as much work as you can into gaining the best possible range of motion in your new knee.

You can drive when you are able to walk without crutches and have good control of your leg. You should not drive if you are taking strong analgesics e.g. Endone, codeine etc.

You may increase your activity level within comfort limits  and without restriction.

You will usually have a 6 week check-up with me in the office.

If you ever have any unexplained pain, swelling, redness or if you feel unwell you should contact me or see your doctor as soon as possible.

Risks and Complications

  • As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages
  • It is important that you are informed of these risks before the surgery takes place

Complications can be medical (general) or local complications specific to the Knee

Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

  • Allergic reactions to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization etc.

Local complications

Infection

Infection can occur with any operation. In the hip this can be superficial or deep. If it occurs it can be treated with antibiotics but may require further surgery. Very rarely your implants may need to be temporarily removed to eradicate infection.

Infection is very rare in the hospitals where I do revision knee replacement surgery.

Blood Clots (Deep Venous Thrombosis or DVT)

These can form in the calf muscles and can travel to the lung (Pulmonary embolism).  If you get calf pain or shortness of breath at any stage, you should notify the medical team.

Stiffness in the knee

Ideally your knee should bend freely but on occasion the knee may not bend as well as expected. Sometimes manipulations are required, this means going to the operating room where the knee is bent for you under anesthetic the knee.

Wear

The plastic liner may wear out over time, and may need to be changed. However it should be noted that the current 3rd generation polyethylene has an extremely low wear rate and therefore revisions for wear are likely to be far less common than with older first and second generation implants.

Wound Irritation or Breakdown

Surgery will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream, bio-oil and massaging can help reduce this.

Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely further surgery.

Cosmetic Appearance

The knee may look different than it was because it is put into the correct alignment to allow proper function.

Patellar Problems

The Patella (knee cap) can dislocate. Further surgery to stabilise the patellofemoral joint may be required.

Ligament Injuries

There are a number of ligaments surrounding the knee. These ligaments can be torn or stretch with injury or time. Surgery may be required to correct this problem.

Damage to nerves and Blood Vessels

Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

Feel free to discuss your concerns with me prior to surgery.

Summary

Revision knee replacement surgery is complex but done well can lead to excellent long term outcomes for patients. Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.

Surgery is only offered when non-operative treatment has failed or unlikely to work. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.

  • St Vincent's Hospital Sydney
  • Macquarie University Hospital
  • Australian Orthopaedic Association
  • The Royal College of Surgeond of Edinburgh
  • Royal Australasian College of Surgeons
  • The Royal College of Surgeons of Ireland
  • Sydney University Football Club
  • Bulldogs
  • Cronulla Sharks
  • Moximed