complex or primary revision (redo) knee replacment

What is Complex or Primary Revision (Redo) Knee Replacement?

Although Total Knee Replacement has been shown to achieve long-term success in several cases, it sometimes happens that the substituted knee components loosen or wear out after about 15 to 20 years.

Depending on the extent to which the knee replacement needs to be repaired, a Complex or Primary Revision (Redo) Knee Replacement usually takes longer and is much more complicated than replacing knee components for the first time.

On top of replacing the worn out parts, the bone in which the replacement parts have been installed might have been damaged or weakened, which means this needs to be addressed, as well.

Those who have had a knee replacement might need to have it revised some time down the line, if the knee they had treated becomes swollen, stiff, unstable or starts to hurt, and they have trouble doing everyday tasks. If bracing the knee and physical therapy are unable to help, knee replacement revision surgery might be needed.

It’s also more likely for younger people who have had knee replacements to need revision simply because they live longer than the projected lifespan or durability of the replacement parts.

For some people who have had knee replacement, the surgeon might have expected the bone to grow into the prosthesis, but because of everyday wear and tear, the prosthesis might have loosened just the same. Over time, the person might also have gained more weight, which may place more stress on the prosthesis. The prosthesis itself might also become infected.

For others, minute particles might have come off of the plastic in the prosthesis in the course of daily use, which might be regarded as foreign bodies by the immune system, and are therefore attacked. This causes osteolysis, which is a condition where the immune system attacks healthy bone around the prosthesis, which loosens or destabilises the prosthesis itself.

It’s also possible that someone who had a total knee replacement is unable to regain their full range of motion because of too much scar tissue building up around the knee. In this case, the surgeon may attempt to restore your range of motion by manually bending the knee under anaesthesia. If this proves ineffective, knee replacement revision surgery might be recommended.

Other cases where revision surgery might be needed involve periprosthetic fractures, which are fractures of the bones around the replaced knee, usually resulting from an accident or fall.

This procedure is done either under general or regional nerve block anaesthesia—you can discuss which type is best for you with the anaesthesiologist. The surgery itself takes about two to three hours.

The kind of surgery done will depend on whether one or more, or all of the components of the prosthesis will have to be replaced, and how much of the bone around the knee will have to be repaired. In repairing the bone around the knee, the surgeon will either use a bone graft or metal pieces called augments that will serve as bone substitutes.

Because of the bone damage, it will be hard for the surgeon to use the standard prosthesis used in total knee replacement, which means special prostheses that are thicker, longer and can penetrate deeper into the bone will be needed.

In removing the original prosthesis, the surgeon preserves as much of the natural bone as possible, and removes any cement that was used in the original replacement procedure. This cement removal is part of the reason why revision surgery takes so long. The bones are then prepared to receive the replacement prosthesis.

If the revision is done because of infection, the surgeon can either wash the bacteria out and replace the plastic component in between the bones, which is a process called debridement.

If the prosthesis has to be totally removed to treat the infection, the surgeon has to carry out two separate procedures. In the first, the prosthesis will be removed and a temporary one treated with antibiotics will take its place. The patient will also be given antibiotics intravenously. Once the infection clears up, the temporary prosthesis will be removed and replaced with another one.

Knee replacement revisions don’t last long as an original or first-time knee replacement (generally just 10 years instead of 20) and are more prone to complications.

As with any type of surgery, knee replacement comes with risks, especially since this type of surgery takes longer and is far more complicated. A fracture might take place during the surgery itself. There is also the risk of infection, which may take place where you have it done, at home while you’re recovering, or even years after the procedure.

The wound may also take a longer time to heal, and you may feel your knee is rather stiff and unable to move as much. This procedure also comes with the risk of bleeding, blood clots and blood vessel or nerve damage. Blood clots might even occur in the lungs, and the patient may suffer a stroke, a heart attack or lung problems.

Singapore Knee

How do you prepare for a Knee Replacement Revision? You will need to have a thorough physical check-up several weeks before the procedure to make sure you will be able to withstand surgery and make a full recovery. If you have a heart condition or any other physical conditions you may also need clearance from the necessary specialists.

X-rays, MRI’s and CT scans may also be taken to help the surgeon assess the condition of the bones and to look for the reasons behind the loosening or failure of the prosthesis. To find out whether there is an infection, fluid may be taken from the knee using a syringe, and analysed in a lab along with blood samples.

It’s natural to feel pain after surgery, but there are medications such as anti-inflammatory drugs and local anaesthetics to help manage pain and facilitate your recovery. Make sure you talk to your surgeon if the pain has not begun to subside a few days following the procedure. Do not soak your wound in water until it has completely dried up and sealed.

Co-operate with your physical therapist and do the prescribed exercises for regaining your range of motion and strengthening your leg. This will help you to start walking and resume your normal, everyday activities as soon as possible. Moving your foot and ankle right after surgery is recommended to help prevent blood clots and swelling.

Pain is your body’s way of telling you that something is not right. Don’t just brush it off and risk the chance of compromising your movement and interupting your daily activities. Get it checked today for the right intervention the soonest possible time. Book your appointment with Dr. Dutton, here.

Have a question? Chat with a professional

DON'T PUT UP WITH THE PAIN! MAKE AN APPOINTMENT

Old Couple Jogging Happy - Orthopaedic Clinic Singapore - Dr Andrew Dutton