Knee Joint Revision Surgery

Knee Joint Revision Surgery

Knee replacement surgeries involve replacing the damaged bone with an artificial one (a prosthesis) to relieve the pain and restore the knee's functions. Although most knee replacement surgeries are successful, some may fail for reasons like high-impact activities, obesity, etc. These may result in the prosthetic breaking or wearing out, causing pain, stiffness, or instability and making it difficult to perform everyday activities.

When the knee replacement fails, a second surgery may be recommended, which is called knee joint revision surgery.

What is knee joint revision surgery?

Knee joint revision is a procedure in which the surgeon removes the previously implanted artificial knee joint that is no longer functioning properly and replaces it with a new implant. The procedure is also known as revision total knee arthroplasty, and it also uses bone grafts.

What are the indications for knee joint revision surgery?

The major reason for having a knee replacement revision surgery is knee pain that persists even after surgical treatment. The main problems that may trigger the need for revision surgery are:

• Loosening of the implant: For proper functioning of the bones and joints after the surgery, the implant must remain firmly attached to the bone. However, when the implant loosens, it may cause severe knee pain.
• Infection of the implant: Artificial joints can often become infected after surgery, which causes pain and stiffness in the joint.
• Instability of the knee: When the ligaments around the knee become damaged or improperly balanced, it may result in instability of the knee joint. This will alter the knee's function, cause pain, and hence require revision surgery.
• Fractures: Periprosthetic fractures (fractures around the knee implants) that affect the fixation and stability of the implant will require revision surgery.
• Osteolysis (bone loss): This is a condition characterized by the progressive destruction of the bone tissue. It is a common complication associated with replacement surgeries where the body attempts to clear the wear particles on the surface of artificial joints through autoimmune reactions. These autoimmune reactions will lead to the resorption of healthy bone tissues.

What is the pre-procedure care for knee joint revision surgery?

As knee joint revision surgeries are complex and have high rates of post-surgery complications, it is important that the procedures are done by experienced and skilled surgeons. Before undergoing the surgery, the healthcare team will prepare you to ensure a successful procedure and a fast and smooth recovery. The pre-procedure steps include:

• Your surgeon will ask you to undergo a complete physical examination, including blood tests to evaluate other health conditions. He or she will also ask you about the medications being taken, prior surgeries, and history of complications (if any) with anaesthesia.
• The surgeon will advise stopping or temporarily discontinuing certain medications such as corticosteroids, blood thinners, insulin, etc. as they might lead to issues with the operation.
• Your surgeon will order imaging tests like an X-ray, CT scan, or MRI scan to learn more about the condition of your knee.
• You will be advised not to undergo any dental procedure for at least six months before the surgery. There are chances for bacteria to enter the bloodstream during dental procedures, which may cause complications in knee revision surgery.
• You should arrange for someone to drive you back home after the procedure and assist you at home during the recovery period.

How is knee joint revision surgery performed?

You will be checked into the hospital on the day of the procedure. Your anaesthesiologist will review your primary medical history and other parameters. You will be given a hospital gown to wear before the surgery, and then you will be shifted to the operating room.

The surgical procedure will begin soon after the patient has been anesthetized. The procedure is as follows:

• The surgeon will make a deep incision through the joint capsule.
• The surgeon will analyse the components of the old knee prosthesis and remove the damaged parts.
• After removing the previous implant parts, the surgeon will prepare the bone surfaces for the revision implant.
• Bone grafting will be required to rebuild the knee joint if there is any significant bone loss.
• Bone grafts may be either autografts (bone taken from another site of the patient's body) or allografts (bone tissue from a donor or cadaver).
• The specialized revision implant is then carefully placed in the right position and is well-fixed.
• The knee joint is then washed out with sterile saline fluid, and the layers of the incision are closed.
• A temporary drain may be placed in your knee to collect any fluid or blood that may remain after the procedure.
• The motion of the joint is then carefully examined.

What is the post-procedure care?

After surgery, you will be moved to the recovery room, where your recovery from anaesthesia is monitored. Once you wake up, you will be moved to a hospital room. The recovery period involves a combination of physical therapy and medication, as instructed.

Medication is routinely given after surgery to temporarily relieve discomfort. A doctor may prescribe one or more medications to prevent blood clots and decrease leg swelling. Antibiotics to prevent infections after surgery may also be prescribed.

Your orthopaedic surgeon will refer you to a physical therapist who will teach you specific exercises to strengthen your leg and restore your range of motion. In most cases, you will begin walking and resume other daily activities as soon as possible after surgery.

Before going back home, you will be given assistive devices, such as a walker or crutches, for the first few days or until you are comfortable enough to walk without assistance. You will be asked to continue moving and exercising your knee at home as per the instructions of your physiotherapist.

It is important to keep the stitches or staples in the wound clean and dry to avoid any infections.

Outlook

Knee joint revision surgery is a highly successful operation for patients whose previous knee implant is damaged. Though knee joint revision surgery is complex, the long-term outcome of the surgery includes relief from pain and increased stability and function. More than 90% of patients who undergo revision procedures can expect to have good to excellent results. Though the surgery is successful, complications like bleeding, intra-operative fractures, blood clots, etc. can occur, which you must know before making the decision to undergo the surgery.