Revision Knee Replacement

Complexity and Duration

Revision surgeries are inherently more complex and generally take longer to perform than primary knee replacements. This is due to the need to remove the previous implant, address any bone loss, and prepare the bone for the new implant.

Prosthesis Type

The prostheses used in revision surgeries are often different from those used in primary surgeries. They may include additional components to compensate for bone loss or to enhance stability.

Surgical Challenges

Revision knee replacement faces unique challenges, such as dealing with scar tissue from the previous surgery, bone quality issues, and the presence of complex deformities or instability.

Preoperative Assessment and Planning

This phase involves a comprehensive evaluation of the patient’s medical history, physical examination, and imaging studies such as X-rays, MRI, or CT scans to assess the condition of the existing implant, bone quality, and the extent of any bone loss or deformity. Blood tests may also be conducted to rule out infection.

The surgical team uses this information to plan the surgical approach, select the appropriate revision prosthesis, and anticipate the need for any special techniques or tools to address bone defects or other challenges.

Surgical Steps

The entire procedure can take several hours, depending on the complexity of the case and the extent of the preparation required to accommodate the new implant.

1. Anaesthesia and Incision: Revision knee replacement is performed under general or spinal anaesthesia. The surgeon makes an incision over the knee to access the joint.
2. Removal of the Old Implant: Specialized tools are used to carefully remove the old prosthesis while minimizing damage to the surrounding bone and tissues.
3. Preparation of the Bone: Once the old implant is removed, the surgeon assesses and prepares the bone surfaces for the new implant. This may involve removing any damaged or infected tissue, treating bone defects with bone grafts or metal augments, and shaping the bone to fit the new prosthesis.
4. Implantation of the New Prosthesis: The selected revision implant, which may include additional components such as stems for enhanced fixation, is carefully positioned and secured in place.
5. Closure: The incision is closed with sutures or staples, and a dressing is applied to the wound.

Initial Recovery Phase

• Hospital Stay: Patients typically spend a few days in the hospital post-surgery, during which pain management, prevention of infection, and early mobilization are prioritized.
• Pain Management: Effective pain relief strategies are employed to manage postoperative pain, facilitating earlier participation in rehabilitation.
• Early Mobilization: Under the guidance of physical therapists, patients begin gentle knee movements and exercises soon after surgery to promote circulation, prevent stiffness, and strengthen the knee.

Rehabilitation Process

• Physical Therapy: A tailored physical therapy program is essential, focusing on gradually increasing knee strength, flexibility, and range of motion. The program evolves over weeks to months, adapting to the patient’s progress.
• Home Exercises: In addition to supervised therapy sessions, patients are given exercises to perform at home to enhance their recovery.
• Follow-up Assessments: Regular follow-up with the surgical team allows for monitoring of the knee’s healing and adjustment of the rehabilitation plan as necessary.