Knee Revision Surgery
An individually tailored solution for a failing knee replacement
Knee revision (another repeat knee replacement) involves replacing your failing artificial knee joint because it has become loose, unstable, infected or worn out. It is uncommon to see two patients with exactly the same knee problem. The implication, therefore, is that solutions for patients who have failed knee replacements have to be tailored individually, an area of specialist interest to Mr. Williams.
If the device fails, becomes worn or infected, revision surgery may be required to replace the damaged prosthesis with a new one. Knee revision surgery is much more complicated that the original knee replacement, it carries many of the same risks as the initial surgery, but it is more susceptible to complications.
What Happens During Knee Revision Surgery?
There is little doubt that revision knee surgery is generally much more involved and complicated than a primary (first time) knee replacement operation. Overall, it is a more lengthy operation and associated with a higher level of risk. Patients generally take longer to get over this type of surgery. However, it is crucial to understand that while the primary knee replacement operation is a fairly standard and predictable procedure, the outcome of revisions varies from patient to patient.
The revision surgery takes place under anaesthetic, this can be general, where you are asleep throughout the procedure, or epidural, where you can’t feel anything from the waist down. Mr. Williams will then make an incision over the knee and remove the all or part of the existing knee replacement.During the removal process, Mr. Williams will take great care in ensuring minimal damage to the bone and soft tissues. Once this is complete, Mr. Williams inserts new (and often more complicated) joint replacement component(s) into the joint. In the case of infected joint replacements, a “staged” procedure may be necessary with more than one surgical sessions necessary.
What are the risks of Revision Knee Surgery?
- Thrombosis – As revision surgery is more prolonged and the state of the soft tissues and bone often not as good as when first time surgery is carried out, patients undergoing revision surgery are at a high risk of thrombosis. Patients undergoing this type of surgery may not be as mobile as the patients having first-time surgery. This factor too may contribute to the higher risk of blood clot formation.
- Infection – This remains one of the more serious complications. In order to reduce the risk of infection, patients are given antibiotics routinely into the vein just prior to the surgery and at least two doses after.
- Nerve and Blood vessel injury – Rarely, a nerve or blood vessel may get injured. Recovery following this is variable.
- Fracture of the bone – The word ‘fracture’ is a technical term for a break in the bone. The risk of fracture during the operation is certainly more so that at the time of primary surgery. This is again due to the soft tissue and bone quality.
- Loosening of the revision knee – As with primary hip replacement surgery, there can be no guarantee that the revised hip will last a life time.
- Failure to improve symptoms. Due to the nature of knee problems necessitating revision, results can be on some occasions be unpredictable.
Please talk to Mr. Williams before your operation if you have concerns about possible risks.
What Happens After The Surgery?
As with the rehabilitation program for the initial knee replacement, you will be encouraged to undertake regular exercises to help increase the mobility of the joint and strengthen the surrounding muscles. Physiotherapy will help you rehabilitate as quickly as possible so that you can enjoy a wider range of movement and less pain. It is also important for patients to have regular follow-up appointments after the operation to pick up any signs of failure so that the problem can be dealt with earlier and more easily.
General advice following Revision Knee Surgery
Listed below is some advice with regards to the postoperative period following a revision knee replacement. Mr. Williams, the nursing team and the physiotherapist will discuss this in greater detail prior to your discharge from Werndale hospital.
- You can expect some pain but not the same sort of pain as you had before the operation. It is important to take your painkillers as advised.
- Swelling and bruising may take up to 8 weeks to disappear; for some it can last up to 6 months.
- After your skin clips have been removed you can have a shower or bath once we have shown you how to use it safely. Until then your wound will need to stay covered with a dressing.
- Try to gradually increase your activity each day by walking as well as continuing your exercises.
- You must not drive or resume any sporting or gardening activities until you have seen Mr. Williams and he has cleared you to do so.
One of Mr. Williams nurses will keep in touch with you by phone and a follow-up appointment 6 to 8 weeks after surgery will have been booked prior to your operation.
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