Knee replacement surgery is one of the most successful procedures today. That’s partially thanks to the many improvements made in implant materials and surgical techniques. As a result, 85 to 90% of those who get knee replacement today can expect substantial pain relief, greater knee function and improved quality of life for up to 20 years after their initial procedure.
But in a small number of cases, a knee replacement will fail, and you may require revision surgery. In this surgery, your surgeon removes some or all of your implant and replaces it with new parts. Knee replacement failure can happen for a number of reasons, but these four are the most common for knee replacement revision surgery.
A knee replacement revision, also called revision total knee arthroplasty and reoperation, is surgery to replace a failing knee implant. When a knee implant doesn’t function as it should or the procedure leads to complications, the implant needs to be replaced with a new one through knee revision surgery.
There are different types of knee revision surgeries. Some involve replacing only part of an implant. On the other hand, a total knee replacement revision involves replacing all three components of the implant — femoral, tibial and patellar — and sometimes in both knees. When the whole implant is revised, surgeons need to augment bone lost through the initial knee replacement surgery.
A knee revision is a complex procedure that requires careful preoperative planning, prolonged operating times, specialized tools and implants, and advanced surgical techniques. Orthopedic surgeons undergo extensive training to be able to perform this procedure.
While both surgeries aim to improve the functioning of knee joints, they have more differences than things in common. Knee revision surgery is more complex and requires a longer operating time than an original knee replacement. Rehabilitation and recovery are also slower.
One reason why a knee revision is so complex and taxing on the body is that your surgeon has to first remove the original implant that has now likely grown into the surrounding bone. Because of this, there is also less bone to work with, and your surgeon will need to use a bone graft to replace missing bone. A bone graft adds support and promotes bone growth.
Additionally, there is often extensive damage to existing bone, ligaments, muscles and other tissues in patients who need a knee revision. This puts patients at greater risk of infection and other complications and may lead to further revisions in the future.
There are many reasons people who have had knee replacement surgery may need to come back for a revision. However, the most common reasons are:
Infection is a rare and short-term complication that can show within days or weeks following a knee revision. The metal and plastic surfaces in knee implants can be breeding grounds for bacteria that antibiotics cannot access. This can cause pain, swelling and drainage.
Luckily, this complication is found in less than 1% of all cases. The degree of infection and the severity of damage it causes determines the type of treatment needed.
In some cases, the surgeon may need to perform two separate surgeries. The first one involves removing the original implant and replacing it with a block of cement. The second one involves placing a new implant. In between these two procedures, patients are given antibiotics to resolve the infection.
Over the years, the plastic spacer used in most knee implants can wear down, causing the implant to loosen from the surrounding bone. The progression of arthritis can also lead to implant loosening and knee instability.
You’re more likely to develop this problem if you have a knee replacement at a young age, if you’re overweight or if you take part in high-impact activities. All these factors put more pressure on your implant and knees, which can lead to deterioration over time.
A loosening implant can lead to pain and loss of motion. You may be more prone to falls as well due to knee instability.
Because accidents can and do happen, some patients develop injuries that require a revision of their knee replacement. Motor vehicle accidents, falls and other types of trauma can lead to bone fractures and dislocation of the new knee joint.
A multidisciplinary approach is usually needed when an injury is the primary reason for a knee revision procedure. Surrounding blood vessels may also become damaged, which requires help from a vascular surgeon. If there are bone fractures involved, surgeons will also need to repair the fracture while performing the knee revision.
Some patients develop abnormal or excessive scar tissue around the new knee, which can cause pain and stiffness. This condition is known as arthrofibrosis and can be quite debilitating, making it hard to walk and perform other basic tasks. Researchers believe this problem happens when there is an abnormal immune reaction to surgery.
Initially, the condition is treated with rest, cold packs, anti-inflammatory drugs and physical therapy. Doctors can also treat arthrofibrosis by breaking up the scar tissue through small incisions in the knee. When all other measures fail, patients may need a knee revision surgery to restore normal function to the joint.
Patients can also develop problems with ligaments around the knee, which can lead to instability. However, this problem rarely requires knee revision and is usually treated with physical therapy, bracing and soft tissue tightening.
Learn More About Knee Revision in Lima, OH
Our physicians at the Orthopaedic Institute of Ohio have been specially trained to perform knee revision surgeries using advanced techniques. With our many years of experience treating a wide range of patients and using state-of-the-art technology, you can trust our team to ensure your knee revision goes seamlessly.
Contact the Orthopaedic Institute of Ohio today if you want to learn more about what knee revision surgery is like and what you can expect.