Revision Knee Replacement

What is Revision Knee Replacement?

Revision knee replacement surgery involves replacing a part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and may require a revision surgery.

Indications for Revision Knee Replacement

Revision knee replacement surgery may be advised if you have one or more of the following conditions:

• Trauma to the knee joint
• Chronic progressive joint disease
• Increased pain in the affected knee
• Worn out prosthesis
• Knee instability or a feeling of giving way while walking
• Loosening of the prosthesis
• Infection in the prosthetic joint
• Weakening of bone around the knee replacement - a process known as osteolysis (bone loss)
• Stiffness in the knee
• Leg length discrepancy 
• Fracture around the prosthesis

Revision Knee Replacement Procedure

• Revision knee replacement surgery may involve the replacement of one or all the components.
• Revision knee replacement surgery is performed under regional (spinal) or general anaesthesia.
• During the procedure, Mr Sakis Pollalis will make an incision your knee to expose the knee joint. The kneecap along with its ligament may be moved aside so that there is enough room to perform the operation. Then, the old femoral component of the knee prosthesis is removed. Next, the tibial component along with the old plastic liner is removed.
• The damaged bone is cut and both the femur and the tibia are prepared to receive the new components. In some cases, the damaged bone is removed and bone graft or a metal wedge may be used to make up for the lost bone. 
• Next, your knee is tested with trial implants to check the alignment, soft tissue balancing, and range of movement. After that, the final femoral and tibial components are attached to the end of the bone with bone cement. A new plastic liner will be placed on top of the tibial component. If the patella (kneecap) has been damaged, Mr Pollalis will resurface and attach a plastic component. The tibial and femoral components of the prosthesis are then brought together to form the new knee joint.
• The muscles and tendons around the new joint are repaired. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed with absorbable sutures and a sterile dressing is placed over the incision. Drains are generally avoided to enable early mobilisation and discharge.

Postoperative Care for Revision Knee Replacement

Rehabilitation begins immediately following the surgery. Initially, you will be taken to a recovery area where your pain levels will be monitored, and you will be encouraged to begin moving your knee. You will soon be moved to the ward where you will be assisted to get dressed and you will be offered a meal. You will be given pain medications to ease pain. Whilst in hospital you will have to wear stockings to prevent blood clots in your legs. Physical therapists will work with you to take your first steps using a walker or crutches. They will also provide you with a home exercise program to strengthen your thigh and calf muscles. You will have blood tests and an x-ray to check the positioning of the implants. Mr Sakis Pollalis will review you regularly whilst in hospital and after your discharge to make sure you are progressing well.

Risks and Complications of Revision Knee Replacement

Like all major surgical procedures, there may be certain risks and complications involved with revision knee replacement surgery. The possible complications after revision knee replacement include:

• Infection
• Blood clots in the leg or lung
• Knee pain, stiffness, or limited mobility
• Numbness around the wound
• Ligament injuries
• Patella (kneecap) dislocation
• Bone fracture
• Nerve or Blood Vessel Injury
• Bleeding and Hematoma
• Prosthesis Failure or Loosening
• Requirement of additional surgery
• Cardiovascular risks, also leading to life-threatening complications
• Allergic reaction
• Anaesthetic risks

If you would like to have additional information on the treatment of various knee conditions or would like to learn more about revision knee replacement, please contact Mr Sakis Pollalis serving the communities of Buckinghamshire and Berkshire.