KNEE REVISION

Knee Revision Surgery

While the vast majority of knee prosthesis perform very well with a high level of patient satisfaction a small few require additional surgery. The reasons for this can include;

• infection,

• loosening of the one or more of the implant,

• osteolysis (bone loss),

• dislocation of the prosthesis,

• fracture around the existing implant.

What happens during Revision Surgery?

The surgery itself will depend on the reason behind the need for the revision. Usually objective of the operation is to remove the old implant and replace it with a new one.

In general, the scar used for the first replacement is used. A passage is then created behind the patella to gain access to the implant. After removal of the faulty implants, all the debris due to wear is cleaned. The healthy bone is cut again, then the femur, tibia and patella are prepared to receive the prosthesis. On occasion the fixation of the implant is reinforced by stems in the femur and tibia.

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What happens if there is an infection?

If the loosening of the implant is linked to infection, a period of approximately 6 weeks is often required between the removal of the old implant and the placement of the new one.

During this period, a Spacer, or temporary implant, is fitted to leave the bone time to heal with antibiotics. Once blood tests indicate that the infection has been appropriately treated a decision can be made to proceed with a longer term solution. 

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Post-operative rehabilitation and return to activities. It will be the intention of the physiotherapist to get you mobile within pain limits as early as possible. This will help to initiate a rehabilitation programme that will strongly assist with the success of the operation. Walking sticks will be useful during the first few days, but will be progressively abandoned.

The objective is firstly to reduce the initial pain and maintain flexibility and mobility, then to recover muscle strength and sensations in the knee.

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What are the risks and complications?

In addition to the risks associated with any surgery and the anaesthetic, there are some risks specific to this surgery:

A haematoma may appear around the area operated on due to bleeding.

The occurrence of an infection, although rare (risk below 1 % in our establishment), is a serious complication and can require revision replacement and a long-term course of antibiotics.

As the risk is greater with revision surgery compared to replacement surgery, a course of antibiotics is systematically prescribed for the first few days.

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When the loosening is caused by an infection, the treatment will be required for several months.

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The nerves around the knee may be damaged accidentally. This exceptional complication may cause pain, weakness and a loss of feeling in certain parts of the leg.

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Small blood clots can form and block the veins in the legs resulting in phlebitis. In order to prevent this complication, an anticoagulant treatment is prescribed and support stockings are worn for several weeks.

A fracture of the femur or tibia, as well as a weakening of the extensor mechanism, can occur during the operation, and requires a specific treatment.

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This list of risks is not exhaustive. Mr Leonard can provide you with any additional explanations and will be available to discuss the advantages, disadvantages and risks of each specific case with you.

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What is the expected outcome of the operation?

The results of this technique are encouraging but there are however no guarantees. Expected outcomes, are a reduction in pain along with a recovery of mobility and muscle strength. Even if many patients forget they are have an implant, it is preferable to avoid physical work and violent sports as these activities can increase the wear and decrease the lifespan of the prosthesis despite the use of new, more resistant materials.

Some activities like cycling, swimming, golf or walking are possible, and even recommended, whereas care should be taken with skiing, tennis and jogging. The average lifespan of a knee replacement is about 20 years. With the progress in the materials used today, we hope that the results and the longevity will continue to improve.