Revision Knee Replacement

What is revision knee  replacement?

Revision knee replacement is a ‘re-do’ or ‘second’ artificial hip replacement, performed because of problems with the previous implants.

 

Why is revision required?

The most common reason for requiring revision is loosening of the old implants. Loosening usually occurs slowly over many years, with the artificial knee joint becoming increasingly painful over time. Other reasons for requiring revision knee replacement include infection, dislocation or fracture.

What does revision knee replacement involve?

Revision knee replacement procedures are very variable, depending on the problem and the requirements of the operation. In general, revision is technically more demanding than ‘first time’ knee replacements and is associated with a higher risk of complications. Revision knee replacement often involves the removal of failed implant(s) and insertion of new components. In addition, as a result of the gradual loosening process over time, bone quality may be compromised and a bone grafting may be required. For infection, a ‘two-stage’ revision may be recommended – this is where the old implants are removed and the final implants are inserted in a second procedure after the infection has been eradicated.

What sort of anaesthetic is used?

Most patients need to stay in hospital for a few days.

Revision knee replacement can be performed under regional, or general anesthesia. Regional anesthesia numbs below your waist, and general anesthesia puts to sleep. The anesthetist will help determine which is the most suitable.

What should I expect after the revision knee replacement?

Most patients experience mild discomfort when they wake up after a revision knee replacement.  Wounds will be dressed with waterproof dressings under the outer bandage. The outer bandage may be removed 24hrs after surgery.  The smaller dressing is to remain intact for 7-10 days.

Walking is encouraged either the day of the operation or early the next morning.  Full weight bearing is allowed on the operated leg unless instructed otherwise by the surgeon.  The knee should be exercised regularly for several weeks following surgery to strengthen the muscles of the leg and knee. A physiotherapist may help with an exercise program. Exercises will need to continue at home.  The physiotherapist will advise about proper home care, and may continue therapy for a period of time as needed.

How Long will it take to recover?

Recovery after revision knee replacement is similar to a primary or first time knee replacement. It may take up to 18 months to see the full benefit as this is the time it takes to regain muscle strength.  Patients are usually able to walk without crutches by 2 weeks and are mobilising comfortably by 6 weeks. Sedentary and office workers may return to work approximately 2 weeks following surgery. Driving a car is usually tolerated within four to six weeks after surgery.

 

Is physiotherapy required after revision knee replacement?

Yes.  Physiotherapy is commenced immediately post operatively. A physiotherapist will supervise muscle contractions, walking and weight bearing. The physio will help work on knee bend and should continue on a daily basis following surgery until the dressings are removed 7-10 days following surgery.

Ongoing therapy aimed at strengthening the muscles around the knee and increasing knee motion is helpful for the first six months after surgery.  Often these exercises can be performed at home after guidance from a therapist.

What are the risks?

Revision Knee replacement is a very safe procedure. The most common side effect is temporary discomfort or bruising. Due to the skin incision patients may notice a numb patch on the outer aspect of their leg past the skin incision. This is of no functional significance and is unavoidable. The numb patch tends to shrink with the passage of time and does not affect the result surgery.

Following surgery there is a less than 1% chance of developing an infection. Most commonly these are superficial wound infections that resolve with a course of antibiotics. More serious infections may require further hospitalization and treatment. Injury to the blood vessels around the knee during surgery is a very rare complication (less than 1%). Other potential problems include post-operative stiffness, pain and wound problems and clots.