Knee Replacement Revision Surgery - Types, Procedure, Advantages, and Disadvantages

Introduction

Total knee replacement, which enables people to live without chronic knee pain, is one of the most successful procedures in recent times. Approximately 85 to 90 percent of people with knee replacement will last 15 to 20 years. However, knee replacement may fail over time due to various reasons. The failure of a knee replacement may be due to various reasons and may cause pain, swelling, stiffness, and difficulties performing everyday activities. Therefore, doctors recommend second surgery (knee replacement revision surgery), a complex and long procedure requiring specialized implants to achieve good outcomes.

What Is Knee Replacement Revision Surgery?

Knee replacement revision surgery or second knee replacement is an orthopedic surgical procedure that involves the replacement of failed prosthetic implants with a new prosthesis within the knee joint for people who had previously had total knee replacement surgery. It is more complicated to perform a second-time surgery due to scar tissue, bone loss, and instability. The components include the tibial plateau, femoral condyle component, patella component, and polyethylene spacer.

What Are the Different Types of Knee Replacement Revision Surgery?

There are three types of knee replacement revision surgery, including the following.

1. One implant or component of the prosthesis is revised.

2. Three components - femoral, tibial, and patellar components are replaced.

3. The bone around the knee is rebuilt with augments or bone grafts.

Who Performs Knee Replacement Revision Surgery?

Knee replacement revision surgery is a complex surgical procedure performed by an orthopedic surgeon with specialized training and experience in revision surgeries. In addition, they have experience in treating the complications arising from knee replacement surgery. Therefore, they are referred to as revision specialists or revision orthopedic surgeons. They work in specialized centers and hospitals to perform complex revision surgeries.

When Is Knee Replacement Revision Surgery Recommended?

Knee replacement surgery is recommended when the previous knee replacement fails for the following reasons.

1. Implant Loosening:

• The implant must be firmly attached to the bone for proper total knee replacement functioning.

• Over time, the implant loosens from the bone, causing pain in the knee.

• The reasons for a loosened implant include wearing the plastic spacer, excessive body weight, and high-impact activities.

• Younger patients with knee implants may require revision surgery over time due to loosening.

• In osteolysis, the body’s immune system attacks healthy bone around the implant, making it unstable.

2. Infections:

• Infection is a potential complication that may occur years after knee replacement surgery.

• Infected artificial joints become painful, swollen, and stiff. Therefore, revision surgery is necessary.

• The revision surgery for infection is done in two ways, depending on the bacteria, duration, and degree of infection. They are debridement and implant retention and two-staged surgery.

3. Instability:

• The knee implants become unstable when the ligaments around the knee become improperly balanced or damaged.

• Patients may suffer recurrent swelling due to the instability of the knee implant.

• Revision surgery is needed only if the non-surgical methods (physical therapy and bracing) cannot correct the instability.

3. Stiffness:

• It happens due to excessive scar tissue around the knee joint. The knee replacement will not help the patient to perform daily activities due to stiffness.

• Usually, doctors treat stiffness with manipulation under an anesthesia procedure.

• Revision surgery is recommended if extensive scar tissue is present, limiting the patient’s range of motion.

4. Fractures:

• Bone fractures around the total knee replacement components (periprosthetic fractures) due to falls require revision surgery.

• The revision surgery depends on several factors, such as the fracture’s type and location, the remaining bone’s quality, and whether the implant is loose.

5. Allergic Reactions:

• Allergic reactions to the implant develop in rare cases, leading to implant failure and requiring revision surgery.

How Is a Knee Replacement Revision Surgery Performed?

Knee replacement revision surgery is a complex procedure involving several steps, including the following.

1. Anesthesia: The patient is given anesthesia according to their medical history to ensure they are pain-free and comfortable during the procedure.

2. Incision: The surgeon makes an incision to access the joint and remove the existing implant.

3. Removal of the Existing Implant: The surgeon removes the existing implant, including any bone or cement that is adhered to the implant.

4. Bone Preparation: The surgeon removes any damaged or diseased tissue and smoothens the bone surface to prepare the bone.

5. Insertion of New Implant: The surgeons insert the new implant, which is of a different size or type than the previous implant. Then, the inserted new implant is secured in place using fixation methods or cement.

6. Closure: The surgeon closes the incision with staples or stitches and covers the knee with a dressing.

7. Recovery and Rehabilitation:

• The patient is closely monitored in the recovery room as they wake up from anesthesia and are administered pain medication.

• Rehabilitation programs, including physical therapy and exercises, help the patients regain strength and mobility in the knee joint.

What Are the Advantages of Knee Replacement Revision Surgery?

The advantages of knee replacement revision surgery include the following.

• Improved Mobility and Function - The surgery helps restore function and mobility of the knee joint, reducing pain and allowing patients to resume limited activities.

• Pain Relief - The surgery helps relieve pain caused by worn-out or failed knee replacement implants.

• Better Implant Stability - Revision surgery improves the implant’s stability and reduces the risk of implant loosening or misalignment.

• Reduce the Risk of Complications - The revision surgery reduces the risk of further complications such as implant failure or infection.

• Improved Quality of Life - Knee replacement revision surgery improves the overall quality of life by reducing pain, improving mobility and function, and allowing patients to resume normal activities.

What Are the Disadvantages of Knee Replacement Revision Surgery?

The disadvantages of knee replacement revision surgery include the following.

• Increased complexity.

• Longer recovery time.

• Higher risk of complications.

• Potential for bone loss.

• Higher cost.

• Limited lifespan of the new implant.

Conclusion

Knee replacement revision surgery can relieve pain, restore function, and improve mobility for many patients. However, there are potential complications and risks associated with the surgery, such as blood clots, infections, and implant failure. Therefore, discussing the risks and benefits of revision surgery with a qualified orthopedic surgeon is important to determine the best treatment for individual needs.