Introduction: Patients who undergo a total knee replacement may require a revision surgery at some point in their lives due to different reasons. This may be due to wearing out/loosening of the implant, sustaining a fracture, developing an infection, persistent pain or instability.
Diagnosis: The diagnostic process will likely be more extensive than when you underwent your initial total knee replacement. In addition to an X-ray, your orthopedic surgeon may need to obtain blood work, a CT scan or MRI. If there is a concern for an infection, you may have to have fluid drawn from your knee joint (i.e. aspiration) for further evaluation. Having all of this information allows the surgeon to make a more informed decision and develop a treatment plan.
Non-operative Treatment Options: Patients who have pain may try the initial first line of treatment including physical therapy or taking oral anti-inflammatory medications such as Advil or Aleve. Once you have an artificial knee joint, you are routinely not a candidate for a corticosteroid injection in the hip. If your symptoms fail to improve, then you can have a discussion with your orthopedic surgeon to see if you are a candidate for a revision total knee replacement.
Preoperative Evaluation: If you are deemed a candidate for a revision knee replacement and you elect to proceed, you will have to make an appointment with your primary care doctor to be evaluated prior to surgery. They will order certain blood work and counsel you on which medications you need to continue or stop prior to surgery. It is also recommended that you undergo a teeth cleaning within 6 months of your surgery.
Surgery: The choice of anesthesia will be based upon your surgeon’s preference. Depending on why you are undergoing a revision knee replacement will determine which components need to be removed and replaced. If you are undergoing surgery for an infection, then all of the artificial components need to be removed and a temporary prosthesis is placed that is made of antibiotics.
Post-Operation: You will go to a recovery room while your anesthesia wears off, and you will be monitored. Once the effects of anesthesia wear off, you will get up and start working with physical therapy. After surgery, the amount of weight you can place on the operative leg will be determined by the surgeon. Physical therapy will focus on range of motion exercises, strengthening the muscles around the knee and to gait training. You will initially be using an ambulatory assistance device (such as a walker or cane) and you will gradually wean off this as you tolerate. You may be required to wear a brace following surgery for a short period of time.
Risks and Complications: As with any surgery, there is a risk of infection or blood clots. Patients will be put on a blood thinner after surgery for a few weeks at the discretion of the surgeon to decrease the risk of a blood clot. Sometimes, the range of motion after surgery may be more limited than was expected which may be due to scar tissue that builds up around the knee. Annual follow up is recommend with your orthopedic surgeon following surgery.
Activity Restrictions: After undergoing a revision knee replacement surgery, patients are typically encouraged to refrain from high impact activities such as running or jumping. Activities such as hiking, biking, elliptical, couples’ tennis, golf and bowling are allowed.
Summary: You should seek out a specialty trained orthopedic surgeon to perform your revision knee replacement. This clinician should not only be skilled at performing the surgery, but should also be knowledgeable about choosing patients who are appropriate for the procedure.