Revision Knee Replacement / Arthroplasty

 Revision Knee Replacement Surgery

Introduction

Over the previous10-120 years, artificial knee replacement operation has become more popular. Many people have gotten a new knee joint. The 1st time a joint is replaced with an artificial joint the process is called a primary joint replacement.

As people live longer and more people receive artificial joints, some of those joints begin to wear out and fail. When an artificial knee joint breaks, a second surgery is needed to replace the failing joint. This method is called a revision arthroplasty.

Rationale

Why does a knee revision become important?
The most popular reasons for knee revision arthroplasty are :

  • mechanical loosening
  • disease in the joint
  • fracture of the bone around the joint
  • a weakness of the implant
  • loss of one or more parts of the implant
  • damage of the implant

Mechanical Loosening / Aseptic Loosening

Mechanical loosening means that for some reason the attachment between the artificial joint and the bone has become free. There are many causes why this can happen. It may be that, given sufficient time, all artificial joints will ultimately loosen. This is one reason that doctors like to wait until needed to put in an artificial joint. The younger you are when an artificial joint is put in, the more likely it is that the joint will loosen and need a revision.

Infection

If an artificial joint is infected, it may become difficult and uncomfortable. It may also start to lose its attachment to the bone. An infected artificial joint will presumably have to be changed to try to cure the infection.

The operation may be a one-stage exchange or more usually a two-stage exchange. In rare cases, the knee may need to be combined, or possibly even eliminated.

Fracture

A fracture may happen near an artificial joint. It is seldom important to use a new artificial joint to repair the fracture. For example, if the femur fractures where the prosthesis attaches, it may be simpler to replace the femoral part of the artificial joint with a new piece that has a longer stalk that can hold the fracture commonly while it heals. This is related to fixing the fracture with a metal bar.

Instability

Instability means that the artificial joint disturbs. This is very uncomfortable when it occurs. It is doubtful that the knee joint will fully dislocate. However, it can occur. It is more usual for the knee joint to be either too tight or too loose. If the knee joint is too loose, it can create unsteadiness and pain. If the joint is too tight, the knee is usually painful and doesn’t have a good variety of action.

Wear

With the rise in knee joint replacements, doctors have started to see wear in the plastic parts of the artificial joints. In some cases, if the wear is discovered in time, the revision may only need replacing the plastic part of the artificial joint. If the wear remains until the metal is grinding on the element, the whole joint may need to be replaced.

Breakage

Finally, the metal of the artificial joint can break due to the continuous pressure that the artificial joint undergoes every day. In weight-bearing joints like the knee, this is greatly influenced by how much you balance and how active you are.

Limitations of Revision Knee Replacement

A revision joint replacement of the knee is more difficult and unpredictable than a first joint replacement. Since many factors can influence its seniority, your doctor will not be able to say exactly how long your revision will serve. Also, put in mind that because revision surgery is more difficult than first joint replacement, it may take more time than a first surgery to be able to perform your routine regular activities. Usually, people remain to need a walking aid because knee pain develops when they are on their feet for increased periods. There is also a greater chance that the knee will be tight and unable to bend after knee correction operation.
In some situations, if an artificial joint fails, it may not be possible to fix another artificial joint back in. This can happen if the first joint has failed because of an infection that cannot be controlled, if the bone has been damaged so much that it will not support an artificial joint, or if your medical situation will not allow a major operation.
Seldom an option other than knee revision is best because a big operation might result in a failure or even death. Removing the prosthesis and not displacing it doesn’t mean the patient can’t walk anymore. The doctor may suggest mixing the joints of the knee, placing a spacer in the joint, or some cases removing the leg.

Complications

As with all major operational procedures, difficulties can occur.
Some of the most usual complications following revision arthroplasty of the knee include
1. Medical / Anaesthesia complications
2. Thrombophlebitis / DVT
3. Infection
4. Loosening
5. Incision & wound complications

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