A well done knee replacement surgery usually guarantees a life period of 20 - 25 years. But like any other part, it will undergo wear and tear during this period, which might need another surgery to replace the worn out knee joint. This surgery is called Revision Knee Replacement surgery where the worn out knee joint is replaced with a brand new knee joint.
In some cases, revision knee replacement surgery might be needed if the initial replacement surgery had failed for some reason. With the advent of computer-assisted surgeries, the technical issues have been ironed out and fewer Revision Knee Replacement surgeries are performed to rectify the errors.
Infection can cause early revision surgery but this has a rare chance of causing complications in knee replacement, occurring in less than 1% of the patients. Infection can occur either at home or in a hospital and sometimes it might not occur for many years. An infected artificial knee joint might become stiff and painful. The implant might start losing its attachment to the bone.
We can prevent infection by utilizing the following measures:
A well-equipped operation theatre which has laminar flow with HEPA air filter
Use of Space suit to avoid the spread of infection
Use of disposable items, wherever possible
Use of antibiotics, as per the norms.
Proper control of diabetes in diabetic patients, before surgery.
Laminar airflow with HEPA filter for ultra clean environment
Use of space suit to avoid infection
We, at Dr. Raj Kanna’s clinic, perform a two-stage procedure for the infected knee, which is a normal procedure followed by most surgeons.
In the first stage,we remove the infected knee and fill it with antibiotic cement spacer. The patient will be provided antibiotics for a minimum period of 3 months. We will then wait for the infection to subside, which might take 6 months and may be a year. In the meantime, the patient can walk and perform routine activities that include the bending of the knees.
After the initial period of six months to a year, we do a set of blood tests to confirm that there is no residual infection. In the second stage, we then remove the cement spacer and put the new knee.
Antibiotic cement spacer is used in first stage to eradicate the infection
Infection is not the sole reason for Revision Knee Replacement surgery, and it can be caused by other factors like:
Incorrect positioning of the knee
Incorrect alignment of the lower limb
Mismatch of the gaps
Leaving the knee-cap bone without resurfacing
Fracture after knee replacement
Other technical causes.
Patient got her instability fixed and she is now walking with a stable pain free knee
Patient initially had both knees replaced elsewhere 15 years back. Both the knees eventually failed.Both the knees were revised on the same day with the help of computer navigation
Once the infection is eradicated a new knee is put as a second stage procedure.
Patient suffered from unstable knee after replacement surgery done elsewhere
Before Revision: Patient’s legs were bowed because of implant failure. After Revision: The leg alignment was corrected with the help of navigation.
How can we Treat these?
These technical or medical issues can be treated by surgery that might include one or more of the following procedures.
Revision of the leg bone component
Revision of the thigh bone component
Resurfacing of the kneecap
Total Revision of the knee replacement.
Computer Assisted Total Revision of the Knee for the first time in South India
Authored By Dr. Raj Kanna - Orthopaedic and Knee surgeon, Chennai