Revision knee replacement surgery is done when an existing Total Knee replacement surgery has either failed or continues to cause the patient symptoms. The common reasons and symptoms necessitating revision knee replacement are Infection – This can happen soon after a primary knee replacement surgery or several years later.
Infections can be quite aggressive where the knee may turn red, warm and the wounds may start to ooze pus or some form of offensive liquid and occasionally they may be more insidious with just pain and some swelling.
TKRs unfortunately have a finite lifespan and occasionally they will not last a patients lifespan. Modern Total Knee Replacements have a much longer longevity owing to better surgical techniques, materials used to build the prosthesis and increasing understanding of factors which can enhance the life of the Implants. However a small proportion of these will still fail earlier than anticipated for reasons we may or may not understand.
Patients who break their bones close to the Total knee replacement may cause the TKR Implants to come loose prompting a revision knee replacement. However if the Implants are well fixed an attempt can be made to fix the bone with plates and screws with the hope that the fracture will heal and allow the replacement to function as before.
Balancing of ligaments and soft tissues is a critical component in the surgical technique of Total knee replacements. If this aspect is not get addressed well during surgery or if the ligaments fail/get injured subsequently, this can lead to pain and wobbly sensations in the knee which can make walking difficult necessitating a revision knee replacement surgery.
When we need to go for revision knee replacement: There can be several symptoms which can indicate either of the above problems which can be indications for a revision knee replacement. The common symptoms that would prompt a surgeon to consider offering a revision knee replacement would be Pain, inability to walk, difficulty in carrying out day to day activities, signs of infections (fever, redness), increasing deformity. Occasionally revision knee replacement surgery may be offered in absence of significant symptoms when the patients X-rays are showing absorption of the surrounding bone and early surgery may be necessary to reduce the complexity of the surgery.
Patients will usually undergo a full work up prior to the decision of a revision knee replacement surgery being finalised. The patient may also require some other tests to check on their level of fitness for surgery and anaesthesia.
Revision surgeries are complex and technically demanding surgeries and frequently require use of complex implants which will address the issues which have led to the surgery being necessitated. These surgeries require a high degree of skill, expertise and experience and hence is offered mainly in select few centers across the country. However, these days with progress of modern medicine and newer surgical techniques revision knee replacements have become safe and very successful, infant becoming routine in several higher centers.
Dr Gaurav Rathore is a senior orthopaedic surgeon and additional director for Orthopaedics and joint replacement at the Magenta Clinic and Max Super Speciality Hospital ( Previously known as Jaypee Hospital), Noida. He has nearly 25+ years experience in Orthopaedics with 11 years in some of the best centres in the UK, including Wrightington hospital, England, the pioneering hospital for joint replacements in the world.
He also has experience of practising in few of the Premier Hospitals in UK including University Hospitals of Morecambe Bay NHS Trust, John Radcliffe Hospital, Oxford, Chesterfield Hospital, SWELOC, London etc.
In 2013, he moved to India bringing world class Orthopaedic care to Delhi NCR. He has worked at a senior level at Sant Parmanand Hospital, Civil Lines; Fortis Escorts, Okhla and Fortis Hospital, Noida. He has been heading an orthopaedic unit at Max Super Speciality Hospital ( Previously known as Jaypee Hospital ), Noida since 2015.
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