Revision Total Knee Replacement
Total knee replacement surgery has been one of the most successful surgical procedures over the last 50 years, allowing patients to live more productive and active lives free of chronic pain. According to the American Academy of Orthopaedic Surgeons, approximately 600,000 total knee replacements are performed in the United States each year. This number has been steadily increasing each year and is predicted to continue to grow. With more joint replacements preformed each year and the procedure expanding to treat younger, more active patients, the need for revision surgery has become more common. Some of the potential reasons for painful or failed knee replacement includes implant deterioration/wear, ligament instability, implant loosening from the bone, infection, fracture/injury, poorly positioned implants, and stiffness. An evaluation by a fellowship trained Orthopaedic surgeon trained in revision surgery is recommended to determine if revision of part or all of the knee replacement may benefit the patient and alleviate symptoms.
Why do Implants fail?
Gradually, the friction put on the joint replacement causes tiny particles to break off of the replacement. This causes loosening of the bond between the bone and the implant. Occasionally, tiny particles that break off the plastic spacer collect around the knee joint and then are attacked by the body’s immune system. Unfortunately this immune response also attacks the healthy bone around the implant, producing a condition called osteolysis. Osteolysis causes the bone around the implant to deteriorate, making the implant loose or unstable.
When this occurs, the knee can become swollen and painful to move, making it challenging to do everyday activities.
Infection is a possible complication in any surgical procedure, including total knee replacement. An infection may occur at any time from shortly after surgery to years later. Infection can spread from recent colds or urinary infection to involve joint replacement.
If an artificial knee joint becomes infected, it often will become swollen, painful and stiff. The infection may cause the implant to lose its attachment to the bone. Infection around a knee replacement requires one or more revision surgeries to treat the infection.
Most implants are designed and rely on the patients existing ligaments for the knee replacement to work appropriately. If the ligaments around the knee become damaged during or after the surgery or were improperly balanced, the knee will likely feel unstable and loose. The patient may experience recurrent swelling and the sense that the knee is “giving way.” If knee instability cannot be treated with nonsurgical processes such as physical therapy and bracing, revision surgery may be needed.
Rarely, patients are unable to appropriately rehab a knee replacement after surgery and the knee will get stiff. If this is not treated within the first few months by physical therapy or a manipulation under anesthesia, the stiffness will persist. In this case, revision surgery may be necessary to remove the extensive scar tissue and/or change the components in the knee to improve the patient’s range of motion.
A periprosthetic fracture is a broken bone around the components of a total knee replacement. A fall most often causes this type of fracture, and usually requires revision surgery.
In establishing the extent of the revision required, the Orthopaedic specialist will take into account a number of factors, including the location and the type and of fracture, the quality of the remaining bone, and if the implant is loose. Revision surgery may require fixing the fracture alone, fixing the fracture and revising the implant, or completely removing the implant and fracture pieces and replacing with a larger more complex total knee replacement.
How we can help
If you are experiencing pain or problems with your knee replacement, an evaluation with our fellowship-trained Orthopaedic surgeon is recommended. Dr. Paul Roettges performs revision knee surgery. He will evaluate the entirety of your case to determine if revision surgery may be right for you. This evaluation will include a review of your prior surgical documents and images, a detail physical exam, and often an array of specialized tests looking for potential reasons for your symptoms. With this, the potential benefits of revision surgery will be explained in detail to the patient.
Although with the same goal to reduce pain and increase function, revision surgery is different from first time total knee replacement. Revision surgery is often longer and more complex requiring specialized planning, tools, and implants to achieve a better result.
There are different types of knee revision surgery. In some cases, only one piece of the prosthesis has to be replaced. In other cases, multiple or all of the components need to be replaced. More complex revisions often require specialized implants and augments to replace damaged bone and ligaments.
If our Orthopaedic Specialist is able to determine a failure of the implant or reason for symptoms, revision surgery patients commonly experience satisfactory long-term outcomes, including pain relief and increased stability and function. However, complete pain relief and restoration of function are not always achievable.