What is Knee Revision Surgery?
Revision knee replacements involve replacing the previous knee replacement with a new one. Although primary knee replacement surgery offers good results for patients, it is likely that after 15-20 years a revision knee replacement will be required.
There are various reasons why a knee replacement needs to be revised which include
- Wear of plastic component
- Aseptic Loosening
What should I do before my surgery?
Following consultation with Mr Hoad-Reddick and X-Ray investigation, knee revision surgery may be suggested as the best form of treatment.
Once you have decided to proceed with surgery, please contact the HR Orthopaedics office on 0161 722 0007 to arrange a convenient date for your surgery. If you are insured, you will need to contact your insurance company and obtain an authorisation number which you should take with you on admission. Your insurance company may ask for a procedure code which is W4230. Prices for self funding patients can be given on request and more information can be found on our self pay patients page.
The hospital will contact you prior to surgery to arrange your preoperative assessment which will occur at approximately two weeks before your surgery. At assessment, blood and urine tests will be performed along with a heart trace (ECG) to ensure you are healthy enough to undergo anaesthetic and surgery. The pre-operative nurse will advise you on whether you should stop taking any of your medication.
You will see a physiotherapist and occupational therapist, if possible on the same day as your preoperative assessment; they will give you advice on mobilisation, postoperative exercise and rehabilitation. Home circumstances will be assessed and any necessary measures to assist you on discharge can be arranged.
You will be required to fast for a period of time before your operation; this will be confirmed in writing along with your admission details.
What happens on the day of surgery?
Usually you will be admitted to hospital on the same day as your operation. Mr Hoad-Reddick will explain the procedure again and consent forms will be signed.
The operated leg will be marked and an expected position on the surgery list will be given to you; this is decided depending on medical conditions of all patients on that day.
An anaesthetist will see you to discuss your anaesthetic and postoperative pain relief. Following surgery you will be taken to the recovery unit until your condition is stable. You will have an intravenous drip in your arm to administer fluids or drugs and you may also have a catheter in-situ; these are both usually removed 24 hours after your surgery.
Once stable you will be taken to the postoperative unit for close monitoring before returning to your room on the ward. The physiotherapist will visit you on the unit to institute basic exercises.
What happens during knee revision surgery?
Knee revision surgery is a more complex procedure than the primary total knee replacement. The surgery involves removing the components of the old knee replacement and implanting new ones. The failure of primary knee replacements and the subsequent revision surgery can cause loss of bone substance.
If the revision is due to an infection in the knee, Mr Hoad-Reddick will have to do the operation in two stages; first taking out the previous componenets and inserting some bone cement with antibiotics into the knee. After 6 to 8 weeks if there is no more infection, Mr Hoad-Reddick will remove the bone cement and place the new knee implants in. If there was no infection then the whole procedure can be done in one stage.
What are the potential risks associated with knee revision surgery?
As with any operation, knee revision carries risks as well as benefits; the majority of patients undergoing such surgery will encounter no significant complications. 19 out of 20 patients are delighted with the outcome. 1 in 20 may experience dissatisfaction due to a variety of complications.
Infection: To reduce infection risk, surgery is performed in a specially ventilated 'clean air' operating theatre and most patients are given a short course of antibiotics at the time of surgery. Despite these measures deep infection can occur in 1:100 cases necessitating removal of the artificial joint until infection has cleared. This would also be treated with antibiotics.
Blood clot (DVT): Occasionally a blood clot can form in the deep veins of the leg causing pain or swelling in the calf, in a minority of cases this can break away and travel to the heart or lungs and become a risk to life. The overall risk of fatal lung clot is 1:600. To reduce this risk you will be given calf pumps to increase the blood flow and an anticoagulant drug to inject into your stomach for twenty eight days following surgery, in keeping with current recommendations from the National Institute for Clinical Excellence (NICE).
Residual pain: In the majority of cases, knee replacement significantly improves pain and mobility; residual pain and stiffness can occur and in most cases will resolve in time.
Neurovasuclar injury: Very rare occurance of damage to vessels or nerves in the region of surgery.
Dislocation: When a mobile plastic bearing is used there is a small risk of dislocation of the knee. This would require further surgery.
Fracture: This is extremely rare and may require further surgery. This is more likely if patients have reduced bone density.
Failure requiring revision surgery: Fracture or wear of the implants over time can infrequently necessitate revision surgery.
What will my recovery be like?
Your recovery will likely be very similar to the recovery process you experienced with your initial knee replacement surgery.
Exercise and mobility are an extremely important part of rehabilitation and require full patient participation for optimal recovery and outcome. A degree of pain and stiffness can be expected during the early part of the recovery process. You will commence mobilisation with the aid of a walker, progressing onto crutches for approximately 3-6 weeks.
A physiotherapist will see you everyday during your stay, teaching you to climb stairs safely and providing you with an exercise regime to continue at home.
24 to 48 hours following surgery a routine check, including an X-ray and blood tests, will be performed.
What happens when I go home?
The majority of patients will be ready to return home three to four days after surgery dependent upon wound healing and the ability to mobilize safely. The nursing staff will advise you on wound care and dressings. Mr Hoad-Reddick uses glue and a buried stitch; as such there are no stitches to be removed. For further reference please download our wound care booklet.
A physiotherapist review appointment will be arranged for a week following discharge to monitor your progress and adjust your exercise regime accordingly; you may require between four and six physiotherapy appointments.
You can return to driving once you are safely off crutches and mobilizing without a limp; this is usually at around six weeks after your operation.
On discharge you will be sent a clinical appointment for six weeks following surgery by post. Patients will return to clinic for review at three months, one year, three years and five years post-operatively. Reminder letters for these appointments will be sent by post.