Dr. Sumit Mahajan
Total Knee Replacement (TKR) is one of the most successful orthopedic procedures in the present scenario. This is due to the substantial pain relief and restoration of function after TKR. With newer implant designs and improved surgical techniques, total knee replacements can be expected to function well for at least 15 to 20 years in more than 85-90% of patients. However, some procedures will fail and require a second surgery, called revision knee replacement.
Revision Total Knee Replacement is the replacement of the previous failed total knee prosthesis with a new prosthesis. It is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques to achieve a good result. Very few surgeons in India can perform this surgery efficiently.
A failed knee implant is usually indicated by an increase in pain or a decrease in knee function. Persistent pain and swelling can indicate loosening or infection, and the location of the pain can be all over the knee (generalized) or in one particular area (localized). The decline in knee function may result in a limp, stiffness, or instability. Patients who demonstrate these symptoms and signs may require revision joint surgery.
Most revision total knee replacements take longer to perform than primary procedures. The first step is removal of the implant. If there has been significant bone loss, bone grafts may be required to fill the voids. In some cases, metal wedges, wires or screws may be used to strengthen the bone. Finally, specialized revision knee implants are inserted. Greater than 90% of patients who undergo revision procedures can expect to have good to excellent results.
Post-operative care after knee revision surgery is very similar to the care of a primary knee replacement. This includes a combination of physical therapy and pain medication as necessary. Antibiotics and some method of blood clot prevention will be continued in the postoperative period. A brace or splint may be used to protect the joint after the surgery.
Recovery time after revision knee surgery varies; some patients may take longer to recover. In most cases, physical therapy will be initiated within 24 hours of the procedure. Therapy will usually continue for up to three months following the surgery. Assistive devices, such as a walker or crutches, will be used early in the convalescence period, and patients will progress to a cane or walking without any assistance as their condition improves.
(The author is Senior Consultant Orthopaedics, IVY Amritsar)
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