Total knee replacement surgery is one of the most successful surgical interventions in the entire medical field. This procedure enables people live richer & more active lives by freeing them from chronic knee pain in a majority of cases. However, over time a knee replacement could fail due to a variety of reasons. Knee joint as a result can become swollen & painful when this occurs. It may also feel unstable or stiff & may therefore make it difficult for the individual to perform daily activities.
What is Revision Knee Replacement Surgery?
Orthopedists usually recommend patients to undergo a second surgery known as revision total knee replacement surgery whenever a prior knee replacement has failed. Orthopedic surgeons would remove some or all parts of the original prosthesis & replace them with new implants during revision knee replacement procedure. Although both primary & revision procedures have similar goals as to relieve pain & improve function, revision knee replacement surgery is quite different from primary total knee replacement surgery. Revision procedure is a more complex & longer procedure which requires extensive planning & utilizes specialized implants & tools in order to achieve desired results.
When is Revision Total Knee Replacement Surgery Recommended?
Revision total knee replacement surgery is commonly recommended for patients in the following conditions:
- Implant Wear or Loosening – Osteolysis is sometimes found to occur around the tibial component & which causes the artificial joint to loosen from the bone. An implant should firmly attach to the bone for the knee replacement joint to function properly. These components are either cemented into position or the bone was expected to grow within the surface of the implant during the initial surgery. In either case, implant components were expected to be firmly fixed. However, over a period of time implants may loosen from underlying bone & eventually cause the knee joint to become swollen & painful.
Cause of loosening of the implant however is not always clear, but excessive body weight, high impact activities & wearing of plastic spacer between two metal components of implant may all be contributing factors. Moreover, when younger patients undergo primary knee replacement surgery may quite often ‘outlive’ life expectancy of the prosthetic knee joint. Therefore, such young patients are having higher long-term risk that revision surgery may be required at a later period of time due to wearing or loosening of the artificial joint components. Additionally, tiny particles which wear off the plastic spacer in some cases accumulate around the knee joint & are then attacked by the immune system of the body. As a result, immunity-response also attacks healthy bone structures around the implant & thereby leads to a condition known as osteolysis. Bone around the implant subsequently deteriorates while making the implant loose or unstable in osteolysis.
- Infection – Infection in fact is a potential complication with any type of surgical intervention, including revision total knee replacement surgery. Infection may either occur while the patient is in the hospital or after going home, or may even occur years later in some cases. Whenever an artificial joint becomes infected, it may become painful & stiff. As a result implant components may start losing its attachment to bones. Even in cases where the implant remains fixed to bone, drainage, swelling & pain due to infection may necessitate revision knee replacement surgery.
Revision for infection is usually done in any one of the following two ways, depending upon the type of bacteria involved, degree of infection, how long the infection has been present & the preference of the patient.
- Debridement – Bacteria can also be washed out in some cases, plastic spacer can also be exchanged while the metal components of the implant can be left in place.
- Staged Surgery – However, implants must be completely removed & replaced in other cases. When implants have been removed to treat infection, orthopedic surgeons will perform revision surgery in two separate stages. In the first process they will remove implant & place a temporary cement spacer in its place. This spacer has been treated with antibiotics in order to fight infection & with then remain within knee for several weeks. Meanwhile, during this time the patient would also receive antibiotics administered intravenously. After the infection has been completely cleared, orthopedic surgeon will then perform a second surgical intervention which is meant to remove the antibiotic spacer & to insert the new prosthesis in its place. Removing the implant in general leads to higher chances of curing infection but is usually accompanied by a longer period of time for recovery.
- Instability – When ligaments around knee get damaged or are improperly balanced, the knee joint may as a result become instable. Since most of the implants are generally designed to work with the existing ligaments of patients, any changes in ligaments can prevent the implant from functioning properly. Because of this the patient may experience recurrent swelling along with a sense that the knee is giving away. Moreover, revision knee replacement surgery may be necessary in cases where knee instability cannot be effectively treated with nonsurgical treatments like bracing & physical therapy.
- Stiffness – In some cases, total knee replacement procedure may not be able to help patients achieve the range of motion which is required to perform common daily activities. It may happen when excessive scar tissue builds up around the knee joint. Whenever this occurs, orthopedic surgeons may attempt what is known as “manipulation under anesthesia”. This procedure involves administering anesthesia so that the patient does not feel any pain while the doctor aggressively bends the knee in order to break down scar tissue. This procedure is also very successful for improving range of motion in most cases. However, sometimes the knee still persists to remain stiff even after this procedure. Revision knee replacement surgery may therefore be called when extensive scar tissue or position of the components in the knee joint still limit range of motion.
- Fractures – Periprosthetic fractures are breaking of bones which occur around components of the knee joint implant. These types of fractures are most often resulting from falls & invariably require patients to undergo revision knee replacement surgery. Determining the extent of revision which is required makes the surgeon consider several factors like quality of the remaining portion of bone, whether the implant is loose, & the type & location of fracture. In case the bone is weakened or shattered from osteoporosis, damaged portions will be required to be completely removed with larger revision components.
Avail Affordable Knee Replacement Surgery in India
Knee joint replacement surgery cost in India is merely a fraction of what it costs in advanced countries like UK, Canada & United States while the quality of surgery & implant is as good, if not better, with the best that is available anywhere else. Moreover, knee replacement surgery success rates in the country are at par with the best in the world. Orthopaedic Surgery India is a leading specialty medical tourism company which is associated with top orthopedists & orthopedic surgeons & the best accredited multispecialty hospitals in the country so as to give the most competitive treatment packages to international patients for all types of musculoskeletal ailments.