Revision Knee Replacement

Occasionally, it may become necessary to replace all or part of a prosthetic knee. This procedure is known as revision knee replacement surgery. This involves removing all or part of the old prosthesis, re-preparing the damaged bone ends and then attaching new prosthesis to them. A revision knee replacement can involve a larger prosthesis which can have rods (stems) and metal augments attached to it to help support and/or replace damaged bone.

The most common reasons your surgeon may recommend revision knee replacement surgery include:

• Pain – is the most common cause for revision surgery
• Plastic wear – the plastic component (polyethylene spacer) that is placed between the two metal components of your prosthesis or the plastic liner that is used cover to the back of the kneecap, can wear out as time passes.
• Loosening of either the femoral or tibial components
• Infection around the prosthesis
• Osteolysis (bone loss)
• Stiffness

As with any surgery there are associated risks. The general complications of any surgery include:

• Deep vein thrombosis (blood clot legs) or Pulmonary Embolism (blood clot lungs)
• Blood loss requiring transfusion
• Heart attack, strokes, kidney failure, pneumonia, bladder infections
• Complication from nerve blocks such as infection or nerve damage
• Anaesthetic complications

The complications specific to knee surgery include:

• Infection
• Dislocation
• Damage to nerves or blood vessels
• Wound irritation or breakdown, numbness and tenderness around the wound and/or difficulty kneeling
• Patella instability (kneecap can move out of place)
• Failure to relieve pain
• Fracture bones around the knee joint
• Wear of the new artificial joint requiring further surgery
• Ligament or tendon injuries
• Scars

Preparing for your revision total knee replacement

Preparation begins prior to your admission to hospital. Your surgeon will discuss your surgery and what to expect.

Arrangements should be made in advance to prepare for your recovery including:

• Ensuring your home is free from tripping hazards, 
• Ensuring regularly used items are easily accessible,
• Arranging to have someone at home with you or to check in on you when you are discharged.
• A referral to the pre-admission service at the hospital you are having your surgery at can be very useful in helping you plan your discharge following your stay.

Your surgeon may refer you to have:

Routine blood tests and other investigations prior to your surgery.

A pre-rehabilitation physiotherapy review to ensure you are as fit as possible prior to your surgery

A review by peri-operative physician, if you have medical problems that need to be managed around the time of your surgery

You will be given instructions regarding your medications and it is important you follow these. These may include:

• Cease blood thinning medication such as aspirin and anti-inflammatory medications up to 10 days prior to your surgery
• Cease naturopathic or herbal medications 10 days prior to your surgery
• Ceasing certain medications used to treat inflammatory arthritis such as Rheumatoid arthritis

Certain lifestyle risk factors can slow your healing following your surgery. In preparation for your recovery aim to:

• Eat healthy
• Quit smoking
• Limit alcohol intake
• Reduce weight if overweight (follow medical advice on safe exercise prior to and following surgery)

Remember to bring your x-rays with you to hospital.

Post surgery

Following your surgery, you will usually remain in hospital for 5-7 days. In this time, you may require antibiotics and pain relief.  A physiotherapist will start you moving and help you with post-operative exercises as soon as your are assessed as being safe to move, which in most cases is the day of the surgery. It is important you follow the instructions of the physiotherapist to ensure you get the best out of your new knee.

You will need to use a walking aid initially following the surgery.  Once you are assessed as safe, you can also stop using this. 

On discharge, you will be given an appointment to see your surgeon as an outpatient. You will also need to continue physiotherapy as instructed.

Recovering from revision knee replacement surgery takes time, patience and commitment.  You will often start noticing rapid improvement in mobility, comfort and ability to perform normal daily actives around 4-12 weeks.  You will, how ever, continue to improve following your surgery up to and beyond 12 months. 

• Sutures are usually dissolvable but if not will need to be removed 10-14 days after surgery.
• Your dressing is water proof and allows you to shower as usual.  Your surgeon may have some particular instructions about your wound care. You will generally see your surgeon at 10-14 days post operatively to review your wound and remove your dressing.
• Avoid rubbing creams or lotions on your leg until you have discussed this with your surgeon
• Driving can be recommenced following discussion with your surgeon. For revision total knee replacement surgery it is around 6 weeks after surgery.
• Hydrotherapy should not commence before 4 weeks, or after your surgeon tells you so.

• If you are having procedures such as dental work or other surgery, you should consult your surgeon who may recommend you take antibiotics before and after your procedure to prevent infection in your new prosthesis.  All non essential dental work should be avoided for 3 months following your new joint replacement.
• Your new prosthesis may cause the metal detector to alarm at airports. A letter from your surgeon is generally not required prior to travel.
• Your surgeon will continue to follow your progress and how you and your new joint is functioning as time passes.  Regular reviews and X-rays will be performed to ensure that you preforming well.