Revision Total Knee Replacement surgery involves replacing a previous knee replacement with a new artificial joint.

 

It's a complex procedure, more intricate than the primary (initial) total knee replacement (TKR).

 

Revision surgery is typically more complicated because the surgeon must remove the original implant, which has integrated into the existing bone. Additionally, there is often less bone remaining after the prosthesis is removed.

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Therefore, the procedure requires meticulous preoperative planning, specialised tools and implants, and greater surgical skill. It also takes longer to perform compared to a primary knee replacement.

Revision knee replacement surgery is not offered solely due to pain; there must be a valid reason for undergoing major re-do surgery. Patients experiencing pain after knee replacement should be thoroughly examined by a knee revision specialist to determine the appropriate course of action.

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Key indicators for revision knee replacement surgery include:

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• Pain in the knee joint, often with limited walking distance and possibly night pain.

• Confirmation that the pain originates from the knee joint, not from the hip or back.

• Complaints of the knee "giving way or collapsing."

• Swelling, inflammation, and reports of increased knee deformity.

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Accurate patient selection is crucial for a successful outcome in revision knee replacement surgery. Therefore, a complete history of complaints and a thorough examination of the previously operated knee, hip, and back are essential.

Revision surgery involves the careful removal of the old implant and the placement of a more complex implant designed to compensate for any bone loss. This complexity increases the risks associated with the surgery, and the outcomes may not be as favorable as those of primary surgery. However, advancements in instruments, implants, and surgical skills aim to restore the patient to the results of a successful primary surgery.

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The actual surgery typically lasts about 120 minutes. However, Mr. Mahaluxmivala advises relatives not to expect the patient back in the ward within this short time frame.

 

This is because a significant amount of care and time is devoted to preparing the patient for anaesthesia and ensuring safe and correct positioning before surgery. 

The primary reason for revision knee or replacement surgery is often loosening of the previous implant. This loosening may be caused by infection or wear and tear over many years.

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Other reasons for revision knee replacement surgery include misalignment or instability.

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A less common but significant reason for revision knee replacement surgery is fracture around the original knee replacement (periprosthetic fracture).

Diagnosis of issues with the original total knee replacement involves:

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• A thorough history and complete examination.

• Confirmation via X-ray of the knee, including three specialised views, including standing views.

• Periodic specialised X-rays may be needed to monitor for evidence of loosening.

• In some cases, a radioisotope bone scan or a CT scan may be necessary, typically performed 18 to 24 months after the initial knee replacement.

• Blood tests may also be required.

• Aspiration procedure to remove fluid from the knee, which is then sent to a lab for analysis to determine the type of infection and the need for revision surgery.

  • ​This procedure is done in the operating theatre without the need for general anaesthesia.