Revision Knee Replacement
Revision Knee replacement surgeries, are very successful regarding pain relief and return of function in patients with advanced joint disease. One of the most serious complications that may occur after knee replacement is infection. This may require revision surgery to remove the infected joint components, treat the infection, and replace the joint with new prosthetics.
Causes of Infection in Knee Replacements
Contamination during surgery: The infection may occur due to bacteria that enter at the time of surgery, even with sterile precautions.
Postoperative infection of the wound: When the surgical wound is not healed, an infection may occur.
Bacteremia: Bacteria causing infection elsewhere in the body, for example, dental infection or urinary tract infection, may spread through the blood stream to the knee prosthesis.
Symptoms of an Infected Knee Joint
Symptoms of infected knee replacements:
- Chronic pain in the knee
- Redness, swelling, or warmth around the joint
- Drainage from the incision site
- Fever
- Reduced mobility
- Loosening of the prosthetic joint
- Diagnosis of Infection
Diagnosis of infection in a knee joint is made by a step-by-step approach including the following:
- Physical examination: Swelling, tenderness, and drainage are checked.
- Laboratory studies: Blood tests for white blood cell count elevation and inflammatory markers of ESR and CRP may point to infection.
- Joint aspiration: Synovial fluid is aspirated from the joint and cultured to find out the infecting bacteria
- Imaging: X-rays or MRIs to see placement of the implant or damage to the joint.
Treatment Options for Infected Knee Replacements
Management of infected knee replacement should be done in a step-wise manner and is based on the severity and timing of infection.
One-Stage Revision
With our expertise we do One-stage revision in cases of chronic infection, in which an infected prosthesis is removed, cleaning of the joint, and insertion of a new implant are done in the same surgery. This can be considered when the infecting organism is less virulent and well-identified, and it is well-treatable with antibiotics.
Debridement with Component Retention
This approach is typically chosen for early infections, diagnosed within the first few weeks after surgery. In this procedure, we open the joint, remove the infected tissue, thoroughly lavages the joint, and exchanges the polyethylene liner without removing the metal components. Intravenous antibiotics are administered for 4 to 6 weeks after surgery.
Recovery
- Right courses of antibiotics
- Physical therapy to Provide mobility and strength
- Follow-ups as frequently as necessary to monitor the infection and ensure adequate healing
Prevention of Infection in Knee Replacements
- We maintain strict sterile technique during the time of surgery.
- Patients are educated regarding wound care and the signs of infection.
- Prophylactic antibiotics are administered before and after surgery.
- Good blood sugar control in diabetic patients and optimization of other medical conditions preoperatively reduces infection risk.
- Infection after knee replacement is a serious complication that requires early and sufficient management. Revision of an infected knee joint is complex, but in case of early diagnosis, appropriate surgical intervention, and comprehensive antibiotic therapy, patients can achieve good results and regain function in the affected joint. Recovery levels are fast and patient is able to do his/her routine work.
Personalised Primary Knee Replacement
Customization of various aspects of the knee replacement surgery characterizes personalized primary knee replacement, but not limited to:
Preoperative Planning: Advanced imaging such as CT or MRI is utilized to create an exact 3D model of the patient’s knee. This enables us to understand the particular anatomy of the knee joint and come up with a personalized surgical plan as per patient need.
Custom implants are those designed to exactly replicate the natural bone anatomy of the patient. This ensures good fit, appropriate joint alignment, and function post-surgery.
Robotic-Assisted Surgery: With the Use of robotic systems during knee replacement surgery we get an advanced level of precision. We also use the robot to make the positioning of the implants as accurate and precise as possible, tailoring it to the structure of each patient’s joint.
Increased Precision and Better Fit
Custom implants and patient-specific instrumentation allow for a more precise fit, thus enhancing the alignment and stability of the new joint. This ultimately results in an improved range of motion and more natural movements once the patient has recovered from the surgery.
Longer Implant Longevity
It is proper alignment and balanced knee mechanics that minimize the wear and tear of the artificial joint, thereby enhancing the implant’s longevity. This becomes important for younger or highly active patients who want their replacement to last as long as possible.
Reduced Risk of Complications
A tailored approach reduces the risk of such potential complications as implant loosening, misalignment, or infection.
Faster Recovery
A tailored surgery often offers the patient a faster recovery. Because the surgery is well-planned and prepared in advance, surgery time is shortened, and postoperative pain and inflammation are reduced to a minimum. Results are quicker for mobilization and rehabilitation.
Improved Function and Patient Satisfaction
Custom knee replacements are made according to the natural anatomy of the patient’s knee. This means much smoother movement and greater stability, translating to an improved quality of life. Our patients has higher satisfaction rates because of the customized fit and feel of their new joint.
Who May Benefit from Personalized Primary Knee Replacement?
Personalized knee replacement is very helpful in Patients with:
Unique knee anatomy: personalization considers shape, bone structure, alignment of the legs, tension of the soft tissues.
Active lifestyles: Athletes or active patients require implants that can withstand increased stress and wear. Our custom approach ensures joint alignment will handle demands of an active life.
Complex surgical histories: Individuals with previous surgeries, deformities, or other various internal issues are in need of more customized knee replacement.
High mobility expectations: Those who wish to return to high activity/ mobility post operation will see better outcomes due to the optimal fit and the general stability of a customized knee.
The Process of Custom Primary Knee Replacement Initial Evaluation
The first consultation consists of a thorough assessment. We go through the history of the patient, including his or her lifestyle and surgical objectives. X-rays, CT, or MRI scans are done to assess the present condition of the knee joint.
Preoperative Planning
Advanced imaging creates a 3-D model of the patient’s knee. The model serves as a guideline for preoperative planning in minute details enabling us to choose the best implant size along with the correct positioning and alignment. Custom implants or patient-specific surgical tools are decided at this stage.
Surgical Procedure
The surgical intervention is guided either by patient-specific instruments or robotic assistance during the process. Accuracy of implant placement is extreme in the above-mentioned technologies to reduce the possibility of complications.
Postoperative Care and Rehabilitation
After surgery, Our team starts individualized rehabilitation plan. The goal of physiotherapy is to restore movement, strength, and flexibility of the knee. Since the procedure is so personalized, Our patients find recovery after the surgery faster and easier compared to a standard knee replacement.
Knee replacement is a life-changing surgery for people experiencing debilitating knee pain due to arthritis, injury, or deformity. While regular knee replacements are extremely successful, a percentage of cases does present certain challenges that are usually categorized as complex knee replacements. These could range from serious bone loss and deformities to previous unsuccessful surgeries and rheumatoid arthritis. Thanks to recent advances in surgical technique, materials and technology, even the most complex knee replacements have the potential of having excellent outcomes.
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Revision Knee Replacement – When and How
Frequently Asked Questions
A revision knee replacement is a surgical procedure to replace or repair a previously implanted knee prosthesis that has failed or is no longer functioning properly. This will help in addressing the problems of pain, loosening of the implant, infection, or mechanical failure of the implant.
Chronic Pain: The patient has persistent pain or soreness with conservative treatment.
Loosening of Implant: The implant is loose/unstable as indicated by an imaging study.
Infection: Deep infection in the knee joint.
Mechanical Failure: The prosthesis has failed or is showing a wear and tear pattern.
Limited Function: There is inability to carry out activities of daily living because of knee dysfunction.
Revision knee replacement consists of the removal of the existing implant and its replacement with a new one. The surgery may include:
Bone preparation: cleaning off old cement or pieces of implant for preparing the bone for a new implant.
Tailor made Implant placement: correctly positioning and aligning the new prosthesis, which may be specifically tailored in its positioning and alignment to meet particular needs of the patient.
Repairing surrounding tissues: repairing damaged tissue or ligaments.
It takes around 2-3 hours to perform and is done under general or spinal anesthesia.
Revision knee replacement needs more time for recovery compared to primary knee replacement. Most patients are able to walk with support within one or two days of surgery. The full recovery and resumption of normal activities take around 6 months along with additional physical therapy to get good strength and mobility.
Risks include chances of infection, blood clots, implant failure, stiffness, and prolonged recovery since the revision procedure is often more complex.
With newer implant technologies and improved surgical techniques we use , revision knee replacements have the potential now to last 20 years, and even longer in certain cases. The longevity of the implant will, however, depend on various factors such as the activity level of the patient, weight of the patient, and general health of the patient.
It might involve further non-surgical treatment-avoiding surgery-with medicines, physiotherapy, or injections. If these fail to work and symptoms persist, then revision surgery is done.
Yes, but being overweight may raise the complications and could make the surgery more difficult. Even modest preoperative weight loss might result in improved outcomes and fewer risks.
Preparation includes:
Preoperative Testing: These include tests to check overall health and find out whether one is fit for undergoing this type of surgery.
Weight Control: Loss of weight, if recommended.
Physiotherapy: Pre-operative exercises to help strengthen the knee along with the surrounding muscles.
Life Style Changes: Whatever change one needs to bring about for easy recovery-planning a post-operative care and support and making necessary adjustments at home.
Yes, physical therapy is critical to a successful recovery. It helps restore strength, flexibility, and function to the knee. Your therapy program will be tailored by our team for your particular needs and may continue for several months depending upon your mobility recovery.