Revision knee surgery, sometimes referred to as a revision total knee replacement, is a specialized procedure performed to address issues with an existing knee replacement. Over time, artificial knee parts can wear out, leading to the need for replacement.

This procedure involves removing the old, worn-out components and replacing them with new, durable metal and plastic parts. Continue reading to learn about the various aspects of revision knee surgery; we offer comprehensive insights into what patients can expect before, during, and after the procedure.

• What is Revision Knee Surgery?

• Understanding the Need for Knee Revision Surgery

• How to Prepare for a Revision Total Knee Replacement

• What's the Revision Knee Surgery Process?

• Listing the Risks Associated with Revision Knee Surgery

• Recovering from Revision Knee Surgery

A revision knee surgery is called a reoperation because the doctor performs the same operation on the same person for a second time. It is done for patients who have previously undergone a total knee replacement, and the nature of this procedure can vary from the replacement of a single implant to a complete overhaul, involving all prostheses from the original surgery.

Because revision knee surgery is a complex procedure, it demands extensive preoperative planning, the use of specialized implants and tools, and longer operating times than most surgeries. The physician performing the procedure must have a high level of expertise in using a variety of challenging surgical techniques.

Most patients who have had this procedure enjoy favorable outcomes in the long run, including significant pain relief, enhanced stability, and improved knee functionality, although a minority may still experience some postoperative pain.

When a patient has been experiencing increased pain and limited mobility in an already replaced knee, they'll likely need a knee revision procedure. Total knee replacement implants are durable and typically last around 15 to 20 years. Those who have a higher risk of needing reoperation are younger patients or those with active lifestyles. Here are some common ways to know that knee revision surgery is needed:

Infections: Although rare, an infection requires a knee revision immediately.

Instability: Functional activities become much more difficult when the soft tissues and prostheses around the knee fail to provide adequate support while walking or standing.

Excessive scar tissue: The excess buildup of scar tissue in the knee after a knee replacement, called arthrofibrosis, can lead to stiffness that greatly restricts range of motion.

Breakdown of Prosthetics: Over time, prosthesis components will loosen or break due to ongoing friction.

Symptoms indicating a failed knee replacement include increased pain, persistent swelling, and reduced knee function, often manifesting as a limp, stiffness, or instability. These symptoms necessitate a thorough evaluation for possible knee revision surgery.

Properly preparing for a revision total knee replacement will ensure a successful procedure and recovery. Firstly, a comprehensive physical examination by your primary care physician is necessary a few weeks before the surgery to confirm your fitness for the operation. Patients with chronic conditions like heart disease may need additional evaluations from specialists like cardiologists.

Preoperatively, your physician will conduct a thorough clinical exam, order X-rays and laboratory tests, and possibly aspirate the knee joint to test for infection. Advanced imaging like CT scans or MRIs may also be used to assess the condition of the existing prosthetic components and the extent of bone loss.

Preparing for the recovery phase is vital, as your mobility will be limited for some time after your procedure. Arrangements for assistance with daily tasks such as cooking, shopping, and personal care should be made in advance, especially if you live alone.

Revision knee surgery is a detailed, extensive procedure, and normally it will go as follows:

1. The patient will be administered anesthesia to ensure comfort and painlessness throughout the operation. Depending on how extensive the replacement is, patients will either be put under general anesthesia or regional anesthesia using an epidural.

2. The physician makes an incision to access the knee joint, moving aside the patella to evaluate and remove any loose or damaged implants.

3. If significant bone damage is present, the physician may reinforce the bones before placing new implants using metal wedges, wires, or screws. This could also involve the use of bone grafts, either from the patient's own body (autograft) or a donor (allograft).

4. Specialized revision implants are then inserted, and temporary drains might be placed to collect excess fluids.

5. The new joint is carefully tested to ensure proper fit and functionality. Then, the incision is closed.

The entire procedure can take two to three hours, and special postoperative dressings may be applied to promote healing. After the surgery, you will be monitored in a recovery room as you wake up, and your physician will advise you on the next steps for your recovery.

Revision knee surgery carries certain risks. If it's determined that the old knee implant must be removed, the procedure could become more complicated. This is because bone could have grown over the implant, meaning that when it is removed, there will be less bone for the physician to work with, increasing the risk of instability. Keeping that in mind, a few other potential complications could arise during or after revision knee surgery, they are:

• Infection

• Excessive bleeding

• Damage to nerves or blood vessels

• Bone fractures during the procedure

• Pulmonary Embolism caused by DVT (Deep Vein Thrombosis)

Due to its complexity, revision joint surgery might be more prone to these risks compared to primary knee replacements. Factors such as scar tissue, increased surgical time, and potential poor blood supply to tissues and bones contribute to the complexity of the procedure.

Recovering from a revision knee surgery requires careful attention and adherence to postoperative care instructions from your physician. The recovery process is similar to primary knee replacement, consisting of physical therapy, medication for blood clot prevention, and pain management medication.

You might need to use a brace or splint to stabilize the joint, and usually, physical therapy begins within 24 hours of the surgery. Therapy often continues for up to three months post-surgery, with the gradual transition from assistive devices like walkers or crutches to independent mobility. Continuing physical therapy exercises at home is vital for rebuilding strength and mobility.

Initially, you will have to limit weight-bearing on your knee. It's essential to follow your doctor's instructions for wound care and avoid soaking the wound in water until it's healed. Stitches or staples are usually removed a few weeks after the surgery. Recovery times vary from patient to patient, but a full recovery and return to strenuous activities can take up to 12 months.

Schedule an appointment with our physicians if you desire a consultation to determine if you need revision knee surgery.