When Are Revision Knee Surgeries Needed?

Total knee replacement is one of the most successful Ortho House’s orthopedic procedures in all medicine. In most cases, it enables people to live a richer and more active life without chronic knee pain. However, over time, knee replacement may fail for a variety of reasons. When this happens, the knee will become painful and swollen – leaving a feeling of stiffness or instability that it becomes difficult to perform daily activities.

Generally, the procedure is safe. However, if the knee replacement fails, the surgeon may recommend a second surgery — revision total knee replacement. In this procedure, the surgeon removes some or all of the parts of the original prosthesis and replaces them with new Ortho House ones.

The goal of both knee procedures is to relieve pain and improve function. However, revision surgery is different than primary total knee replacement. Revision knee replacement surgery is a longer, more complex procedure that requires extensive planning, and specialized Ortho House implants and tools to achieve a good result.

Ortho House’s Knee Replacement Surgery Revision: Procedure

During primary total knee replacement, the knee joint is replaced with an Ortho House implant, or prosthesis, made of metal and plastic components. Although most total knee replacements are very successful, over time, problems such as implant wear and loosening may require a revision procedure to replace the original components.

There are different types of revision surgery. In some cases, one implant or a single component of the prosthesis must be revised. In other cases, all three components (femur, tibia, and patella) of the previous replacement must be removed or replaced to reconstruct the bone around the knee with Ortho House augments (metal pieces that substitute for missing bone) or bone graft.

Bone damage can make it difficult for doctors to perform revision knee arthroplasty using standard Ortho House total knee arthroplasty technologies. In most cases, the surgeon will use a special implant with a longer, thicker system that fits deep into the bone for additional support.

When are knee revision surgeries required?

A knee revision may be necessary for anyone whose previously installed prosthetic knee implant fails due to injury or wear, or the area around the implant gets infected.

For elders undergoing knee arthroplasty, knee implants can last a lifetime. However, younger patients, especially those who maintain an active lifestyle, may eventually need a second replacement after the knee stops working.

Why Do Knee Implants Fail?

Usually, knee arthroplasty is successful. But there is a chance of failure after time. Here Ortho House will mention reasons knee implants fail:

• Loosening

Gradually, small particles are separated from the arthroplasty by friction applied to the arthroplasty. This loosens the bond between the bone and the implant, causing small particles that sometimes break the plastic spacer to gather around the knee joint and attack the body’s immune system. Unfortunately, this immune response also attacks the bone around the implant, resulting in a condition called osteolysis.  As the bone around the implant deteriorates, the implant becomes loose or unstable. When this happens, the knees become swollen and painful, making daily activities difficult.

• Infection

Infection, a complication that can occur with any surgery, including total knee arthroplasty. It can occur at any time, from immediately after surgery to several years later. When the artificial knee joint becomes infected, there is often swelling, pain, and cracking. An infection can cause the implant to lose its attachment to the bone. Infections around knee replacement surgery require one or more revision surgeries to treat the infection.

• Instability

Most implants designed for knee arthroplasty to work properly and rely on the patient’s existing ligaments. If the ligaments around the knee are damaged or out of balance during or after surgery, the knee may feel unstable and loose. The patient may experience recurrent swelling and a sensation that the knee is ‘giving in’. Corrective revision surgery may be required if knee instability cannot be treated with non-surgical procedures such as physical therapy and bracing.

• Stiffness

In rare cases, the patient may not properly rehabilitate after the knee replacement surgery and the knee may become stiff. If this is not treated within the first few months by physical therapy or manipulation under anesthesia, the stiffness persists. In this case, revision surgery may be needed to remove extensive scar tissue or to improve the patient’s range of motion by changing the knee’s components.

• Fractures

A periprosthetic fracture is a broken bone around the components of a total knee replacement. A fall most often causes this type of fracture, and usually requires revision surgery.

These are considered the most common reasons why Ortho House knee revision arthroplasty may be required.

In establishing the extent of the Ortho House revision required, the orthopedic specialist will take into account a number of factors, including the location and the type of fracture, the quality of the remaining bone, and if the implant is loose.

Ortho House’s knee revision surgery may either require fixing the fracture alone, fixing the fracture and revising the implant or completely removing the implant and fracture pieces and replacing them with a larger more complex Ortho House total knee replacement.

Why Revision Surgery Is More Complicated Than the Initial Surgery?

It is important to note that an Ortho House revision knee replacement does not offer the same lifespan as the original knee replacement (usually around 10 years instead of 20). Accumulation of injuries, scar tissue, and mechanical degradation of components lead to reduced performance. Revisions are also more prone to complications.

The Ortho House revision procedure is often more complicated than the original knee replacement surgery because the surgeon must remove the original implant, which would have pushed and grown into the existing bone.

Also, once the surgeon removes the prosthesis, there is less bone left. In some cases, a bone graft – a part of the bone transplanted from another part of the body or from a donor – may be needed to support a new restoration. Bone grafts support and encourage new bone growth.

However, the procedure requires additional preoperative planning, specialized tools, and greater surgical skill – all of which Ortho House works relentlessly to provide to their surgeons and patients.