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   • Unilateral Knee Replacement


   • Bilateral Knee replacement


   • Total Knee replacement


   • Unicondylar Knee                       Replacement


   • High Flex Knee                           Replacement


   • Both Knee Replacement             together


   • Minimally invasive Knee               Replacement


   • Revision Knee                             Replacement



Revision Knee Replacement :
Orthopedic Surgery
Introduction

Revision Knee Replacement means that part or all of your previous knee replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone. The typical knee replacement, replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).


Why does a Knee replacement need to be revised?

Pain is the primary reason for revision. Usually the cause is clear but not always. Those knees without an obvious cause for pain in general do not do as well after surgery.

Plastic (polyethylene) wear. This is one of the easier revisions where only the plastic insert is changed

Instability which means the knee is not stable and may be giving way or not feel safe when you walk

Loosening of either the femoral, tibial or patella component. This usually presents as pain but may be asymptomatic. It is for this reason why you must have your joint followed up for life as there can be changes on X-ray that indicate that the knee should be revised despite having no symptoms.

Infection- usually presents as pain but may present as swelling or an acute fever.

Osteolysis (bone loss). This can occur due to particles being released into the knee joint which result in bone being destroyed

Stiffness- this is difficult to improve with revision but can help in the right indications


Pre-operation


Day of your surgery


Surgical procedure

Each knee is individual and knee replacements take this into account by having different sizes for you knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.

Surgery is performed under sterile conditions in the operating theatre under spinal or general anaesthesia. You will be on you back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes about two hours .

The Patient is positioned on the operating table and the leg prepped and draped.

A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilising solution.

An incision around 7cm is made to expose the knee joint.

The bone ends of the femur and tibia are prepared using a saw or a burr.

Trial components are then inserted to make sure they fit properly.

The real components (Femoral & Tibial) are then put into place with or without cement.

The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.


Post-operation coursee

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain called Patient Controlled Analgesia (PCA).

Once stable, you will be taken to the ward. The post-op protocol is surgeon dependant, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post of day to make movement easier. Your rehabilitation and mobilization will be supervised by a physiotherapist.

To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.

Your orthopaedic surgeon will use one or more measures to minimize blood clots in you legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section.

A lot of the long term results of knee replacements depend on how much work you put into it following your operation.

Usually you will be in hospital for 3-5 days and then either go home or to a rehabilitation facility depending on your needs. You will need physiotherapy on your knee following surgery.

You will be discharged on a walking aid either on frame or crutches and usually progress to a walking stick at six weeks.

Your sutures are sometimes dissolvable but if not are removed at approx 10 days.

Bending you knee is variable, but by 6 weeks should be to 90 degrees. The aim is to get 110-115 degrees of movement.

Once the wound is healed, you can take a shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks.

More physical activities, such as sports previously discussed may take 3 months to be able to do comfortably.

When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements especially if they are up a lot of stairs.

You will usually have a 6 weeks check up with your GP who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray.

You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee.

If you ever have any unexplained pain, swelling, redness or if you feel unwell you should see your doctor as soon as possible.

India Surgery Revision Knee Replacement, Cost Knee Revision Surgery
This 82 year lady required a tibial tubercle osteotomy to gain access to the knee and proceed with the revision total knee replacement.


What happens if my knee replacement gets infected?

Fortunately infection of a total knee replacement is quite rare. The infection rate for primary total knee replacement is less than 2%. Infection of a knee prosthesis is a serious issue. Very occasionally the infection can be treated with wound debridement (removal of non viable tissue around the knee joint) and antibiotics.

In the majority of cases however the presence of the total knee replacement prevents the elimination of the bacteria causing the infection and removal of the implant is required in order to have a chance of curing the infection.

After the components have been removed a antibiotic loaded articulating spacer can be used so that the patient has reasonable knee function whilst the infection is being treated with antibiotics.

Sometimes more than one debridement may be required to eliminate the infection.

When there is good evidence (blood tests and aspiration of the knee joint testing for bacteria) that the infection has been removed an attempt can be made at re-introducing a new revision total knee replacement. In the majority of cases the time to re-implantation is about 3 months but this time varies from patient to patient.
India Surgery Revision Knee Replacement, Cost Knee Revision Surgery India Surgery Revision Knee Replacement, Revision Knee Replacement, Repeat Knee Replacement India Surgery Revision Knee Replacement, Repeat Knee Replacement, India Revision Surgery, Knee Revision Treatment
India Surgery Revision Knee Replacement, Knee Revision Treatment, India Surgery Tour Cost Knee Revision Surgery, Revision Knee Replacement, India Revision Surgery, Knee Revision Treatment India Surgery Revision Knee Replacement, Cost Knee Revision Surgery, India Revision Surgery, Knee Revision Treatment, India Surgery Tour
This 71 year old gentleman had an infected total knee replacement. He was treated with a two stage revision. Antibiotic loaded spacers where used after the knee replacement was removed. 3 months later after the infection had settled a new revision total knee replacement was performed


Risks and complications

- As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

- It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or local complications specific to the Knee.

Medical complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications include
Local complications

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.


Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of there prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.
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Introduction

Why does a knee replacement needs to be revised?

Pre-operation

Day of your surgery

Surgical procedure

Post-operation course

Risks and complications

Summary


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