What is revision knee replacement surgery?
Revision knee replacement surgery is the replacement of a failed total knee prosthesis with a new prosthesis. Essentially, it is the replacement of a knee replacement.
The revision can be related to the replacements for the end of the shin bone and thigh bone, between which plastic is typically inserted.
What can I expect from the procedure?
On the day of surgery, you will typically be asked a series of questions by nurses, and have the opportunity to have your own questions answered by Mr Mann. You will also discuss the mode of anaesthesia best suited to your needs, with your anaesthetist.
Each operation is different and is related to the type of revision required. Typically, patients lie on their back and a tourniquet is applied to the upper thigh to restrict blood flow. Several measures are used in order to prevent blood clots from forming.
Why might I need revision knee replacement surgery?
There are a series of reasons why a knee replacement may require revision surgery. They include instability, which causes patients to feel unsafe when walking, and infection, which may result in fever symptoms or swelling.
The plastic used in a replacement can become worn, and this is one of the more simple revisions which is required, with the plastic insert needed to be swapped. Should implants become unattached to the bone, that is another reason for knee replacement revision surgery to be recommended. Erosion of the bone, also known as osteolysis, and in some cases severe stiffness, can also be addressed with knee replacement revision surgery.
What is the recovery time?
You can expect a three to five day stay in hospital following knee replacement revision surgery. Crutches are typically needed for a two to three-week period. After then a walking stick is usually sufficient for support.
Physical therapy work will be recommended to improve range of motion, and activity level can be increased gradually. Mr Mann will provide expert advice and support on your aftercare and when you can go back to work, to make sure you can get back to your daily life as soon as possible.
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Postoperative period and recovery
Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.
After your operation, a routine enhanced programme of recovery will commence. The main parallel work streams of this programme are as follows:
Mobilisation is commenced on Day One. Gradually there is an increase in the frequency of transfers in and out of bed. This then progresses onto stairs and mobilisation to the toilet/shower and back. Before discharge, the patient is well rehearsed in the exercise routine and the knee should bend to at least ninety degrees. It is extremely important to remain well motivated and perform your exercises after discharge to fully optimise the range of motion of the newly replaced knee.
Will focus more on activities of daily living, functional transfers and adaptation of the home environment.
During the operation, spinal anaesthesia with local infiltration of anaesthetic around the knee is used. After the operation regular oral medication is then used. Ask for extra if required. Before discharge required prescriptions are provided.
It is perfectly ok to experience an ooze from the wound especially as one mobilises. Your dressing may require changing. Before discharge, the wound should be dry and arrangements will be in place for staple removal by your practice nurse.
Immediately after the operation intravenous (directly into the veins) fluids are given. Medications such as routine antibiotics are also given via this route. Urine output is carefully monitored. A bedside commode may be needed during the first postoperative day.
Normal diet is introduced as soon as possible. The urine catheter is removed once mobile. Bowel habit should also return to normal before discharge.
On the first morning after the operation ablutions are performed at the bedside. Showering is then gradually introduced – at first with assistance and then independently.
Problematic total knee replacement
Sometimes a total knee replacement can become problematic earlier than expected and may require revision surgery. Alternatively, you may be one of the many patients out there who has had a well-performed total knee replacement which has now failed or become problematic with the passage of time.