Revision Knee Replacement

What is a Revision Knee Replacement?

This is a procedure which involves removing the original knee prosthetic, for whatever reason, and replacing it with a new knee implant. It is also known as a Revision Total Knee Arthroplasty. Just like the primary knee replacement, the goal of this procedure is to produce a knee that is stable and well-aligned.

Who is this operation for?

This operation is mainly done for implants that have loosened, usually secondary to infection or wear and tear of the implant material. Other indications include malalignment and ligament instability.

What are the benefits of the operation?

Having a knee that is functional and improves your quality of life.

Risks of not having the surgery

Difficulty doing day to day activities due to pain or knee instability. Also if the issue is an infection at the prosthetic site, the consequences of not treating can be disastrous and permanent damage can be done to your knee.

Complications

The risks and complications of a Revision Knee Replacement are very similar to those of a Knee Replacement and include:

Before the operation

Preadmission Clinic | Preparing for Surgery

Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.

During the visit, you will be seen by a

  • doctor
  • nurse
  • anaesthetist (if necessary)

Tests

Tests that may be ordered for you include:

  • blood tests
  • Xray hip
  • Xray of your Chest
  • Urine Test
  • ECG

Preparing Your Skin

Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.

Tip

Carry a list of your medications with you including the name, dosage and how often you take it.

Medications

Our doctors will advise you which medications you should stop or can continue taking before surgery.

Get some help from your friends and family

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended-care facility during your recovery after surgery also may be arranged.

Home Planning

The following is a list of home modifications that will make your return home easier during your recovery:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home

About the Operation

The procedure is very similar to the Knee Replacement but there are a few notable differences. The revision procedures normally take longer to perform than a primary knee replacement. For the procedure itself, firstly, the original implant needs to be removed. Then depending on if there is bone loss, bone graft may be used. Afterwards the new prosthetic is put it.

After the Operation

The care required after your replacement is essentially the same as for a normal primary knee replacement. You will stay in hospital for about a week after the operation so the nurses and doctors can monitor you. The time for you to recover can be longer or shorter than your first replacement. After being discharged from hospital you will undergo physical therapy, rehabilitation and possibly have some home assistance.

Recovery and Rehabilitation

Once your arrive on the ward, a team of nurses, physiotherapists, occupational therapists and doctors, will help you recover from your operation.

My Pain

You can expect to have pain in the operation site. You will have either:

  • An injection into your spine – an epidural – which may be connected to a fine tube and a pump which sends painkiller into your spine. This can cause headache and soreness at the injection.
  • A patient controlled analgesia which, when you press a button, releases a painkiller into your IV drip. This can cause nausea and vomiting, sleepiness, and/ or trouble emptying your bladder. These pain-killing devices will stay in for 24 – 48 hours depending on the amount of pain you have.

My Food

You may have a drip in your arm, this will be removed by the second day after your operation. To begin with, you can have small sips of water, then slowly take more until you are eating normally.

My Wound

Your wound will be a cut about 20 to 30 cms down the front of your leg from above to below the knee and will be closed with either stitches or clips. The stitches or clips will stay in for 10 to 14 days. A dressing will cover the cut and you will have a drain to drain any blood and fluid from the wound into a small bag. This is removed 24 to 48 hours after operation – or once the drainage has stopped. You can shower 1 or 2 days after surgery. A waterproof dressing will be put on over the top. Your dressings will be changed as ordered by the surgeon. You may go home with a dressing covering your wound until your stitches or clips are removed. Continue to keep your wound clean and protected until healed and no seepage is present.

My lungs and blood supply

It is very important after surgery that you move as soon as possible. Pump your feet backwards and forwards and bend and straighten your non- operated leg at the knee. This prevents blood clots forming in your legs and possibly travelling to your lungs. This can be fatal. You will be shown which of your pre–operation exercises to continue after surgery. You will start walking the second day after surgery with the use of walking aids. You will be told when you can put your full weight on your new knee. Also, you need to take ten deep breaths every hour, to prevent secretions in the lungs becoming stagnant. If this happens, you may develop a chest infection. At all costs, avoid smoking after surgery as this increases your risk of chest infection.

My Exercises

You will feel tired for a few weeks after surgery. You need to take things easy and return to normal duties, as you feel able to. It takes about 3 months to recover. You will be given exercises to do for a month after your surgery. You will also be shown how to safely climb stairs, shower, dress and toilet yourself.

There are a number of movements to avoid:

  • Avoid jumping – even from low surfaces.
  • Avoid sudden jolts to the leg (e.g. stepping off kerbs).
  • Avoid gaining weight, which puts extra stress on your joint.
  • Keep to low – key activities at work and at recreation.
  • Avoid kneeling on your new knee joint.
  • Be careful in slippery, cluttered or uneven areas so that you don’t fall.xiii You will be told about these before you go home.

Looking after my knee joint

Joint replacements can become infected at any time after the surgery from the first postoperative day to many years down the line.

You can take the following steps to help prevent infection:

  • Take antibiotics before dental or any medical procedure.
  • See your doctor to treat all suspected urinary tract infections.
  • Look for signs of infection in the knee including pain, redness, swelling or increased warmth.
  • Your new joint replacement may trigger airport metal detector alarms. We will give you a certificate that verifies that you had a knee replacement.
  • Keep in mind that you need to protect your knee replacement to ensure a long lasting, successful result. Follow all instructions concerning any activity restrictions.

F.A.Q.s | Frequently Asked Questions

What are the alternative treatments to having a Revision Knee Replacement?

There are a couple but they are not very popular. One is knee fusion (arthodesis) whereafter you cannot bend your knee. Another is above knee amputation.

Are there important things I need to tell my doctors?

  • Redness, swelling or warmth around the cut
  • Leakage from the cut
  • Fever and chills.
  • Severe knee pain that is not relieved by prescribed painkillers.
  • Sudden sharp pain and clicking or popping sound in the knee joint
  • Loss of control over leg movement
  • Loss of leg movement
  • Further surgery planned for the future i.e. dental work, bladder catheterisation, examinations of the bowel, bladder, rectum or stomach.

What are the bones of the knee?

The knee is a hinge joint, formed by the end of the thighbone (femur) and the end of the shin bone (tibia). The bones are coated in cartilage, which acts as a cushion between the two bones and allows the knee to move. In front of these bones is the kneecap (patella) which glides in a groove on the end of the thigh bone.

Diagram of the bones and ligaments of the knee