Complex Revision Total Knee Replacement

Introduction

Knee replacement, also known as knee arthroplasty, involves the replacement of a damaged joint with an artificial prosthetic. It involves the replacement of the ends of the femur and tibia, and often the patella, with artificial components. In some cases, the original implant may fail, causing pain and limiting function. This requires complex revision knee replacement, which involves replacing the failed components of the original implant with new.

Indications and contraindications for complex revision total knee replacement

Complex revision total knee replacement is effective for the treatment of:

Primary implant failure: where components of the primary knee replacement have worn, loosened, or failed.

Infection: wherein revision is neccessary to remove infected components and address the infection.

Instability or malalignment of the existing implant.

Periprosthetic fractures: wherein fractures around the existing implant have compromised stability.

Extensive bone loss: Severe bone loss or compromised bone quality around the knee joint can make complex revision surgery necessary to provide stability for the new components.

Contraindications for complex revision total knee replacement include

Poor general health, including uncontrolled diabetes and severe heart and lung disease.

Severe osteoporosis or poor quality bone. 

Vascular insufficiency, including avascular necrosis. 

Active infection (local or general).  

Neuropathy. 

Significant deformity of the component parts of the knee.

Benefits and complications of complex revision total knee replacement

Benefits

  • Relief from painful symptoms.
  • Restoration of function and improved mobility.
  • Preserves range of motion in the ankle joint.
  • Reduced joint stiffness.
  • Resolution of infection and other implant issues. 
 

Known complications

  • Permanent nerve damage resulting in sensory or motor deficits.
  • Superficial or deep infection.
  • Vascular injury and bleeding.
  • Pain.
  • Implant loosening or failure 
  • Deep Vein Thrombosis (DVT)
  • Bone loss. 

The surgery

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

 

On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general or spinal anaesthesia.
  • An incision is made following the line of that from the primary knee replacement. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • The joint is assessed for damage or infection.
  • The existing implant and the cement holding it in place is removed. 
  • Where extensive bone loss has occured, metal augments and platform blocks may be added to the revision implant.
  • The revision implant is fitted. This may be held in place using special screws until bone healing is complete. 
  • X-rays are taken to confirm positioning.
  • The wound will be sutured and dressed.
 

After your surgery

  • In-patient care: you will remain in hospital for several days for monitoring and early-stage rehabilition. 
  • Pain and swelling: You may experience mild to moderate pain. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum) and elevation.
  • Mobilising: you will be encouraged to move the knee and walk within a day or two of surgery. You may require a walker or crutches until around 6 weeks post-surgery. By week 6, the knee should be able to bend to about 90 degrees, with a target range of 110-115 degrees. 
  • Aftercare: at one week post-surgery, you will be required to attend a wound check and at two weeks your sutures will be removed. At 6 weeks, you will undergo further X-rays to assess healing, and at three months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing. 
  • Physiotherapy: a tailored program of strengthening and mobility exercises will be provided to support recovery. 

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.