Revision Knee Replacement
Revision Total Knee Replacement is the replacement of the previous failed total knee prosthesis.
During this surgery we remove some or all of the parts of the original prosthesis and replaces them with new ones.
There are different types of revision surgery. In some cases, only one implant or component of the prosthesis has to be revised. Other times, all three components-femoral, tibial, and patellar-need to removed or replaced and the bone around the knee needs to be rebuilt with augments (metal pieces that substitute for missing bone) or bone graft.
5 Signs you May Benefit From a Revision Knee Replacement
In order for a total knee replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, it was either cemented into position or bone was expected to grow into the surface of the implant. In either case, the implant was firmly fixed.
Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful.
In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body’s immune system. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable.
If the ligaments around your knee become damaged or improperly balanced, your knee may become unstable. Because most implants are designed to work with the patient’s existing ligaments, any changes in those ligaments may prevent an implant from working properly.
You may experience recurrent swelling and the sense that your knee is “giving way.”
A periprosthetic fracture is a broken bone that occurs around the components of a total knee replacement. These fractures are most often the result of a fall, and usually require revision surgery.
If an artificial joint becomes infected, it may become stiff and painful. The implant may begin to lose its attachment to the bone. Even if the implant remains properly fixed to the bone, pain, swelling, and drainage from the infection may make revision surgery necessary.
The left image shows a periprosthetic distal femur fracture where both the medial and lateral condyles have fractured off the femur. The tibial component is grossly loose and there is a cement mantle fracture. The right image shows a distal femoral replacement (DFR), which was used to replace the loose tibia and fractured femur. By using the DFR, the patient was able to start weight-bearing right away. The little white beads are dissolvable antibiotic beads to help prevent infection.
For the four images below, the two images on the left (labeled Pre-op) are AP and lateral images of a cemented total knee replacement done by another surgeon that has failed due to aseptic loosening and has collapsed into varus malalignment. The two images on the right (labeled Post-op) show the prior knee replacement was removed and replaced with revision components which were reinforced with long stems to fit more securely into the bone and provide more stability.