Revision Knee Replacement
Revision knee replacement entails the removal of an existing knee prosthetic followed by implantation of a new, well-fixed prosthetic component or device. It is a very intricate procedure that requires a special set of skills. This special surgery is performed by very few Orthopedic professionals due to its difficulty, but when done properly the results can be transformative to a patient’s life.
Planning for Revision Knee Replacement
When planning for revision knee replacement the patient is evaluated thoroughly to determine the possible cause of a prosthetic failure. In addition, the patient’s history must be evaluated to determine whether they would be a good candidate for revision knee replacement or whether another treatment option would better suit them. If the plan is to then move forward with revision knee replacement, the patient will be consented for surgery and given orders for pre-operative lab work and other medical clearances. All lab work and medical clearances will then be completed within thirty days of surgery and the patient will return to clinic two weeks prior to surgery for their pre-operative appointment to further discuss details of the surgery. On the business day prior to surgery the patient is contacted by the hospital to confirm the time of the surgical procedure and the time to arrive at the location of surgery. In addition, the patient’s prescription medications will be discussed and the patient will be instructed as to which medications they may and may not take on the morning of surgery, based on the anesthesia protocol.
Revision Knee Replacement Procedure
The knee will typically be accessed through the existing incision scar or at the front of the knee. The incision length can vary but averages 8-10 inches. The incision will allow for removal of the defective component(s) and preparation of the femur (thigh bone) and/or tibia (shin bone) for implantation of new components. After the new components are applied to the femur and tibia, varied thicknesses of polyethylene spacers are inserted between the two components and the knee is then taken through a full range of motion by bending and straightening the knee to check for proper motion. When the proper fit has been achieved the incision is then closed and the patient awakened from anesthesia. The typical length of surgery for a revision knee replacement is 1.5-2 hours, but can vary depending on many factors.
After the patient has awakened from anesthesia they are encouraged to begin walking. It is important to note that no muscles or tendons are cut during the procedure so the patient is capable of applying full weight to the joint and can begin walking with the help of assistive devices such as a walker or cane. Following surgery, the patient will work with a physical therapist prior to their discharge. During this process the patient will learn the exercises they will perform as part of their recovery process, as well as how to navigate everyday obstacles such as going up and down stair or getting in and out of bed. Typically within a day of discharge the patient will begin at-home physical therapy which will continue for the first two weeks post-surgery, after which they will transition to outpatient physical therapy. In rare cases and depending on the patient’s homelife situation, the patient may require discharge from the hospital to a skilled nursing facility for post-operative care and rehabilitation. Upon discharge from the facility, the patient will then transition directly to outpatient physical therapy to continue their rehabilitation. In all cases the patient will return to clinic for a two-week post-operative evaluation and x-rays of the new prosthetic. After this visit the patient will continue with their outpatient physical therapy, as well as their home exercise program. The length of time from surgery to full mobility will, of course, vary from patient to patient, but by 4-6 weeks post-surgery the patient should be experiencing increased mobility, less pain, and may not require the use of assistive devices.