Revision Knee Replacement Surgery in Indore

Understanding Revision Knee Replacement 

Carefully planning and performing revision knee replacement is crucial. The primary surgery approach is generally simpler than the surgical approach, in that the implants that were previously placed must be removed without significant loss of bone and scar tissue from the original surgery must be handled. 

Comprehensive Pre-operative planning is performed by Dr. Sanjay Rawat and all imaging studies and previous surgeries are reviewed when available. Special tools and instruments are used to remove the components of the prostheses – namely specific types of saws, cutters and extraction devices – as a way to safely remove the components and avoid excessive bone loss. 

Removal of prosthetic cement is difficult and takes a long time. Cement can be securely attached to bone and not easily removed without depleting too much bone. With modern techniques, the removal of the cement can be done more efficiently, and minimal damage to the bone. 

It is important to assess bone loss for planning revision surgery. If there is a significant amount of bone loss, special designs of prostheses might be necessary, which are known as “revision prostheses” and must be able to fit the new bone structure. In areas of great bone loss, bone grafting could be required to regenerate bone. 

Soft tissue evaluation and repair is a crucial aspect of revision surgery.  Ligaments, tendons and the joint capsule may be worn, loose or over-motioned, and must be evaluated and, if needed, repaired or reconstructed. 

Prosthetic Component Selection for Revision 

Revision knee prostheses are specially designed for the anatomical changes which take place over time. The revised femur and tibia typically are longer with a deeper stem that will reach beyond the area of bone loss from the original implant and provide fixation below the site. 

If the bone loss has been serious, revision prostheses with increased surface area or modified designs might be needed. Some revision components are made to be able to rotate in some instances to maximize positioning in the face of irregular bone anatomy. The degree of stability (constraint level) which is built into the design of the prosthesis varies depending on the severity of soft tissue loss and the weakness or lack of ligaments. 

In cases of severe revision requiring extensive bone loss and ligament deficiency, more conservative designs of the prostheses may be needed that offer more intrinsic stability. The smaller the patient size, or if the patient has a specific bone anatomy, customized or patient-specific components may be necessary. 

Currently, revision prostheses have been greatly improved and can have excellent long term results when used and implanted correctly.

The Revision Surgical Procedure 

The time for revision surgery is usually longer (2-3 hours or more) than for a primary knee replacement. The surgical team carefully manages the previous surgical scar, either from the previous surgical incisions, or a new incisions, depending on the case. 

Care is taken to remove scar tissue in order to gain access to underlying prosthetic components. The old prosthetic devices are then gradually taken out. If the femoral component is to be removed, it will need to be cut out of the cement and carefully removed. Removal of the tibial component and its fixation is  similar. 

Specialized tools such as special saws, cutters and manual tools are used to remove cement. The objective is to get rid of all of the cement, and to preserve as much bone as possible. Large bone loss areas can be detected following the removal of the components. 

The joint is well flushed to make sure all debris and cement particles are removed.  Assessment of bone loss is made based on site, amount, and healing and/or supplementation potential. If there is a lot of bone loss, a bone graft (using the patient’s own bone or donor bone) may be indicated. 

New prosthetics are chosen to fit the new anatomy.  Appropriate bone cuts and component alignment is carefully optimised for component positioning. Surgical technique and choice of components provides appropriate soft tissue balance and/or ligamentous stability. 

Correct component positioning, range of motion and stability are confirmed by the surgical team prior to closure. The joint is flushed and soft tissues and skin are closed in layers. 

Special Considerations in Revision Surgery 

Particular attention should be paid to the issue of infection in revision knee replacement, especially if it is for revision because of infection. All the components of the prosthesis and the associated bacterial film (bacterial protection) need to be removed. After removal, the joint space is thoroughly irrigated with  antimicrobial solutions. 

A period of time may elapse between removal of the infected prosthesis and  placement of new components to allow the infection to be eradicated.  In a single-stage revision for infection, new prosthetic components are inserted at the same time, following good irrigation and irrigation with antibiotic-containing fluid. 

Prophylactic antibiotics are administered perioperatively in all revision surgeries and may be extended if there is an infection. In revision cases, where there is a lot of bone loss, bone grafting may be required.  When available, the bone from the patient (usually the distal femur) is best for autografting; however, bone from a tissue bank (allograft bone) is also used. 

When a ligamentous insufficiency develops, soft tissue reconstruction/repair becomes an important part of the treatment. Ligament reconstruction/augmentation may be used to restore stability in some instances. Today, because of special surgical techniques and designs of prostheses, options are increasing for patients with even the most complex revision cases. 

Hospital Stay and Immediate Recovery 

Revision knee replacement usually necessitates hospitalization, and is frequently 2-3 days or more, versus primary knee replacement, which is performed on an outpatient basis and many patients are able to go home after 1-2 days. The longer the hospital stay, the more complex and important the surgery was. 

The treatment of pain is essential and usually involves a combination of drugs, regional anesthesia methods, ice and positioning. Early mobilization starts at 24 hours after surgery when pain is tolerable. Physical therapy is used to help get patients started in range of motion exercises and early ambulation with assistance. 

Drainage tubes can be inserted to evacuate excess fluid and blood; this is usually taken out within 1-2 days as drainage decreases. This is normal and generally worse after revision than after primary surgery. Elevation and icing will help control swelling. 

Patients should be able to control their pain with oral pain medication, be able to ambulate with assistive devices, have reasonable range of motion improvement and be able to meet the criteria for self-care function prior to discharge. A few patients do better from a short-term inpatient rehabilitation program prior to discharge.

Soft tissue assessment and repair are important components of revision surgery.  Ligaments, tendons, and joint capsule that may have been compromised by wear,  loosening, or prolonged motion must be carefully assessed and, if necessary,  repaired or reconstructed. 

Prosthetic Component Selection for Revision 

There are revision knee prostheses that are specifically designed to cope with the anatomical changes that happen with the passage of time. Revised femoral and tibial components tend to have a longer stem that will penetrate deeper within the bone than the original stem fixing lower than the bone that has been lost due to the primary stem. 

If large areas of bone loss are present, a revision prosthesis with a greater surface area or a modified design might be needed. There are some revision components which rotate to ensure optimal positioning even with abnormal bone anatomy. The severity of soft tissue loss and the deficiency of ligaments determine levels of constraint (how firm the design of the prosthetic is). 

Long-Term Recovery & Rehabilitation 

Recovery after revision knee replacement typically takes longer than primary  knee replacement. The first 2-4 weeks emphasize pain/swelling control, ROM progress and gradual weight bearing and ambulation. 

Post-revision surgery physical therapy is usually 6-8 weeks long or longer, whereas post-primary surgery is 4-6 weeks. Therapists work on increasing range of motion, strength, gait training and functional progression. 

Recovery to normal activities is usually 3-4 months or more, some 

Continued functional improvement after this period of time. Return to work is dependent on ability to work based on job demands: Desk jobs may be able to go back at 4-6 weeks, Physically demanding jobs may require 8-12 weeks or longer. 

Walking and low impact activities can usually be resumed 6-8 weeks after the onset of pain and swelling has significantly decreased and strength is returning. High impact activities: typically, should not be undertaken in perpetuity. 

The long-term results of revision knee replacement surgery are good when it is performed at the right time and has been performed in the right manner. The satisfaction rates achieve high results, where most patients have noticed that their level of pain has decreased considerably more than it was before surgery. 

Longevity of Revision Prostheses 

The modern revision knee prostheses are extremely long lasting. Long-term studies show that well placed revision prostheses will last for 10-15 years and sometimes more. The life of a person’s specific prosthesis is dependent on the design of the prosthesis, bone quality, bone stock, soft tissue quality, patient age and activity level, and patient adherence to activity limitations. 

Certain revision prostheses have been shown to have excellent function in the right patients at 20+ years. Some patient populations may have slightly reduced survival rates of revision prostheses versus primary prostheses, however, because of the inherent challenges of revision. 

Good adherence to weight management, activity limitations and footwear is crucial to the longevity of a prosthesis. Follow-up exams can be done regularly to check for complications at an early stage and manage them. 

Why Choose Dr. Sanjay Rawat for Revision Knee Replacement 

Dr. Sanjay Rawat has a long track record in the successful management and delivery of complex revision knee replacements with high satisfaction and success rates. He has extensive experience in the complete preoperative assessment and surgical planning as well as the mastery of contemporary revision surgery techniques and knowledge of revision prosthetic design and use and is adept at handling difficult anatomical situations. 

Dr. Rawat always takes a patient-centric approach and provides a detailed explanation of the indication for revision, discusses surgical options and the likely outcomes, explains potential risks and complications, and provides continuous postoperative care to optimize recovery. 

His commitment to excellence and technical precision have earned recognition  among orthopedic peers for outstanding expertise in complex revision knee  replacement. Dr. Rawat’s patients consistently have excellent results with high satisfaction level.

Schedule Your Consultation 

If you have a knee replacement that is no longer functioning satisfactorily or  you’re concerned about complications, Dr. Sanjay Rawat invites you to schedule a consultation. He will perform comprehensive evaluation, discuss findings and  options, and determine the most appropriate treatment approach for your specific situation. 

Contact Dr. Rawat’s office today to address your knee replacement concerns.