Revision TKR (Total Knee Replacement)
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Introduction: Total Knee Replacement is one of the most successful procedure over last 50 years,allowing patients to live more productive and active lives free of chronic pain.

With more joint replacements performed every year and procedures extending to treat younger more active patients, there is an increase in need of Revision Total Knee Replacement.

Over a period of time the Knee Replacement may fail due to a variety of reasons. When your Knee Replacement fails, then what you need is a second surgery i.e. Revision Total Knee Replacement where your doctor will remove some or entire part of original implant and replace them with new implant.

Revision Knee Replacement is a longer and more complex procedure that requires extensive planning and specialized implants and technology to achieve the desired goals.

We at Neem tree healthcare have vastly experienced surgeons trained extensively in revision surgery and routinely dealing in Revision Knee Replacement cases with satisfactory patient outcomes.

Why does a Total Knee Replacement fails:

1) Implant loosening and wear:

Usually fails due to high impact activities, excessive body weight and wear of plastic spacer.

In some cases particles wear off from plastic spacer and accumulate around the joint and initiate body immune response that unfortunately attacks healthy bones around the joints and leads to osteolysis

2) Infection:

Infection is the potential complication of any surgical procedure including Total Knee Replacement.

Infection may occur immediately afer surgery or even years later. The infected joints become stiff and swollen.

Revision in case of infection can be

1. Debridement with implant retention and spacer exchange.
2. Two stage revision (stage 1 involves removal of infected implant, debridement and insertion of antibiotic spacer. Stage 2 involves removal of antibiotic spacer and replacement with revision knee implant.

3) Instability:

It’s mainly due to injury to ligament /ligament insufficiency

1. a) MCL/LCL injury or incompetence.
2. b) Improperly balanced ligaments.
3. c) Improperly balanced flexion gap.

Patient usually has complaint of recurrent swelling of joint and sense of giving away of knee.

4) Stiffness

Rarely, patients are unable to appropriately rehab a knee replacement after surgery and the knee will get stiff. If this is not treated within the first few months by physical therapy or a manipulation under anesthesia, the stiffness will persist. In this case, revision surgery may be necessary to remove the extensive scar tissue and/or change the components in the knee to improve the patient’s range of motion.

5) Peri Prosthetic Fractures

1. a) Fracture around prosthetic implant.
2. b) Treatment of the fracture depends upon location and type of fracture, bone quality and implant loosening.

6) Patello Femoral Maltracking:

7) Metal Hyper Sensitivity:

Diagnosis:

Evaluation includes:

1) Details of previous surgery.

2) Detailed physical examination.

3) Special investigation:

1. a) X - Ray (AP, Lateral and weight bearing radiographs).
2. b) CT Scan
3. c) Bone Scan
4. d) Blood Tests (ESR, CBC and CRP)
5. E) Knee Aspiration

Procedure:

During the procedure the surgeon removes the old implants and replaces them with the new revision implant. Depending on particular case, variety of revision implants may be used.

1) Unconstrained PCL retaining implant.

2) Unconstrained PCL substituting implant.

3) Constrained implant (non hinged).

4) Constrained hinged implant with rotating platform.

In some cases there may be significant bone loss around the knee and special metal blocks / augments are to be used

RECOVERY AND REHABILITATION

1. Recovery in Hospital

• Pain Management ( Includes Oral/ Intravenous medicines + epidural Injections)
• Physical Therapy ( Joint mobilization, ambulation and exercises for muscle strengthening)
• Blood Clot Prevention (Compression stockings, DVT pumps and blood thinner medicines.)
• Preventing Infection (Oral and Intravenous antibiotics and wound care.)

1. Recovery at Home

• Wound Care
• Physical Therapy ( You may require help of therapist for a few weeks)
• Medications for pain relief, blood clot formation and preventing infection.

Complications

The possible risks and complications of revision tkr surgery include:

• Poor wound healing
• Reduced range of motion or stiffness in the knee
• Infection in the wound or the new prosthesis
• Bleeding
• Blood clots in the legs, which may travel to the lungs (pulmonary embolism)
• Bone fracture during surgery
• Damage to nerves or blood vessels

Long-Term Outcomes

The majority of patients who have revision surgery experience favorable long-term outcomes, including relief from pain and increased stability and function. Complete pain relief and restoration of function is not always achievable, however, and some patients may still experience pain or knee stiffness following revision surgery.

Why choose Neem Tree?

50+ Specialist Onbaord

35+ Years of Experience

24X7 Medical Assistance

Free Pick & Drop

PSUs & TPA & Insurances are Accepted

All Govt Panels Accepted

Post Surgical Rehabilitation

EMI Option Available

Post Discharge Home Care

Transparency

Hassle Free TPA/Panel Desk

Medical Visa Assistance

• Neem Tree is Covid19 safe - The patient's safety is first here, and it is mainly taken care of by social distancing and sanitized clinics besides sterilized hospital rooms.
• Our team of doctors is fully vaccinated.
• Post-surgery care - We tend to offer fantastic follow-up sessions, including consultations and instructions like dietary tips and physiotherapy to all patients to ensure you have a seamless recovery.
• Home Care including change of dressing, stitch removal and physiotherapy sessions at home.