Revision Total Knee Replacement Surgery
Most pateints only under go one knee replacement in their lifetime. It's a successful procedure that allows most people to continue living an active lifestyle. Unfortunately, a total knee replacement may fail.
Dr. Morton is an expert in revision hip and knee replacements and will evaluate your knee for possible problems. He will discuss with you that you may require another operation to remove and exchange some or all of the components.
The goal of a revision total knee replacement is to improve function and pain. The surgery can be significantly different than a primary total knee replacement and is often a longer and more complex procedure. There may be more extensive planning and the use of specialized equipment in order to correct your problem.
Implant Loosening and Wear
Sometimes the implant can become loose. It is not always clear what may lead up to a loose implant. Orthopedic surgeons believe that repetitive high-impact activities, high body weight, and wear of the plastic liner may lead to quicker wear of your knee replacement, leading to implant loosening. Patients who undergo a knee replacement at a younger age are at a high risk of having their knee replacement become loose.
Loosening occurs when the tiny particles generated when the plastic liner wears out is attacked by your body’s immune system. The immune system then destroys the healthy bone around the implant. This bone destruction is called “osteolysis”. When osteolysis occurs, the implants can begin to have a windshield wiper movement and become loose, causing pain.
When bacteria enter your knee, it can become attached to the surface of your implant. This infection can begin in the hospital at the time of your initial operation, or can begin years later. The risk of an infection after a knee replacement is 0.5% - which is very small. Unfortunately, when it happens, it is a major complication for patients. The risk for infection can be higher in patients with underlying medical conditions such as diabetes, or patients who smoke. Infection is considered whenever patients have a complication with their knee replacement, such as pain, instability, or drainage. Possible treatment options for an infected total knee include removal of the implant, revision, debridement, or just antibiotic suppression. Often, multiple surgeries are required to cure your infected total knee. You should have a discussion with Dr. Morton regarding the long process to treat an infected knee replacement.
Read more about infected knee replacements.
Sometimes patients feel their knee is unstable. This can begin when the knee is put in initially (such as improper surgical technique) or over time as the ligaments begin to stretch out. Patients with an unstable knee replacement will feel as though their knee “gives way”, and often experience recurrent swelling. Robotic-assisted joint replacements are an excellent way to prevent technical errors that can occur, providing the perfect balance of your knee replacement at the time of operation.
Stiffness and Arthrofibrosis
Sometimes excessive scar tissue build-ups around your total knee joint. This can often frustrate patients when they lose range of motion after surgery. Sometimes this stiffness can prevent the ability to perform everyday activities. If stiffness is treated early, a simple manipulation may be done while you are given some anesthesia. Sometimes stiffness is a very late finding. When stiffness is severe and your knee is not functioning well, this is called "arthrofibrosis." Arthrofibrosis is a severe scarring of your joint. The treatment of arthrofibrosis may require a revision surgery. Dr. Morton is an expert at arthrofibrosis surgery and has treated many patients with severe contractures to their knee.
Fractures (broken bone) usually occur after a fall, or severe osteolysis.Dr. Morton will evaluate the break around your knee by investigating the remaining bone, loosening of the implant, and the location of the break. Most fractures require surgery to correct. In some cases, only a period of protected weight-bearing is required, without surgery.
Preparing for Surgery
A revision total knee requires extensive preparation. Dr. Morton will require your previous medical charts, x-rays, and other imaging. Sometimes before surgery, he will order more advanced imaging such as a CT or MRI may be required. You will almost always need laboratory tests to determine if there is an infection in your knee.
Risks of a revision knee replacement are often higher. Patients may require longer stays, are usually sicker compared to when they first had their surgery, and their surgery may be more challenging. Risks include:
- Blood clots
- Blood loss
- Implant loosening
- Knee stiffness
- Nerve or blood vessel damage
Dr. Morton will do his best to minimize your risk of complications. If you have questions, please discuss your case with him and make sure all of your questions are answered before surgery.
Dr. Morton is a leader in innovative technology in Hawaii. He uses robotic technology to minimize his complications. If you are concerned about an upcoming surgery performed by someone else, please feel free to schedule a second opinion.
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Meet Dr. Paul N. Morton, MD
Dr. Paul N. Morton, MD is a fellowship-trained orthopedic surgeon in Hip and Knee Replacement, specializing in robotic joint replacements, sports injuries, and trauma. Reach out to him to learn more about treatment options for your problem.