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Knee revision surgery, which is also known as revision total knee arthroplasty , is a procedure in which the surgeon removes a previously implanted artificial knee joint, or prosthesis, and replaces it with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from another donor.
Total knee replacement implants may fail after 10 to 15 years, or occasionally sooner. The parts may come loose or they may wear out. In either case an operation will be required to replace the damaged part or even the entire implant.
It may also require an increase in the length of the hospital stay. The magnitude of this surgery depends on the difficulty of prosthesis removal and on the quality and quantity of bone left behind after the implant has been removed. The revision operation may require bone grafts from a bone bank to be used. A custom prosthesis is sometimes needed (a prosthesis specially manufactured for a specific patient). Patients who have had knee revision operations are frequently advised to continue the use of a full-time support (such as a cane), in order to protect the replacement. This is especially true of those who are younger than 70, have higher activity levels, increased weight, and other stress factors.
Purpose
Knee revision surgery has three major purposes: relieving pain in the affected hip; restoring the patient's mobility; and removing a loose or damaged prosthesis before irreversible harm is done to the joint. Knee prostheses can come loose for one of two reasons. One is mechanical and is related to the fact that the knee joint bears a great deal of weight when a person is walking or running. It is unusual for the metal part of a knee prosthesis to simply break. This part, however, is inserted into the upper part of the tibia, the larger of the two bones in the lower leg, after the surgeon has removed the upper surface of the tibia. The bone tissue that receives the metal implant is softer than the bone that was removed, which means that the metal implant may sink into the softer bone and gradually loosen.
Diagnosis/Preparation
In most cases, increasing pain, stiffness, and loss of mobility in the knee joint are early indications that the patient may benefit from revision surgery. The location of the pain may point to the part of the prosthesis that has been affected by osteolysis. Pain around or in the kneecap is not always significant by itself because many TKR patients have occasional discomfort in that area after their knee replacement. If the pain is diffuse (felt throughout the knee rather than in only one part of the knee), it may indicate either an infection or loosening of the prosthesis.
Failure of Total Knee Replacements done elsewhere due to implant failure or polyethylene wear and loosening can be remedied by special Revision Knee Prosthesis. Patients with Knee Replacement, who have accidents and periprosthetic fractures, can also be internally fixed with special implants. The results are excellent and tailor made to suit each individual patient.
Risks
The complications that may follow knee revision surgery are similar to those for knee replacement. They include:
Deep vein thrombosis.
Infection in the new prosthesis.
Loosening of the new prosthesis. The risk of this complication is increased considerably if the patient is overweight.
Formation of heterotopic bone. Heterotopic bone is bone that develops at the lower end of the femur following knee replacement or knee revision surgery. Patients who have had an infection in the joint have an increased risk of heterotopic bone formation.
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