Although the vast majority of knee replacements perform very well, with success usually lasting twenty years or more, there are specific instances when a revision knee replacement may be necessary. Such common reasons include significant wear of the components, loosening and infection.
When the components have significantly worn or have loosened from the bone, revising the knee replacement with one or more new components can predictably restore function and mobility with a low rate of complication. Approaching this surgery requires a comprehensive knowledge of manufacturers of components to ensure compatibility of the components selected for the planned surgery. The surgeons at Florida Joint Care Institute have extensive knowledge and resources to appropriately plan and perform this surgery with success. Patients are often referred to our institution for this reason.
Before the surgery is performed, our surgeons take time to carefully plan each case. This begins from the moment of initial consultation and many health factors that are taken into consideration before surgery in order to minimize the chance of complications and improve outcomes. There are often medical conditions that require further treatment by an internist or specialist prior to surgery. Prior operative reports are obtained and implant manufacturers are contacted to confirm the surgical plan with the chosen components. The surgeons at Florida Joint Care Institute use cutting edge digital X-rays calibrated to each patient as well as specialized computer software to plan the surgery.
The surgery is typically performed utilizing the prior scar in the front of the knee. Components that are worn or loose are removed and new components are placed. Care is taken to make sure that the surrounding ligaments and bone can support the reconstruction. Revision components may provide added stability through their design. During the surgery there is specialized instrumentation that measures anatomy directly to ensure sizing is exact. There is no more precise way to measure size and restore anatomy than planning the surgery appropriately and verifying using this direct technology during the operation. Rehabilitation after the surgery often follows the same progress expected from performing a primary knee replacement.
The majority of patients will start physical therapy to stand or even walk the same day of surgery or the following morning. This improves early functional recover and lowers the risks of blood clots from forming. All patients recover in a private room and work with the orthopaedic and nursing teams within the joint care program. Many patients are able to walk and transfer independently by the second or third day after surgery and may be discharged home with a home visiting nurse and therapist to perform visits for the first few weeks after surgery. If additional needs are required, a patient may elect to go to a rehabilitation facility to work aggressively with physical therapy until enough independence is reached to be discharged home.
Recovery occurs as a stepwise process. Within the first few weeks, independence is reached and patients progress away from a walker and cane. 75% of the recovery occurs within the first six weeks. The last 25% occurs in the subsequent couple of months as strength improves. The vast majority of recovery is therefore completed within four months of surgery, but endurance will continue to improve as activities are resumed.
Although revision knee replacement technology continues to improve, and outcomes are better than ever, there are unique risks inherent to the operation. With careful planning these risks are minimized but it is important to have this discussion with your surgeon prior to the operation to be appropriately informed. By understanding these risks and expectations of benefits, our patients are able to achieve the best outcomes possible.