Revision Total Knee Arthroplasty

“As well as the very good results of the knee prosthesis, there are also solutions for cases with loosening over time and fractures around the prosthesis after trauma.”

Over the last decades total knee arthroplasty (TKA) has been widely established as a highly successful treatment for advanced osteoarthritis of the knee in terms of pain relief and improvements in function and health-related quality of life . Based on these experiences and supported by constant advancements in long-term patient-oriented outcome, this has led to an increasing number of surgeons offering total knee arthroplasty to younger and higher-demanding patients more frequently nowadays.

Although perioperative mortality rates remain low (∼0.5%), about 3–5% of all TKA fail each year due to septic or aseptic loosening or component failure. This is of particular concern as the financial and economic impact of revision knee arthroplasty is substantially greater compared with primary TKA , due to longer times of surgery, more expensive prostheses, longer length of stay and higher rates of complications.

With newer implant designs and improved surgical techniques, total knee replacements can be expected to function well for at least 15 to 20 years in more than 85% to 90% of patients. However, some procedures or implants can fail at some point. When this happens, a knee revision surgery may be necessary.

The primary causes of knee implant failure are wear and loosening, infection, instability, leg fractures, or stiffness.

Revision total knee replacement is the replacement of a failed total knee prosthesis with a new prosthesis. In simple terms, it is the replacement of a knee replacement (or a "second knee replacement").

Knee revision surgery is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques to achieve a good result.

Postoperative care is very similar to that after a primary knee replacement. This includes physical Infection, bleeding, damage to nerves or blood vessels, and intra-operative fractures can be minimized by using antibiotics before and after surgery, employing sterile surgical techniques and utilizing well-planned surgical exposures. Patients who are obese are particularly at increased risk of infection and wound drainage issues post operatively.

Similar to primary knee replacement, some mild swelling of the knee or ankle may be present after surgery for as long as three to six months. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.

Prior medical conditions, such as heart and lung complications or stroke conditions, can be aggravated by a revision procedure. These conditions may also develop in patients after revision surgery. Very rarely, death can occur. The decision to perform revision joint surgery is made when the benefits of pain relief and functional improvement outweigh the risk of potential complications. therapy, blood management, pain medication as necessary, antibiotics and some method of blood clot prevention. A brace or splint may be used to protect the joint after the surgery.

Although total knee replacement is a highly successful operation in the majority of patients, some procedures will fail. Certain signs and symptoms such as an increase in pain or a decrease in knee function may be indicative of joint failure. There are several reasons for the failure of knee implants such as infection, instability, stiffness, wear and loosening, and leg fractures.Advanced techniques and materials for revision knee surgery usually allow for substantial pain relief and improved function; however, this may not always be possible. Revision total knee replacement is a complex procedure that requires an experienced surgeon and proper preoperative planning to achieve satisfactory outcomes.