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One of the treatment methods for an arthritic knee is revision knee replacement. This article outlines the 8 things you need to know about a complex or revision knee replacement.

Arthritis, a disease characterized by joint inflammation, can affect several joints in the body including the knees. While many patients can be treated using a combination of medication and exercise, some patients will require surgery down the road. The type of surgery that patients with arthritis of the knee often undergo is known as a knee replacement. There are four major types of knee replacement surgeries, one of which is a complex knee replacement.

Here are the eight things you should know about complex or revision knee replacement.

1. Who typically gets a complex knee replacement surgery?

Patients will get a complex knee replacement surgery if they are having a second or third joint replacement in the same knee. They may also get this surgery if their arthritis is very severe. Patients that undergo a complex knee replacement tend to exhibit major bone loss due to arthritis or fractures, significant deformity of the knee and/or weakness in the main knee ligaments.

2. Why do patients get a complex knee replacement surgery?

While this operation is largely conducted for patients who need for additional joint replacements, this surgery is also beneficial when conducted in patients with severe arthritis. The reason why patients may undergo a second or third joint replacement is because they experienced certain complications in their initial knee replacement surgery which led to the failure of their original implant.

Most patients with arthritis of the knee who undergo surgery will initially get either a total knee replacement or a partial knee replacement. If these surgeries fail, the patient will have to have a complex knee replacement. In a complex knee replacement, the surgeon will revise part or all of your previous knee replacement.

3. How extensive is the surgery?

The extent of the surgery can vary significantly. It can range from a very minor adjustment to a significant operation in which large sections of your damaged bone are replaced.

4. What is the difference between complex knee replacement and a total knee replacement?

The difference between a complex knee replacement and a total knee replacement is that the implants for a complex knee replacement have a longer stem, which causes the components to be securely fixed into the bone cavity. Furthermore, the components of the implant have can interlock in the center of the knee, which helps form a type of hinge that gives greater stability.

Surgeons may also use additional pieces of metal or plastic to replace any bones that they were removed or are badly damaged. Joint revision surgery is also much more complex than a total knee replacement. It requires significant planning, special tools and implants and significant skill on the part of the surgeon.

5. Who is eligible for a complex knee replacement surgery?

Patients who are eligible for a complex knee revision surgery include:

  • Patients who have pain that persists after surgery
  • Patients whose implants or plastic lining are worn out
  • Patients who are unstable
  • Patients who have a loosening of their implant/prosthesis
  • Patients who get infected at the site of surgery
  • Patients who experience weakness of the bone in the region surrounding the replacement (a condition called osteolysis)
  • Patients who experience stiffness of the bone.

6. What happens during the actual surgery?

The surgeon will work under sterile conditions in an operating room after the patient has been administered either spinal anesthesia (in which the patient stays awake but is numbed) or general anesthesia. The patient is put on the operating table with the leg already prepped and draped. Additionally, a tourniquet (a device that applies pressure to a limb to stop the flow of blood) is applied to the upper end of the thigh and then a sterilizing solution is applied leg before the doctor starts operating.

Next, the surgeon will make an incision of about seven cm long to expose the knee joint. Once the knee joint is exposed, the surgeon will use a saw or a burr to prepare the ends of the thighbone and shinbone. At this point, the surgeon will put in trial components to see if they are an adequate fit. If they are, the surgeon will go ahead and put the real components, both related to the shinbone and the thighbone, in place. This positioning of the implant is either done using cement or without cement. Then, the knee is closed and the drains are usually inserted. Finally, the knee is dressed and bandaged and the patient is then taken to recovery.

7. What are the risks and complicated associated with a complex knee replacement surgery?

There are risks and complications involved with undergoing a complex knee replacement surgery. First of all, similar to any other major surgery, there are always risks involved including risk of developing or contracting infection and adverse reaction to the anesthesia. There are also risks that are specific to patients undergoing a complex knee replacement. These include joint or bone dislocation, blood clots, inequality in length of limbs and failure to ease pain.

8. What happens after surgery?

Rehabilitation is vital after a complex knee replacement surgery, as this helps avoid further complications related to arthritis. For example, rehabilitation helps patients retain their range of motion, improve muscle weakness, and reduce the risk of recurrence. In fact, rehabilitation and physical therapy can be started right after the surgery and can go on for up to three months. During the physical therapy, you can learn how to use crutches or walkers as well as conduct strengthening and mobilization exercises to improve mobility and range of the motion of your joint.

  • Hartford, James M., et al. "Complex primary and revision total knee arthroplasty using the condylar constrained prosthesis: an average 5-year follow-up." The Journal of arthroplasty 13.4 (1998): 380-387.
  • Pradhan, N. R., et al. "Salvage revision total knee replacement using the Endo-Model® rotating hinge prosthesis." The knee 11.6 (2004): 469-473.
  • Harrison Jr, Richard J., et al. "Distal femur replacement is useful in complex total knee arthroplasty revisions." Clinical Orthopaedics and Related Research® 446 (2006): 113-120.
  • Photo courtesy of SteadyHealth

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