Common Reasons For Revision Joint Replacements
When a patient with an artificial hip or knee is involved in a fall or trauma such as a motor vehicle accident, most often it is the bone surrounding and anchoring the artificial joint that breaks before the metal prosthesis fails. This is called a periprosthetic fracture. As a result, the joint replacement needs to be revised as part of the surgery to treat the broken bones.
Mechanical loosening, meaning that the prosthesis becomes loose from the surrounding bone, is another common cause of eventual revision joint replacement. As a patient ages, the bone around the implant may become softer due to age related changes or microscopic particulate wear. With today’s modern materials, longevity and the incidence of mechanical loosening have improved dramatically over 50+ years of total joint replacement, and improvements in materials science and engineering mean that most implants will have a service life of decades.
Artificial joints do not often become infected, but when they do, surgery is usually required. If you become ill with a fever or you have a prolonged infection in another part of the body, you should seek medical treatment. Bacteria from an infected body part can travel through the blood to the site of the joint replacement and infect the prosthesis.
When Will I Be Able To Walk Again After Bk Amputation
People heal at different paces, so its important to adhere to your doctors instructions. Its also important to note that your incision will need to heal completely before youre able to walk using a prosthetic leg. However, below knee amputation patients are usually able to walk with crutches soon after surgery.
Many below knee amputee patients are able to use the iWALK hands-free crutch two or more weeks after surgery. This enables them to use both legs instead of relying on crutches or a wheelchair. Unassisted walking using the iWALK facilitates independent living and is, in and of itself, a form of exercise that reduces muscle atrophy while promoting healthy blood flow and faster healing.
Swelling is a very important factor in the healing process, and all swelling must subside before a permanent artificial leg can be fitted. Swelling can take months to subside, so its important to be patient and find ways to get around like crutches, a knee scooter, wheelchair, or hands-free crutch like the iWALK. Its also important to adhere to a strict exercise and stretching regiment. Maintaining strength and flexibility in your muscles, hips and knees will ease your transition to a permanent prosthesis.
Theres a learning curve associated with using an artificial leg, and patients should be prepared to learn to walk with the new limb. Parallel bars are commonly used at first, then walkers or canes to help with the transition to walking with an artificial leg.
Postoperative Recovery & Rehabilitation
The postoperative recovery procedure is very similar to the procedure after Total Knee Replacement surgery, although recovery can take longer in the case of revision surgery, with crutches or other form of support necessary for a slightly longer duration.
Risks and complications of revision total knee replacement are similar to those of primary knee replacement surgery, but can be of increased severity and incidence.
You May Like: Cellulite Above Knees
Experience With Special Or High
Be sure to discuss your complete medical history with your surgeon prior to surgery. This will ensure they are able to handle your needs and any potential complications that may arise.
For example, if you have any pre-existing conditions like anemia or diabetes, or if you have had other trauma that may complicate surgery, inquire about the surgeons experience in handling these types of cases.
Once you have compiled a short list of potential surgeons, you will want to schedule a consultation with each one. During these sessions, you will want to:
- discuss your situation
- ask any questions you have
- solicit their opinion
What To Expect Immediately Following Bka Surgery
In general, the incision from BKA surgery will heal over a period of two to eight weeks. During the first few days, a physical therapist will help the patient perform basic exercises and functions. These will include gentle stretching and range of motion exercises, as well as learning how to roll in bed, sit on the side of the bed, and move safely to a chair. The therapist will also teach a recent amputee to prevent contracture, a muscle tightening and deformity that can result from knees being bent too much or too long.
Protecting the limb and incision after surgery is paramount. One small bump can open the incision and delay recovery, and possibly create the need for additional surgeries.
Don’t Miss: Inversion Table For Knee Pain
Ligament Instability Was The Primary Reason For Repair Surgery
Doctors writing in the German medical journal, Der Orthopäde said:
- In 32.6 % of all cases , ligament instability was the primary reason for revision.
- In another 21.6%, ligament instability was identified as a secondary reason for revision.
- Analysis of the different instability forms showed combined instability in extension and flexion as the most common cause, followed by isolated instability in flexion and isolated instability in extension .
The summary statement of this research is extraordinary in its simplicity
Correct anatomical positioning of the components and balanced ligaments in the different extension and flexion positions are important for good clinical results, a stable joint, good function, and longevity.
In other words, put the ligaments back where you found them.
Posterior Cruciate Ligament Retaining
The posterior cruciate ligament runs along the back of the knee, connecting the femur to the tibia. This design keeps the PCL intact, but it depends on several patient factors: good bone quality, few defects in the bones, intact soft tissue around the knee and a functional PCL.
There are two types of PCL implants: retaining and substituting. The difference between the two comes in part from how the PCL is affected by the implant surgery. A surgeon may remove the ligament to implant a PCL substituting implant. But if the ligaments are in good condition, the surgeon may want to preserve it. In that case, he or she will use a PCL retaining implant.
Preserving the ligament may not necessarily result in better post-operative knee function. A simple polyethylene bearing attaches to a metal component implanted in the tibia, and a metal implant in the femur hinges on the polyethylene. It is a minimal design dependent on the PCL to stabilize the implant but a tight PCL may lead to excessive wear on the bearing.
Less bone is removed with a PCL retaining implant. A PCL retaining implant is less likely than a PCL substituting version to result in a condition called patella clunk syndrome. This syndrome results from scar tissue forming near the implant and becoming caught in part of the device as the knee is fully extended.
Read Also: Get Rid Of Knock Knees
Up To A Third Of Knee Replacements Pack Pain And Regret
Danette Lake thought surgery would relieve the pain in her knees.
The arthritis pain began as a dull ache in her early 40s, brought on largely by the pressure of unwanted weight. Lake managed to lose 200 pounds through dieting and exercise, but the pain in her knees persisted.
A sexual assault two years ago left Lake with physical and psychological trauma. She damaged her knees while fighting off her attacker, who had broken into her home. Although she managed to escape, her knees never recovered. At times, the sharp pain drove her to the emergency room. Lakes job, which involved loading luggage onto airplanes, often left her in misery.
When a doctor said that knee replacement would reduce her arthritis pain by 75 percent, Lake was overjoyed.
I thought the knee replacement was going to be a cure, said Lake, now 52 and living in rural Iowa. I got all excited, thinking, Finally, the pain is going to end and I will have some quality of life.
But one year after surgery on her right knee, Lake said shes still suffering.
Im in constant pain, 24/7, said Lake, who is too disabled to work. There are times when I cant even sleep.
Most knee replacements are considered successful, and the procedure is known for being safe and cost-effective. Rates of the surgery doubled from 1999 to 2008, with 3.5 million procedures a year expected by 2030.
How Can You Prove Service Connection For Knee Pain
The first option for obtaining a VA disability rating for knee pain is to establish a direct service connection. The stronger the connection between your military service and the injury you sustained, the more likely you are to have a successful disability claim. However, this process can be complicated. One of the most common reasons claims fail is that they fail to include three essential factors:
1. A current diagnosis that includes the disability that is being claimed
In this case, you will need a diagnosis that accounts for the knee pain you are experiencing. If your diagnosis loosely explains your knee pain, it is unlikely that it will apply to your disability claim. It is important to persist until you receive a diagnosis that directly connects your knee pain to the illness or knee condition.
2. Documentation of an in-service occurrence or incident that caused the disability, or at the very least, aggravated the condition
3. A medical nexus that connects the current, diagnosed disability to the in-service occurrence, incident, or exposure
The medical nexus can make or break a disability claim. A medical nexus letter from a medical provider can establish strong ties between the condition and military service. This evidence can be critical when the condition developed over time.
You May Like: Best Knee Walker 2016
Care After The Operation
Please give some thought as to how you will be looked after once you have had the operation, well in advance. Most people like to be independent, but you are going to need support with day-to-day activities for a while. If you have an able-bodied partner, this might fall to them, but otherwise you may need a friend or relative to come to stay with you for a while. Some people may arrange to stay in a care home until they have their mobility and independence back.
Who Is Offered Knee Replacement Surgery
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
You May Like: Dcf Compression Knee Sleeve
Problem: Fixing Pain After Total Knee Replacement May Include Amputation
Three in 1000 patients will need to have their leg amputated.
The causes of the amputation were:
- infection around the implant ,
- soft-tissue deficiency surrounding the implant ,
- severe bone loss ,
- fracture around the implant ,
- circulatory damage .
In 80% of the cases, there were more than 2 of these factors for amputation.
In research from April 2017, doctors writing in the European Journal of Orthopaedic Surgery and Traumatology wrote:
Treatment for prosthetic knee replacement is becoming more common. Infection is an arthroplasty-related complication leading to prolonged hospitalization, multiple surgical procedures, permanent loss of the implant, impaired function, impaired quality of life, and even amputation of the limb.
The purpose of this study was to identify risk factors for amputation in the periprosthetic infected knee through a case-control study, analyzing patients treated from January 2012 to November 2016 in a hospital with a high incidence of this diagnosis. We included 183 patients with periprosthetic knee infection 23 required amputation as definitive management .
They found that patients with:
- Increased surgical time > 120 min,
- diabetes mellitus had an increased risk of amputation.
Alternative Surgeries For Younger Patients
Determining when the right time for a joint replacement is can be hard enough for any patient, let alone younger adults who have to be realistic about how long an artificial joint can last. Here are some of the procedures that can delay your need for a total knee replacement. .
High Tibial Osteotomy or Distal Femoral Osteotomy
HTO and DFO are for younger patients who have unicompartmental articular cartilage damage. In the surgery, bone is either removed or added to the tibia or femur. The procedure shifts body weight from the damaged part of the joint and reduces pain. By realigning the knee, body weight is transferred to the healthy, outer or inner parts of the knee. This slows the progression of osteoarthritis, letting you keep your natural joint for longer.
Pros: With this procedure, younger patients can engage in high-impact activities like jogging or tennis which are discouraged after a total or partial replacement.
Unicompartmental Knee Arthroplasty
Pros: Like a total replacement, UKA delivers long-term results of 10-15 years or more. The incision is smaller and the recovery time tends to be shorter than the full-fledge TKR.
A final word of advice for the younger men and women dealing with chronic joint pain and osteoarthritis: think about the long-term when plotting your next move, do your research, and know that the discussed orthopedic procedures are among the most successful in modern medicine.
Don’t Miss: How To Get Rid Of Dark Spots On Knees Fast
What Is Revision Total Knee Replacement
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 .
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.
Revision Joint Replacement Surgery
While modern-day joint prostheses are more durable than ever, nearly all artificial joints can be expected to wear out after enough time and wear. Interestingly, many of the revision surgeries we perform at Orthopaedics New England are not so much because the implant failed, but rather because the bone surrounding the implant failed and no longer provides adequate support. The prostheses gradually may become loose.
As described below, there are a number of reasons why joint replacements may need to be revised. Regardless of the reason, revision surgery is complex and demanding. The complexity depends upon many variables, including the diagnosis and underlying problem, scar tissue, potential damage to nerves or blood vessels, and longer surgical time and increased blood loss because of the need to remove the old components.
Because revision joint replacements are among the most complex procedures in modern orthopaedics, relatively few surgeons perform revision surgeries. For that reason, many of our patients undergoing revision surgery have been referred from other centers or surgeons.
Recommended Reading: Can Cartilage Be Rebuilt
There Is Little In The Literature To Guide Clinicians In Advising Patients Regarding Their Return To Work Following A Primary Total Knee Replacement
One of the reasons the surgeons may not have prioritized this factor may be found in the literature. Researchers at the Case Western Reserve University School of Medicine. in their study published in the Journal of Joint and Bone Surgery, wrote:
There is little in the literature to guide clinicians in advising patients regarding their return to work following a primary total knee . aimed to identify which factors are important in estimating a patients time to return to workhow long patients can anticipate being off from work, and the types of jobs to which patients are able to return following primary total knee arthroplasty.
Information for patients to assess from the study scores were:
- The average time to return to work after the surgery was nine weeks.
- Patients who reported a sense of urgency about returning to work were found to return in half the time taken by other employees
- Other preoperative factors associated with a faster return to work included being female, self-employment, higher mental health scores, higher physical function scores, higher functional comorbidity, and a handicap accessible workplace.
- A slower return to work was associated with having less pain preoperatively, having a more physically demanding job, and receiving Workers Compensation
Information for patients to assess from the study scores were:
If you are on this page because you are seeking alternatives to knee replacement, lets continue on with these articles on your options:
Revision Knee Replacement Vs Knee Replacement
Many of the patients who have had revision knee surgeries achieved favorable outcomes: significant pain relief and increased stability and mobility. Nonetheless, absolute pain relief and restoration are not always achievable, and there are patients who still experience knee pain and stiffness long after their revision surgery.
Its also worth noting that compared to the initial knee replacement, a revision knee replacement doesnt guarantee the same longevity. While initial knee replacements can last up to twenty years, revision knee surgeries only typically last about ten.
A revision knee replacement also has a higher risk of complications, such as bleeding and blood clots, infection, and reaction to anesthesia, compared to that with the original replacement surgeryall the more so if the patient already has extensive scarring from the initial procedure.
Moreover, given its greater complexity, a revision knee replacement involves more extensive preoperative planning and takes longer to perform. The surgeon has to remove the original implant, which would have already fused into the existing bone . Removing the prosthesis can result in significant bone loss. In such a case, the surgeon will require a bone graft to fill the void, support the new prosthesis, and encourage new bone growth. Bone grafting is a procedure in which a piece of bone is transplanted from another area of the body or from a donor.
Read Also: How To Get Rid Of Knee Fat And Cellulite