Dr. Gens Goodman, DO
Hip and Knee Replacement Surgery

REVISION KNEE REPLACEMENT

 A third type of knee replacement is referred to as a revision total knee. About one in ten total knee implants will fail over a 10-year period and will require a revision of the prosthesis. Since a revision is performed to replace failed knee implants, a revision is more complex and often requires an implant specially designed for a knee replacement that has failed. The bone is not as strong when an implant is removed, and the ligaments supporting the knee may be damaged. A revision prosthesis can help address these problems. For example, the surgeon can fit a stem inside the canal of the bone to provide more support for the prosthesis.

 Preparation for revision surgery is more complex than for an initial surgery. Revision patients who had their primary surgery at another institution can help us by obtaining detailed records of previous surgeries so that we know exactly what types of damaged parts need to be replaced. Revision surgery can be relatively simple when it involves just the exchange of the plastic insert. However, the procedure is complex when it involves replacing failed components, since cement removal is tedious and time consuming. When the procedure includes removing cement or repairing damaged bone, the operation takes longer, and a patient’s recovery time might be longer than for the first-time knee replacement.

 Scar tissues from previous surgery and bone from the failed knee replacement require special attention both during and after surgery. For example, bone grafts may be used to rebuild areas where bone loss has occurred. Patients also may require multiple blood transfusions when revision surgery takes longer.

 We customize the rehabilitation plan for each revision patient on the basis of the difficulty and the extent of surgery. Customized rehabilitation can be as simple as limited exercise or limited weight bearing, or as complex as using a brace for 6 to 12 weeks.

 
Bone Graft

If the bone is badly damaged, some revision total knee replacements require a bone graft or metal augments to reconstruct the deficient area. This is an unusual circumstance and will be discussed, in most cases, at the time of your office visit. The human-donor bone graft, which is obtained from a bone bank, has been tested for disease, a testing process even more stringent than the testing process for blood. Your surgeon and his assistants will be glad to answer your questions about bone grafting and will review the advantages and disadvantages with you

 In a small percentage of primary and revision knee replacement surgeries, a bone graft is needed to correct a deficiency in the patient’s knee anatomy. The bone graft, which is obtained from a bone bank, has been tested for disease. While the testing process for bone graft is even more stringent than the testing process for blood, there is a small risk of disease transmission.