Is Your Knee Pain Worse After Revision Surgery Even Though At First It Wasnt So Bad
A knee revision surgery is when a failed or loosened implant is replaced in part or whole by new hardware, but what does it mean if soon after this procedure, the knee pain is a 9 or 10 out of a 10 pain scale?
Might this mean that the knee revision surgery failed? My father recently had a knee revision surgery.
In the several days after the knee revision surgery, while he was still in the hospital, he reported that everything felt fine, other than the surgical pain, which is to be expected with these procedures.
He spent four days in the hospital. The fourth night after the knee revision surgery, he slept at his house, and next morning, reported that the knee felt good .
However, next day, he said it was hurting bad and became concerned. I noticed that he wasnt walking as much .
The next day it was still worse, and he couldnt help but wonder if the knee revision surgery actually failed, even commenting that maybe something in there was loose.
Interestingly, his physical therapist, who came to the house, noted some oozing from the incision, and decided that this, in combination with the severe pain, might mean an infection.
The PT contacted the surgeons office he was told that my father should report to the emergency room.
I drove him there. The ER doctor said the knee didnt appear to be infected. An X-ray was normal.
Then come maybe the fifth or sixth day after knee revision surgery, the patient reports an increase in pain, sometimes dramatic.
Implant Loosening And Wear
In order for a total knee replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, the implant was either cemented into the bone or press-fit to allow bone to grow onto the surface of the implant. In either case, the implant was firmly fixed. Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful.
The cause of loosening is not always clear, but high-impact activities, excessive body weight, and wear of the plastic spacer between the two metal components of the implant are all factors that may contribute. Also, patients who are younger when they undergo the initial knee replacement may “outlive” the life expectancy of their artificial knee. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear.
In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body’s immune system. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable. Advances in material science and plastic quality have made osteolysis less common today than in past decades.
Osteolysis has occurred around the tibial component, causing it to become loosened from the bone .
Orthopedic Joint Specialist Located In Chevy Chase Md
Though rare, knee revision surgery is sometimes necessary following a failed knee replacement procedure. Gautam Siram MD, in Chevy Chase, Maryland, is a fellowship-trained orthopedic joint replacement surgeon. Dr. Siram and his team perform knee revision surgery to restore knee health and function following a failed knee replacement. To schedule a consultation, call the office or book an appointment online today.
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What Is A Knee Revision
A knee revision is the replacement of prosthetic implants in a person who previously had a total knee replacement. In this surgery, known as a “reoperation,” an original prosthesis is removed and a new prosthesis put in place.
Some knee revisions may require the replacement of only one implant, while others require a complete exchange of all the prostheses that were implanted during the original knee replacement surgery . A complete revision of this type is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques.
What Is A Revision Knee Replacement
Knee replacement surgeries are very successful at relieving pain, restoring mobility, and improving function for patients with knee arthritis. Currently, over 500,000 total knee replacements are performed in the United States each year. Now that our older population is living well into their 70s and 80s, it has been projected that over 1.3 million knee replacements will be performed in 2030!
Despite great results, there are times when a knee replacement procedure needs to be re-done because just like your car, certain parts can wear and/or fail over time. Patients may complain of increasing pain and swelling in addition to stiffness and catching. These signs may represent a problem with your knee replacement, and you should talk with your surgeon regarding these issues and concerns. There are several common reasons for revision surgery that we will cover in this article.
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Find Out What Likely Will Happen With Your Knee If You Dont Have Revision Surgery For A Failed Total Replacement
Youve had a total knee replacement and, over time, things have gotten worse, leading to a diagnosis of a failed implant.
Youre told youll need revision surgery: a replacement of some or even all of the hardware.
Suppose youre afraid to undergo revision surgery for a loosened knee replacement and are wondering if the situation will simply stabilize over time and be managed with painkillers, cold packs, gentle exercise, acupuncture, etc.
Theres bad news if youve been hoping that your failed total knee replacement will magically stop getting worse.
For this article I asked a hip and knee replacement surgeon if a failed TKR will necessarily continue getting worse and worse, rather than stop declining and taper off to a standstill status.
Yes as time goes on, the loosened implants lead to more bone destruction around the joint, and lead to an increased risk of fracture around the joint replacement, says Jeffrey A. Geller, MD, Associate Chief, Division of Hip & Knee Reconstruction Director, Minimally Invasive Hip & Knee Replacements, Columbia University Medical Center, New York, NY.
Pain worsens, but the bone around the replacement weakens, making likelihood of fracture higher as time goes on, continues Dr. Geller. Typically the pain worsens and walking becomes more difficult.
You have to decide if you can continue living in pain, or take that chance with the revision procedure.
What Does The Knee Revision Procedure Involve
Although primary total knee replacement and revision replacement have the same goal to relieve pain and improve function knee revision surgery is a longer, more complex procedure. This surgery usually takes from 2-3 hours.
Dr. Zelicof enters through the incision from your primary total knee replacement. He may need to extend the incision slightly to remove the old components. Next, he moves the kneecap and tendons to one side to gain access to the knee joint. He checks your soft tissues to be sure they are free from infection and then assesses the state of the metal and plastic components of your prosthesis. Hell determine which parts of your original replacement have worn, become loose, or shifted out of position.
The original implant is removed. The goal is to preserve as much as much bone as possible. Bone cement, if used, will also be removed. With the implant removed, its time to prepare the bone surfaces for your new implant. In some patients, there has been significant bone loss, which may have been the cause of dictating revision. Dr. Zelicof can add metal augments and platform blocks to make up for this lost bone mass.
Now its time to insert your new specialized revision implant. At this point, Dr. Zelicof will repair any soft tissues that are damaged. Hell return the kneecap and tendons to the front of the knee and then hell test the motion and mobility of your repaired knee joint. Satisfied, he then closes the incision. This ends the procedure.
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Questions To Ask Your Physician About Knee Revision Surgery
You want to make sure you are selecting the best option for your knee condition. Be sure to write down and bring your questions to your consultation to ensure that you understand all your options and your surgery. Here are some to get you started:
- Why is revision surgery needed?
- Can physical therapy alone help my condition?
- What is the success rate of knee revision surgery?
- What can I expect after my surgery? Will my mobility be improved?
- Will the surgery get me out of pain?
- What will my recovery time be?
- What activities can I do? What should I avoid doing?
Why Revision Surgery Is More Complicated Than Initial Surgery
Its important to note that a revision knee replacement doesnt provide the same lifespan as the initial replacement . The accumulated trauma, scar tissue, and mechanical breakdown of components lead to diminished performance. Revisions are also more susceptible to complications.
A revision procedure is typically more complex than the original knee replacement surgery because the surgeon must remove the original implant, which would have grown into the existing bone.
In addition, once the surgeon removes the prosthesis, there is less bone remaining. In some instances, a bone graft transplanting a piece of bone transplanted from another part of the body or from a donor might be required to support the new prosthesis. A bone graft adds support and encourages new bone growth.
However, the procedure requires additional preoperative planning, specialized tools, and greater surgical skill. The surgery takes longer to perform than a primary initial knee replacement.
If a revision surgery is necessary, youll experience specific symptoms. Indications of excessive wear or failure include:
- diminished stability or reduced function in the knee
- increased pain or an infection
- a bone fracture or outright device failure
In other cases, bits and pieces of the prosthetic device may break off and cause tiny particles to accumulate around the joint.
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What To Expect With Knee Revision Surgery
According to the American Academy of Orthopaedic Surgeons knee revision surgery is more complex than total knee replacement surgery. This is because where in your original surgery, your joint was replaced with an implant, when the implant itself develops problems, your surgeon is actually going in and repairing that original implant. Or, it may need to be removed and a new joint put in, or parts of it replaced.
Reasons Why A Revision Replacement Is Necessary
Revision replacements are performed for a number of reasons. Some of the more common include:
- Loosening of the implant
- Instability of the knee
- Malalignment of the parts
Many people ultimately have a revision knee replacement because the problem is causing significant pain. While pain can be a problem in itself, a revision knee replacement surgery should not be performed without understanding why the pain is occurring. Performing this type of surgery for pain without an identified cause is unlikely to yield good results. Instead, the cause of the problem with the knee replacement needs to be precisely understood, and there needs to be a plan to address that problem with the implant. An operation without a clear plan to address the problem is unlikely to be helpful.
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How Common Is Knee Replacement Surgery
The surgery is very common. Surgeons started doing it in the 1960s, with regular updates to techniques and implants along the way.
Almost 800,000 knee replacements currently get performed each year in the United States. The surgery is often done in older adults whose knees have worn down over time. But its also become popular in middle age, as people want to stay active.
Are You A Candidate For Knee Replacement
To determine the most appropriate knee replacement surgery for you, our knee surgeons consider a wide range of factors, including severity of symptoms, overall health and response to previous treatment.
If you are experiencing the following, surgery may be advised.
- Severe pain that prevents you from participating in everyday activities
- Have weakness in your knee and cannot move it fully
- If your symptoms dont improve with non-surgical treatments
For those who may have been diagnosed with advanced osteoarthritis, the condition of your knee joints will determine your surgical options. Surgery on the knee is common for severe osteoarthritis with a high success rate.
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What Happens During Knee Replacement Surgery
During the surgery, a surgeon removes damaged cartilage and some bone from the surfaces of your knee joint. Cartilage is tissue that covers your bones where they meet. Healthy cartilage is smooth and helps the bones glide over each other when you move. When cartilage becomes rough and wears away, the bones rub against each other, causing pain.
After removing the damaged knee cartilage and bone, the surgeon attaches the artificial parts to your bones. The artificial parts are made of metal and plastic. They will give your knee new, smooth surfaces.
Knee replacement surgery may replace all the damaged parts of your knee or just part of your knee . In a total knee replacement, the surgeon replaces 3 surfaces:
- The end of the shinbone
- The end of the thighbone
- The back of the kneecap
What Is A Knee Replacement Surgery
Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.
Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.
The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.
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Understanding Revision Knee Replacement Surgery
Total knee replacement surgery helps to restore movement and reduce pain in knee joints affected by arthritis or injury. However, knee replacements can eventually wear out over time, just like a normal joint.
When this happens, revision knee replacement surgery will be needed in order to help you remain as mobile and pain-free as possible.
What Type Of Outcomes Should I Expect From A Revision Knee Procedure
Generally, revision surgeries are more complex therefore, healing may take longer compared to your original knee replacement. The length of recovery from a revision knee replacement depends on your medical issues, the extent of the revision surgery, and your physical therapy afterwards.
Usually, the typical recovery from a revision knee procedure takes about 3-4 months. However, some studies have shown it can be between 1-2 years before fully recovering from your knee revision surgery. Most of the time, your surgeon will allow you to weight bear on your operative leg almost immediately after surgery witha walker or crutches. In some cases, your surgeon will ask you to limit how much weight you place on your operated leg for a period of time to allow the bone and soft tissues to recover. Remember it is normal for swelling to come and go during the recovery process.
Because revision knee replacement takes longer than your original knee replacement, there is a higher risk for complications during/after revision surgery. The most common risks and complications include:
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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 or general anesthesia. The patient is put on the operating table with the leg already prepped and draped. Additionally, a tourniquet 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.
How Long Until I Can Drive After Knee Revision Surgery
The timeframe for returning to driving is usually about one month, but it can be longer. This is if youve had surgery on your right knee and your car is an automatic transmission. If you have a manual transmission, this applies to both knees. If you have an automatic and your left knee has had the revision surgery, you can begin driving as soon as youre physically comfortable.
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Knee Replacement Revision Surgery Process
Knee replacement revision surgery typically takes longer than the original knee replacement procedure. In many cases, knee replacement revision surgery takes roughly two to three hours. After the old components of a replacement device are removed, the surgery area is prepared for the revision implant. Implants for a revision surgery are different from the original, or primary, surgery implants. There are longer and thicker stems for extra support. Any damaged bone in the area must be removed and damage is usually extensive.