Who needs a revision knee replacement India?

Any person with a failed knee replacement which needs to be redone. Knees fail for the following reasons.

• Aseptic loosening.
• Instability.
• Stiffness.
• Infection.
• Mal-alignment.
• Peri prosthetic fractures.

The knee shown in the picture below is obviously infected.  It was done elsewhere and sent to me for an opinion. It will need revision.  Most commonly infected knees don’t present like this. The one main symptom which suggests an infection is Pain at rest. If you have had a knee replacement and still continue to suffer from pain even at rest, then it could be an infction. Other factors which raise a suspicion of infection are

• History of Diabetes.
• Delayed wound healing with prolonged discharge.
• Night pain.

I will perform additonal tests to confirm infection. My index for suspicion is very high. I use modern markers to pick up infection within 24 hours. If it turns out that your knee is infected, then the best treatment is a revision knee replacement.

Considerations before a revision knee replacement

• Is it infected?
• What is the amount of bone loss?
• What is the state of the skin and soft tissues?
• What type of implant is to be used?
• What is the surgical exposure?
• What degree of confidence can be given to the patient?
• Does it require a one stage or two stage procedure?

Techniques

Revision knee replacement can be done as a single stage or two stage revision. Single stage revision means that the previous implant is removed and a new one put in during the same operation.
In a two stage revision. the previous implants are removed first, an antibiotic spacer is used followed by re implantation after a couple of months.
A one stage knee replacement is done for aseptic loosening. Causes of aseptic loosening include malalignment, polythelene wear debris.Two stage revison knee replacement is done for septic loosening. a cement spacer is used inbetween the two procedures to maintain the joint space and range of movement
The cement prosthesis contains antibiotics. The advantage is that the patient can ambulate  with partial weight bearing.  When blood indices have shown that the infection has been controlled, then a revision knee surgery with another prosthesis, bone graft can be done.
I do both one and two stage revisions. In those infected knees requiring a revision, I have developed a new technique to get rid of the infection with high degree of success. This paper was presented at the annual conference of the Indian association of orthopedic surgeons in Dec 2012. – “Biocomposites in joint replacement“.

Revision surgery on the rise in India.
With increase in knee replacements in India, there is also an increase in the number of revision knee replacements. Most of these are for infection and premature loosening.

If you are in need of a revision knee replacement, e mail us at drvenkat@kneeindia.com.

See this British patient’s testimonial