Total Knee Replacement, partial knee replacement MJRC India

Revision knee replacement

Indications for revision knee replacement
The indications for revision knee replacement are aseptic loosening and infection . The status of the skin, presence of scars, intactness of the extensor mechanism, infection and the status of the bone are important considerations. In septic loosening all cement,debris, granulation tissue have to be removed. Bone graft may be used to fill up defects in the leg bone or thigh bone.

Incidence of revision knee replacement are on the rise
The last decade saw knee replacements being performed in great numbers particularly after the knee surgery on the former prime minister Shri A.B.Vajpayee. He underwent bilateral knee replacements. This triggerd off an upswing in favour of primary knee replacments. Many of these were done under non ideal conditions by improperly trained staff. The consequences are that many of these surgeries that took place are requiring revision knee surgery now. Primary knee replacements should be only performed by properely trained and qualified knee surgeons in India in hospitals with clean air theatres. Otherwise loosening, infection, premature wear can arise.

Technical difficulties.
These knee operations are difficult to do. There is loss of bone, multiple scars from previous operations, infectious material.

Techniques
They can be done as one stage or a two stage revision. A one stage revison is done when there is no infection. A constrained prosthesis may have to be used when there is bone loss. A two stage operation is done when there is infection of the primary knee replacement has occurred.

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 move around and weight bear partially. When blood indices have shown that the infection has been controlled, then a revision knee surgery with another prosthesis, bone graft can be done.

Revision surgery on the rise
With the initial increase in TKR's over the last 5 years and computer assisted knee replacements, many TKR's have failed due to infection, septic loosening.