Knee revision surgery





Definition

Knee revision surgery, which is also known as revision total knee arthroplasty , is a procedure in which the surgeon removes a previously implanted artificial knee joint, or prosthesis, and replaces it with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from another donor.


Purpose

Knee revision surgery has three major purposes: relieving pain in the affected hip; restoring the patient's mobility; and removing a loose or damaged prosthesis before irreversible harm is done to the joint. Knee prostheses can come loose for one of two reasons. One is mechanical and is related to the fact that the knee joint bears a great deal of weight when a person is walking or running. It is unusual for the metal part of a knee prosthesis to simply break. This part, however, is inserted into the upper part of the tibia, the larger of the two bones in the lower leg, after the surgeon has removed the upper surface of the tibia. The bone tissue that receives the metal implant is softer than the bone that was removed, which means that the metal implant may sink into the softer bone and gradually loosen.

The second reason for loosening of a knee prosthesis is related to the development of inflammation in the knee joint. The plastic part of a knee prosthesis is made of a material called polyethylene, which can form small particles of debris as a result of wear on the prosthesis over time. If the patient has an uneven gait, or pattern of walking, the debris particles tend to form at a faster rate because one side of the prosthesis will tend to pull away from the bone and the other side will be pushed further into the bone. These tiny fragments of plastic are absorbed by tissue cells around the knee joint, which become inflamed. The inflammatory response begins to dissolve the bone around the prosthesis in a process known as osteolysis. As the osteolysis continues, bone loss accelerates and the prosthesis eventually comes loose.

A knee prosthesis that has become infected or completely dislocated must be removed and replaced to prevent permanent damage to the patient's knee.


Demographics

The demographics of knee revision surgery are somewhat difficult to evaluate because the procedure is performed much less frequently than total knee replacement (TKR). TKR itself is a relatively new operation; the first total knee replacement was performed in the United Kingdom in 1968 and the first TKR in the United States in 1970. As of 2003, it is estimated that 98% of knee prostheses are still functioning well 10 years after surgery, with 94% still working after 20 years. Because of this high success rate, the number of patients who have had knee revision surgery yields a much smaller database than those who have had TKR. It is estimated that about 22,000 knee revision operations are performed in the United States each year; over half of them are done within two years of the patient's TKR.

Another difficulty in evaluating the demographics of knee revision surgery is the growing trend toward TKR in younger patients. A Canadian survey released in January 2003 stated that the number of knee replacements performed in patients below the age of 55 rose 90% between 1994 and 2001. As the number of knee replacement procedures done in younger patients continues to rise, the number of revision surgeries will increase as well. A study done in the United States in 1996 reported that women were almost twice as likely as men to have knee revision surgery, and that Caucasians were 1.5 times as likely as African Americans to have the procedure. This study, however, was limited to patients over the age of 65, so that its findings are not likely to be an accurate picture of younger patient populations.


Description

Most knee revision operations take about three hours to perform and are similar to knee replacement procedures. After the patient has been anesthetized, the surgeon opens the knee joint by cutting through the joint capsule. The first step in revision surgery is the removal of the old femoral component of the knee prosthesis. After the metal shell has been removed, the damaged bone at the end of the femur is scraped off and the femur is reshaped. If the bone is weak, the surgeon may decide to fill the cavity inside the femur with bone grafts. In some cases, metal wedges may be used to strengthen the attachment of the new femoral component.

After the new femoral component has been glued in place with bone cement, the old implant in the tibia is removed and the bone is reshaped to receive a new implant. If the old implant had loosened because it had moved downward into the softer tissue inside the tibia, the surgeon will pack the space with morselized bone from a donor before putting in the new implant. This technique is known as impaction grafting. The impaction grafting may be reinforced with wire mesh. If the tibia has been shortened by the removal of damaged bone, the surgeon will insert a wedge along with the new tibial implant and secure them to the end of the tibia with bone cement. A new plastic plate will be fastened to the tray at the top of the tibial implant so that the patient's femur can move smoothly over the tibia. If the patient's patella (kneecap) has been damaged, the surgeon will resurface its back surface and attach a plastic component to protect the patella from further bone loss. The tibial and femoral components of the prosthesis are then fitted together, the kneecap is replaced, and the knee tendons reattached with surgical wire. The knee joint is washed out with sterile saline fluid and the various layers of the incision closed.

Revision surgery on an infected knee requires two separate operations. In the first operation, the old prosthesis is taken out and a block of polyethylene cement known as a spacer block is inserted in the joint. The spacer block has been treated with antibiotics to fight the infection. The incision is closed and the spacer block remains inside the patient's knee for about six weeks. The patient is also given intravenous antibiotics during this period. After the infection has cleared, the knee is reopened and the new revision prosthesis is implanted.


Diagnosis/Preparation

In most cases, increasing pain, stiffness, and loss of mobility in the knee joint are early indications that the patient may benefit from revision surgery. The location of the pain may point to the part of the prosthesis that has been affected by osteolysis. Pain around or in the kneecap is not always significant by itself because many TKR patients have occasional discomfort in that area after their knee replacement. If the pain is diffuse (felt throughout the knee rather than in only one part of the knee), it may indicate either an infection or loosening of the prosthesis. Pain felt throughout the knee accompanied by tissue fluid accumulating in the joint points to a problem with the polyethylene part of the prosthesis. Pain in the lower thigh or in the part of the leg just below the knee suggests that the metal plate attached to the femur or the metal implant in the tibia may have come loose.

The doctor may take risk factors into account in assessing the likelihood of a failed knee prosthesis. Six factors have been identified as increasing a patient's risk of needing revision surgery within two years of knee replacement surgery:

  • age (Younger patients tend to be more active and to wear out knee prostheses more rapidly than older ones.)
  • a long hospital stay for the original knee surgery
  • concurrent diseases or disorders
  • any type of arthritis
  • surgical complications during the first knee operation
  • having the first knee operation performed at an urban hospital

The doctor will then usually order a series of imaging tests to determine the location of the problem and the extent of bone loss. X-ray studies can be used to check for complete dislocation of the prosthesis as well as loosening. Computed tomography appears to be more effective in detecting the early stages of osteolysis than x-ray studies. If the doctor suspects that the knee prosthesis has become infected, he or she will aspirate the joint. Aspiration is a procedure in which fluid is withdrawn from a joint through a needle and sent to a laboratory for analysis. The fluid will be cultured in order to identify the specific organism causing the infection.


Aftercare

Aftercare following knee revision surgery is essentially the same as for knee replacement, consisting of a combination of physical therapy, rehabilitation exercises, pain medication when necessary, and a period of home health care or assistance.

The length of recovery after revision knee surgery varies in comparison to the patient's first knee replacement. Some patients take longer to recover from revision surgery, but others recover more rapidly than they did from TKR, and they experience less discomfort. The reasons for this variation are not yet known. As of 2003, the Hip and Knee Center at Columbia University is conducting a study of 100 knee revision patients at five different sites in the United States in order to evaluate the outcomes of revision surgery. The patients will be examined at three-month, six-month, 12-month, and 24-month intervals in order to measure their progress after surgery.


Risks

The complications that may follow knee revision surgery are similar to those for knee replacement. They include:

  • Deep vein thrombosis.
  • Infection in the new prosthesis.
  • Loosening of the new prosthesis. The risk of this complication is increased considerably if the patient is overweight.
  • Formation of heterotopic bone. Heterotopic bone is bone that develops at the lower end of the femur following knee replacement or knee revision surgery. Patients who have had an infection in the joint have an increased risk of heterotopic bone formation.
  • Bone fractures during the operation. These are caused by the force or pressure that the surgeon must sometimes apply to remove the old prosthesis and the cement that may be attached to it.
  • Dislocation of the new prosthesis. The risk of dislocation is twice as great for revision surgery as for TKR.
  • Difference in leg length resulting from shortening of the leg with the prosthesis.
  • Additional or more rapid loss of bone tissue.

Normal results

Normal results of knee revision surgery are quite similar to those for TKR. Patients have less pain and greater mobility in the affected knee, but not complete restoration of the function of a normal knee. Between 5% and 20% of patients report some pain following either TKR or revision surgery for several years after their operation. Most patients, however, have considerably less discomfort in the knee after surgery than they did before the procedure. A recent British study found that revision knee surgery patients had the same positive results at six-month follow-up as patients who had had primary knee replacement surgery.

As with knee replacement surgery, patients who have had revision surgery may experience mild swelling of the leg for as long as three to six months after surgery. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.


Morbidity and mortality rates

The 30-day mortality rate following knee revision surgery is low, between 0.1% and 0.2%. The estimated rates of complications are as follows:

  • deep infection: 0.97%
  • loosening of the new prosthesis: 10–15%.
  • dislocation of the new prosthesis: 2–5%.
  • deep venous thrombosis: 1.5%

Alternatives

Nonsurgical alternatives


LIFESTYLE CHANGES. The American Association of Orthopaedic Surgeons (AAOS) has published a fact sheet about the effects of aging on the knee joint aimed at the baby boomer generation. Many adults in their 40s and 50s have been influenced by the contemporary emphasis on youthfulness to keep up athletic activities and forms of exercise that are hard on the knee joint. Some of them try to return to a high level of activity even after TKR. As a result, some surgeons are suggesting that adults in this age bracket scale back their athletic workouts or substitute low-impact forms of exercise. Good choices include water aerobics, tai chi, yoga, swimming, cycling, and walking.


COMPLEMENTARY AND ALTERNATIVE (CAM) APPROACHES. Complementary and alternative therapies are not substitutes for knee revision surgery, but some have been shown to relieve physical pain before or after surgery, or to help patients cope more effectively with the emotional and psychological stress of a major operation. Acupuncture, chiropractic, hypnosis, and mindfulness meditation have been used successfully to relieve postoperative discomfort following revision surgery. Alternative approaches that have helped patients maintain a positive mental attitude include meditation, biofeedback, and various relaxation techniques.


Alternative surgical procedures

Arthroscopy is the most common surgical alternative to knee revision surgery. It is a procedure in which a surgeon makes three or four small incisions in the knee in order to insert a device that allows him or her to see the inside of the joint, insert miniaturized instruments to remove or repair damaged tissue, and drain fluid from the joint. Arthroscopy has been used successfully to treat stiffness in the knee following TKR and improve range of motion in the joint. It is not successful in treating infected prostheses unless it is used very early.

Other surgical alternatives to knee revision surgery include manipulation of the joint while the patient is under general anesthesia, and arthrodesis of the knee. Arthrodesis is a procedure in which the joint is fixed in place with a long surgical nail until the growth of new bone tissue fuses the knee. It is generally considered a less preferable alternative to knee revision surgery, but is sometimes used in the treatment of elderly patients with infected prostheses or weakened bone structure.

See also Arthroscopic surgery .


Resources

BOOKS

Darrow, Marc, MD, JD. The Knee Sourcebook. Chicago and New York: Contemporary Books, 2002.

Silber, Irwin. A Patient's Guide to Knee and Hip Replacement: Everything You Need to Know. New York: Simon & Schuster, 1999.

PERIODICALS

Barrack, R. I., C. S. Brumfield, C. H. Rorabeck, et al. "Heterotopic Ossification After Revision Total Knee Arthroplasty." Clinical Orthopaedics and Related Research 404 (November 2002): 208–213.

Djian, P., P. Christel, and J. Witvoet. "Arthroscopic Release for Knee Joint Stiffness After Total Knee Arthroplasty." [in French] Revue de chirurgie orthopedique et reparatrice de l'appareil moteur 88 (April 2002): 163–167.

Hartley, R. C., N. G. Barton-Hanson, R. Finley, and R. W. Parkinson. "Early Patient Outcomes After Primary and Revision Total Knee Arthroplasty. A Prospective Study." Journal of Bone and Joint Surgery, British Volume 84 (September 2002): 994–999.

Hasegawa, M., T. Ohashi, and A. Uchida. "Heterotopic Ossification Around Distal Femur After Total Knee Arthroplasty." Archives of Orthopaedic and Trauma Surgery 122 (June 2002): 274–278.

Heck, D. A., C. A. Melfi, L. A. Mamlin, et al. "Revision Rates After Knee Replacement in the United States." Medical Care 36 (May 1998): 661–669.

Incavo, S. J., J. W. Lilly, C. S. Bartlett, and D. L. Churchill. "Arthrodesis of the Knee: Experience with Intramedullary Nailing." Journal of Arthroplasty 15 (October 2000): 871–876.

Katz, B. P., D. A. Freund, D. A. Heck, et al. "Demographic Variation in the Rate of Knee Replacement: A Multi-Year Analysis." Health Services Research 31 (June 1996): 125–140.

Lonner, J. H., P. A. Lotke, J. Kim, and C. Nelson. "Impaction Grafting and Wire Mesh for Uncontained Defects in Revision Knee Arthroplasty." Clinical Orthopaedics and Related Research 404 (November 2002): 145–151.

Peersman, G., R. Laskin, J. Davis, and M. Peterson. "Infection in Total Knee Replacement: A Retrospective Review of 6489 Total Knee Replacements." Clinical Orthopaedics and Related Research 392 (November 2002): 15–23.

Shah, S. N., D. J. Schurman, and S. B. Goodman. "Screw Migration from Total Knee Prostheses Requiring Subsequent Surgery." Journal of Arthroplasty 17 (October 2002): 951–954.

Sharkey, P. F., W. J. Hozack, R. H. Rothman, et al. "Insall Award Paper: Why Are Total Knee Arthroplasties Failing Today?" Clinical Orthopaedics and Related Research 404 (November 2002): 7–13.

Teng, H. P., Y. C. Lu, C. J. Hsu, and C. Y. Wong. "Arthroscopy Following Total Knee Arthroplasty." Orthopedics 25 (April 2002): 422–424.

Vidil, A., and P. Beaufils. "Arthroscopic Treatment of Hematogenous Infected Total Knee Arthroplasty: 5 Cases." [in French] Revue de chirurgie orthopedique et reparatrice de l'appareil moteur 88 (September 2002): 493–500.


ORGANIZATIONS

American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, IL 60018. (847) 823-7186 or (800) 346-AAOS. http://www.aaos.org .

American Physical Therapy Association (APTA). 1111 North Fairfax Street, Alexandria, VA 22314. (703)684-APTA or (800) 999-2782. http://www.apta.org .

Canadian Institute for Health Information/Institut canadien d'information sur la santé (CIHI). 377 Dalhousie Street, Suite 200, Ottawa, ON K1N 9N8. (613) 241-7860. http://secure.cihi.ca/cihiweb .

Center for Hip and Knee Replacement, Columbia University. Department of Orthopaedic Surgery, Columbia Presbyterian Medical Center, 622 West 168th Street, PH11-Center, New York, NY 10032. (212) 305-5974. http://www.hipnknee.org .

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. http://www.nccam.nih.gov. .

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. National Institutes of Health, 1 AMS Circle, Bethesda, MD 20892. (301) 495-4484. TTY: (301) 565-2966. http://www.niams.nih.gov .

Rothman Institute of Orthopaedics. 925 Chestnut Street, Philadelphia, PA 19107-4216. (215) 955-3458. http://www.rothmaninstitute.com .

OTHER

Questions and Answers About Knee Problems. Bethesda, MD: National Institutes of Health, 2001. NIH Publication No. 01-4912.

University of Iowa Department of Orthopaedics. Total Knee Replacement: A Patient Guide. Iowa City, IA: University of Iowa Hospitals and Clinics, 1999.


Rebecca Frey, Ph.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Knee revision surgery is performed by an orthopedic surgeon, who is an MD and who has received advanced training in surgical treatment of disorders of the musculoskeletal system. As of 2002, qualification for this specialty in the United States requires a minimum of five years of training after medical school. Most orthopedic surgeons who perform joint replacements and revision operations have had additional specialized training in these specific procedures.

In many cases, knee revision surgery is done by the surgeon who performed the original knee replacement operation. Some surgeons, however, refer patients to colleagues who specialize in revision procedures.

Knee revision surgery can be performed in a general hospital with a department of orthopedic surgery, but is also performed in specialized clinics or institutes for joint disorders.

QUESTIONS TO ASK THE DOCTOR


  • How many knee revision operations do you perform each year?
  • Would I be likely to benefit from arthroscopy?
  • What lifestyle changes can I make to extend the life of the new prosthesis?
  • What are my chances of needing another revision operation in the future?


User Contributions:

gail newell
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Dec 21, 2006 @ 1:01 am
This has really given me a lot of information. I have had polio and have had a total knee replacement and the drs. are thinking about doing a knee revision on my knee since it has become lose. When I had the sugery before and everything was aligned it caused my ankle to turn in. Will this type of sugery fix that.
Cathy
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Jan 19, 2007 @ 7:07 am
Hi, Just want you to know I learned a lot from this article. I had a partial right knee replacement 9 months ago. I was all cleared to go to work and then had a twisting injury. Had a ct and it showed my knee cap sublixed and sheared off about 50 % of the bone on the other side of the knee from where the partial was. I am a little nervous about this. I don't want my right leg shorter than my left. I am short enough only 5' 1
I am have this done on 1/23/07 at Brigham and Womens Hopsital in boston thanks for the info.

Cathy
Kim Frasch
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Feb 9, 2008 @ 8:20 pm
Had a Stryker knee replacement in April 2004. Had a bone scan that determined the implant has come loose. they could drain 35 CCs of fluid any time. It hurt all the time after surgery and I never did what I was NOT suposed to. Dr. Mrak Hanna will do a knee revision on Feb 19th 2008. He will use a DePuy device. I am one month shy of being 59, weigh 195 and exercise daily, with NO running, just walking and light yard work. I hike around a lake, but that is it. The Stryker device lasted less than 4 years and I want this one to last. If anyone has advice, please send it on. I am nervous about only having an 85% chance of success, but what choice do I have?
Jack L Henning
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Oct 18, 2008 @ 6:06 am
I had bilateral knee replacements performed April,6 1998. In June 2008 I started to have intermitent pain in my left knee. My Orthopedic Surgeon informed me that the polyethylene disk in my left knee was worn down (X-rays confirmed)and the residue was most likely effecting the function of the knee resulting in pain. On August 14, 2008 I had " Revision Knee Surgery" performed on the left knee. My post-operation experience has been consistant with those described in the artical above with one exception. I continue to experience a sharp jabbing pain throughout the knee joint when I have a sudden deep cough or deep exhalation. My Doctor stated that he had not previously heard of this type of on-going source of pain. I would appreciate knowing if there is any information about this "on-going pain source" issue. Thank You.
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Feb 18, 2011 @ 5:05 am
I am now at a three month post op total revision stage, microbiologists were unable to locate bacteria causing the problem of my previous (uni-compartmental) and then total knee replacements this is my third. My question is: will my leg ever be straight I am having physio three times a week and although much improved, my knee is bent for most of the time and I am finding it is putting strain on my back and ligaments.

Many thanks Suzi P
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Feb 18, 2011 @ 7:07 am
I am now at a three month post op total revision stage, microbiologists were unable to locate bacteria causing the problem of my previous (uni-compartmental) and then total knee replacements this is my third. My question is: will my leg ever be straight I am having physio three times a week and although much improved, my knee is bent for most of the time and I am finding it is putting strain on my back and ligaments.

Many thanks Suzi P
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Mar 3, 2011 @ 10:10 am
I am a 82 year old male who had a knee replacement 4 years ago. Had a very trying time. My knee is very painful and I was told the cement was eroding. I also have bone on bone in the other knee. Can you please give me some insight how to approach treatment in the correct fashion? The discomfort has gotten bad over the past year. Thank you very much.

bob0500@live.com
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Mar 28, 2011 @ 5:17 pm
I had a total knee replacment done Sept. 2010. It,s now march 28 and still in pain. After a visit to the mall it is very hard to even walk, left knee swells up(feel like fluid in it)it stays warm to the touch 24/7, swollen 23/7. 3 Weeks ago I went back to the doctor who did the surgery to see whats going on. Standing at the door way he asked me some questions and stated he needed to do orthoscopic surgery to clean out some scar tissue, or maybe opening me up and replace the poly spacer??. 2nd visit last week he now states that if he can straighten my leg out while I am under drugs the orthoscopic is all he will have to do, if it cant be straightened the go in and replace the poly. My leg can phiscially be straightened, but I cant do it on my own. All this said, the doctor not touching me or any X-rays.My question is ,does he know something that I dont. After thinking about it I decided to get a 2nd opinion. The 1st thind the new doctor did was a Xray, next was a nueclear bone scan. The results show that the lower implant may be coming looses, this is causing increased pressure in my knee because there is not sufficiant room for the parts to move without binding. He stated that he would have to remove the implant resurface the bone and install a new implant, this would give my knee more space to move in. He also stated that my implants were pressed in vs cemented in move. The 1st doctor has tried to fix my problem 1st time steroid injection, 2nd time Suparts injections, then 3rd time orthoscopic surgery (his coment,this will fixa right up,good as new) and 4th time TKR, comment ( You are ready to go dancing). My implant was a Stryker Howmedica.If anyone has had a simular issue please contact me at my email address, or if there is a attorney reading this, can I get some help. I am almost 68 years old, living on Fentanal patches and 90 percoset a month. 24/7 pain, very limited in what I can do. It just does not feel right what the 1st doctor is saying, I feel he has screwed up somewhere and now wants to fix it up properly, to much info from him with no xrays taken.
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Apr 6, 2011 @ 10:10 am
Questions to ask before surgery. Make sure to ask about MRI.
LOZITA VAN
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Jul 9, 2011 @ 12:12 pm
HAD BILATERAL TKR 1/10/65. FABULOUS SURGEON AND PIONEER OF PROCEDURE, CHITRANJAN RANAWAT AT HSS, NY. I RECOVERED IN 3 MONTHS WITH THERAPY AND WAS BACK AT WORK AND TAKING DANCE CLASSES! RECENT 2 OR SO MONTHS HAVE HAD SWELLING AND WARMTH AT TIMES OF LEFT KNEE WHICH WAS THE WORSE OF THE TWO BEING REPLACE. WENT BACK TO SEE DR. RANAWAT AT WHICH TIME XRAYS WERE DONE AND REVIEWED. HE EXAMINED THE KNEE AND STATED THAT I COULD CONTINUE MY ACTIVITIES BUT IS THE PAIN PERSISTED I MUST RETURN. THE KNEE GOT BETTER FOR AWHILE BUT IS TROUBLESOME AGAIN. BOTTOM LINE:MUST GO BACK TO DR. RANAWAT. ADVISE TO OTHERS: SEE DR RANAWAT AT HSS, NY. HE IS THE DANCERS DOC AS WELL AS OTHER CELEBS! HE EVEN SAW ME AND TREATED ME WITH THE SAME TYPE OF INTEREST AND ATTENTION.
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Sep 14, 2011 @ 1:13 pm
i make opertaion replacment revvision knee replacment before 8 mounth ( in this period time can take there is no infaction > after this time i feel hot in my knee then the infaction happened
what i have to do how
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Sep 28, 2011 @ 10:10 am
I underwent in both knee replacement ie. right knee in 2004 & left one in 2008. From the very beganing of TKR of right knee. I had been in severel complications like stiffness,instability & swelling on the knee. In a words functioning of right knee was very troublesome. Subsequently during May of this year abnormal swelling & pain started at this time I attended my doctor Mr.M Ali in Bangladesh Appollo Hospital who stuyed the X-Ray of the knee & remark the implant has become losen which in his opinion requires revision of TKR. For information I like to say that the implant was of Zimmer Company.At present I am 70 years & retired Govt. Officials. As a heart patient i had 3 blocks in the heart for which CABG was done 2 month back.In this circumstances i solicide your better suggession for solution.
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Oct 12, 2011 @ 3:15 pm
I had a l knee replacement in April 2009 nine days after the surgery the implant loosened and slide through my knee it took 18 months to get a doctor to believe me or they where waiting for the statue of limitations to run out to fix me but on Feb 2011 i had to have a total revision and now it is Oct 12,2011 and the knee is failing again please will anybody help or refer me to a proper dr to take care of me i do not take pain meds i just want to be fixed MK 883gearheadgirl@gmail.com
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Nov 25, 2011 @ 12:00 am
In 12/2006 I had TKR in right knee. Went back to work after 4 months.I felt fine. My job consist of lifting 2 to 4 year old children. I told my surgeon what I did and said there was no problem going back to work. In 2010 I started to feel pain in my right knee and knew something was very wrong. Went to another surgeon, as it turns out I need Total knee revision. My implant and cement became loose. No infection. In July 2010 I had my Revision. He put a longer post into my lower leg so it would hold better and he did not have change the implant to the top part of the knee. Also I had General anesthesia. Two weeks after the surgery I started to get very itchy. It started on my right knee and all over the lower part of the leg then it went to the left leg also. It is now November 2011 and I am still very itchy it is driving me crazy. I went to my internist as soon as the itch started. She said it was scabies and gave me meds. it didn't help. I went back to my surgeon and he doesn't know what it is. I went to a dermatologist, he said it wasn't scabies that it was eczema but wasn't too sure. My question is...Why after more then a year later I am still itchy, it never lets up and it is all day long. Will I have to live with this for the rest of my life. Please help me.
gene
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Dec 10, 2011 @ 2:14 pm
for future reference...lots of information, here. A very thorough description. Now, to find an experienced surgeon for the procedure.
susan
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Dec 23, 2011 @ 10:10 am
Hi
Had Bi Lateral Knee replacements 7 months ago. I still have stiffness and soreness. How long does this linger? I was told that this could go on for almost one year. I also have a little scar tissue on both knees Doctor says that this will get better that also can take two years. No pain from surgery only what I have mentioned above Any one else having these problems?

Thanks Sue
Susan
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Jan 15, 2012 @ 6:06 am
I had a Left TKR December 2010 knee was great no pain good ROM, perfect than after riding an exercise bike for less than 5 min October 27 2011 knee swelled up could not walk on it, very painful. Stayed swollen with decreased ROM and pain, cultured 6 times no infection. Had a revision January 2012, on IV ATB for six weeks. No absolutes on what the problem was ? Plastic delaminating ? Any one know of any recalls on stryker knees?
patty
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Feb 1, 2012 @ 4:16 pm
I had a TKR 2 1/2 years ago. I needed a manipulation under general anesthesia to get the knee bending. Had to petition my insurance company to get an additional 25 physical therapy sessions (50 total) to get the thing to 115 degrees and mostly straight, but really it never felt right. The more I used it, the more it hurt. My doctor didn't want to see me until the end of one year even though it was very painful and I only able to walk short distances (1/4 mile). Most of the pain was on the medial side below the knee -- probably where the tibial piece connects, but in general the whole knee hurt. Anyway after the year, he took xrays and found no indication of loosening. A few months later he did a bone scan and although it looked inflamed, he said that may be normal more a TKR after 14 months. Over the past two years I have seen 8 doctors in the area for opinions. I walk with a cane and only very short distances. It's a long story so to cut to the case.

I had a revision last week. As it turns out, the piece of hardware that's inserted down into the tibia was loose. I could see that the plastic piece clearly had more wear on the medial side (I kept the old parts) and the tibia piece has no bone on it while the femur piece had lots of bone stuck to it. They reported the knee was too "lax" as well. During the surgery a piece of bone came up (with a ligament attached) and had to be stabled back. The doctor said it was because my bone tissue was soft.

I can't believe after 2.5 years and 8 different opinions, none of the doctors caught this sooner. Several of them suggested that my knee was probably as good as it was going to get and not to have another surgery. Don't loose components have the potential to do damage to the bone?

As long as the glue holds, the new knee is aligned and balanced right, and the bone isn't too soft from all the wear and tear over a loose component for the past 2+ years, I should be able to walk without a cane. I'm afraid to be too hopeful since I have had so much disappointment over this. I used to be an athlete.
rose
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Feb 2, 2012 @ 1:13 pm
My mon had tkr on both in the 70's she is 97 and is have a great deal of pain in one knee it loos like the knee shifted - she cannot straighten it out she is in a convelesant home we need help
colleen
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Jun 18, 2012 @ 11:11 am
I had total knee replacement in 2009. I had to have manipulation the first month, My knee has never bent right has always given me a problem. So I had gone back to my Dr. they were going to send me out for test. Which I feel thay were trying to put me off I had to drive long distance and was hard getting back inn forth. I have moved sence then and went to a dr here in Alaska who pretty much looked at the knee and told me what the problem was. But still right there in his office took fluid off my knee to check for infection. It can back negative. So am going back for a revision I'm so nervous about this procedure only because I had nothing but trouble with this one.I feel the first surgeon made a big mistake, can this be the drs. Fault?
Lorraine
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Jul 1, 2012 @ 8:20 pm
Wow, found this article very informative...more than the docs told me! I had my TKR on right knee in 2008. Have been experiencing increased pain in it within the past 6 months. I, of course, went back to the original surgeon. He said X-ray looked fine. Pain was not from my replacement, it must be my back, and sent me for pain management. When they weren't helping me, sent me to spine specialist. 1st spine doc told me was definately not my back. 2nd spine doc told me was not my back. 2nd ortho doc said it was my knee...I needed revision. If anyone reading this knows a good revision doc in South Carolina, please contact me at nanalorr@myway.com.
Thanks
Dave
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Jul 9, 2012 @ 7:19 pm
I agree, very informative reading. After a TKR 2 years ago I finally found a doctor who knew enough to do a revision. Had that Nov. 2011. Two posts with a hinge in the middle now grace my skeletal form. Originally I almost had my leg amputated in 1989 after having an MVA so even though I am only 42, I am having ongoing issues with pain. Far worse still than any of the original osteo-arthritic pain. The surgeon is a good guy and his work is excellent. He is saying at least 6-12 months for pain with this "Bigger Prosthetic". Does anyone have any feedback regarding a similar revision and/or are there any suggestions for treatment.
Margaret Hardy
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Sep 2, 2012 @ 4:04 am
II had aTkr in March 2009 I suffered a DVT during the operation . I had phyo and hydrotherapy
for many months,the knee will not bend and is quite painful recently I had x rays and bone scan and it showed a loosening of the prosthesis.I saw my surgeon who said I would need a revision. I would be interested to see comments from anyone who has had this procedure
In Victoria Australia.
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Oct 5, 2012 @ 9:21 pm
Hi! I am a 55 year-old mom and wife with a fairly active lifestyle. I had TKR on my right knee on 4/19/12 due to nearly bone on bone and severe deterioration of half of knee joint over a short period...lots of fluid draining and various injections, etc. The TKR went okay and proceeded with PT right away and at home. After the first nearly 4 months of PT at one facility, I was at 6 degrees and 87 degrees at best. I swithched facilities due to frustration and got to 5 and 90. At a follow-up appt. my doc and I decided to try manipulation and had that done on 9/24/12 which he got me to 0 and 105 degrees in op. room. Went to therapy the next day and every day for 10 days until next appt. PT could get me to 0 with someone literally sitting on my knee, and to 95 with 2 people forcing it painfully. I am walking with a limp for all these months since I still cannot straighten and I am fearful that it will cause my back, spine and other joints to get out of alingnment. On the 10 day follow up after manipulation my doctor is talking about revision. Got x-rays and he believes that the tibial plate may need to be reduced. He says this will allow me to get to 0 extension and he also wants to remove scar tissue. He advised a second opinion and I am looking into it. Has anyone had similar experience? Has anyone had the arthroscopy only (to remove scar tissue and facilitate looking at the joint) before getting a revision? I am so sick of going through therapy for nearly 6 months now and do not want to get cut open again! Please send or share experiences...I appreciate any input! Searching for doctors for second, third, and more opinions if needed!
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Dec 8, 2012 @ 12:12 pm
I had TKR in sept. 2010 and revision in november 2012. This recovery is different, in leg brace 24/7 much stiffness and pain. have about 20 % movenent in knew, being told with thereapy told movement will increase. was all of this worth it? All my radings on TKR and revision don not sound good as a whole.I am not a big exerciser so i am stressin about recovery and movement. Any good positive things to say about revision. Thanks michael
EARL DAWSON
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Jan 10, 2013 @ 1:13 pm
I had a rt. knee revision on 7/30/2012. Since that time , I've had the knee drained 3 times. I just had the knee injected with a medicated gel. I will receive 2 more of these injections in the next 2 weeks. If this medicated gel does not provide good results, the doctor mentioned using radiation treatment in order to remove tissue that is causing discomfort and swelling.

Is this potential radiation treatment a safe procedure?

Please advise.

Thank you.

Earl J. Dawson
Sarge
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Jan 11, 2013 @ 7:19 pm
It's been a year since my TK replacement on right knee and have continued to have pain. When I put pressure (weight on knee) no pain, it hurts most when I take pressure off. The pain is opposite of what one would expect. I'm also starting to feel knee giving out and feels like I'm hyperextending my knee. Any thought on what the issue us?
eniya
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Feb 8, 2013 @ 3:03 am
I'm 35 now. I wasd done ACL on 2003 on right knee; after diagnosed as ligament tear and tibial spine injury. After scre fixation tge place got pained and oozing of puss it again cleaned. After a month with the same complicatins I wss hospitaled therat calceneal traction was given and screw removed besides xy quadriceps. No a single degree of flexion received iwas given ring fixator henceforth no flexion possible till now.what need wilk j di for flexion of knee? Now my knee s straight
Earl Dawson
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Feb 28, 2013 @ 7:19 pm
I had a total rt. knee revision on 07/31/2012. The knee has been drained numerous times and has included injections of medicated gel in the last month.

The problem is that I still have significant pain and discomfort in the knee. I would think that after 6 months, the knee should have healed.

Should I visit another knee surgeon? Would a CAT scan reveal any information?

Please advise.

Thank you.
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Mar 30, 2013 @ 2:14 pm
From my research, it appears that somewhere between 25 and 30% of patients are less than satisfied with their total knee replacement. Most of these are due to poor alignment. Understand that the surgeon opens you up, pulls the knee cap away from the joint, rotates it 180 degrees and pulls it far to one side and secures it out of the way while cutting on your leg bones. That maneuver, due to the still attached tendons, rotates both your femur & tibia. If the surgeon doesn't take that into account, you'll be out of alignment.

The surgeon then drills a hole down the center of the femur. If he doesn't get this truly in the center, you're screwed. He then adjusts another tool which will cut the femur for a joint to be 5 to 7 degrees from the previously drilled hole. that's a rough assumption of degrees that the bone is at an angle with the hip ball joint. If you are short, tall, or have a curved femur, you're screwed.

While your surgeon is listening to his favorite music and counting the thousands he's making during this brief surgery, he then drills down the center of the tibia. Watch the youtube videos, and tell me how precise this maneuver appears to you. Again another tool is slid down that drilled hole for the next butchering. Now hop on any website that shows tibia xrays, and try to remember if yours are bowlegged or not. It doesn't matter, you're screwed!

Once that is done, the surgeon pounds in a metal plate and pops in a plastic plate on top of it. Then your knee is flexed to see that "all is good". The back of the knee cap is ground down. A plastic piece is glued to it. Flip it over, snap it into place . . . sew of glue you up . . . and you're good to go! next!

Never mind if it actually functions when you walk! The physical therapist takes care of that, right?

For those of us who fall into that 25 to 30% bracket, we're told to take these pills for pain, shut up and quit complaining, wait 6 months, and hopefully we will die from medication side effects before the doctor has to listen to us complain again.

Okay, so I'm mad. I had TKR in July 2012. It crunched and ground for 7 months until I had a revision in Feb 2013. He replaced the plastic plate, but cut a muscle in the surgery, now I have more pain and even more crunching & grinding.

My insurance company and I have had a conversation. Next stop is to find a worthy surgeon, rip out everything manmade, and start over!

Wish me luck!
john
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May 23, 2013 @ 10:22 pm
yes i had both knees replaced my right knee had a revision 2010 now there is infection that has set in the doctor wants to draw out some of the infection to see what type it is question is this painful and how do they get rid of the infection and put in the new knee thank you
ray curry
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Jul 11, 2013 @ 4:16 pm
I have had seven knee operation,am now going to have an revision knee surgery due too infection. are there anyone out there can or have had this type of surgrey respone back and tell me your outcome because i have read diffence thing and i am having diffence ideal about it.
Tony
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Jul 17, 2013 @ 6:06 am
I had knee revision on my rt knee june 10th of this year and I'm just starting to use my cane.It's taking longer than I thought it would to heal,more painful,alot longer to put weight on it.it still swollen, but I ice it most of the day.I'm only 54 so I try to do to much, so i'm just gonna take it easy and let it heal like the PT tells me, don't try to go to fast with the recovery I don't want to be back in hospital agaian. i didn't realize it's alot more painful and longer recovery time than the original tkr.But hopefully it'll heal alot better than first one.
Dennis
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Jul 25, 2013 @ 4:16 pm
Very good information ... I have had TKR on both knees 6 months apart. I would never, never have both done at the same time!!! Right knee went first and was very good with very little pain. I did not have PT as I live in remote Montana and the drive was 2 hours each way. As it turns out, I was able to hurt myself, as I say, and have very good flexibility in the knee. I did have fluid removed 3 times but it was a snap and it relieved some pressure I was feeling. Twisted the left knee while going down the stairs so it was time for the left knee. Operation went well as in the first and went home after a day and a half. The knee was good for about 2 weeks then pain would not go away ( I only took 1/2 a pain pill at night to sleep well). Had fluid removed 3 times. Dr. did not know what the problem was even after x-rays. I waited 6 months as he wanted and then he looked at new x-ray and said the lower part of the knee was moving a very very small amount. I had a revision 3 months ago and everything is now fine. The Dr thinks the cement did not hold.
Dennis
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Jul 25, 2013 @ 4:16 pm
Sorry ... forgot ... I am 68, 260 lbs. and medicare paid 100% of all three operations plus a fusion of my neck. Love medicare which is not free .. I pay $3K a year.
paul
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Aug 14, 2013 @ 8:20 pm
Had total knee replacement revision surgery in early June. I was just wondering if anyone else has had the after effects of surgery that I have. First of all I have had bad knees all my life. This latest surgery was my twelfth knee surgery. My tenth was a TKR of my right knee last year. It didn't seem to heal properly so my Surgeon did arthroscopic surgery this April. He suspected infection but did not find any. He DID find an excessive amount of scar tissue. Pain was still moderate after the surgery with severe swelling and lack of motion even following PT religiously. So this June he opened me up again and did a revision surgery and installed a 2mm thicker spacer (12mm vs 10mm) cleaned out the scar tissue and back to PT again. Strange symptoms appeared almost immediately. Muscles in right leg continually "fire" and cause considerable pain. Surface of my skin seems weird and touching it will also cause my right leg muscles to "fire". I lost over 50 pounds between last years surgery and this years. Wondering if any one else had these same symptoms. Taking 30 mg of morphine every 12 hours and 15 mg oxycodone every 6 hours. Pain pills help me to sleep but don't even start to kill the pain. Thank You.
Peter
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Oct 30, 2013 @ 4:16 pm
Having had my left knee replaced and then a revision after Ecoli infection the knee has been problematic ever since ,, and after a year I went back to the hospital and was told I had osteolysis behind the femoral component and valgus angulation to the limb.
Because I have overcompensated by throwing all my weight on my right side I have now had to have a TKR to my right knee, which I have to say was a complete success, I would really like to get my left knee sorted out which would be a revision to a revision , the surgeon who carried out the last TKR said to me after looking at xrays of both knees said dont let anyone touch your left knee ,, bit scarry , Im a relatively fit 68 year old gave up work last year , should I heed his advice or seek further opinions.
Sharon
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Dec 9, 2013 @ 7:07 am
Had TKR July 2012- the IT Band has always been EXTREMELY tight and hurts..it is now Dec. 2013. The IT Band pain has now effected up my thigh and into my hip socket..which I will prob. need a new hip eventually, & it is all coming from my knee replacement..it has NEVER been right. I have gotten a second opinion . He feels the plastic part needs to be replaced...the thicker size put in. Has anyone else experienced this...and will replacing the plastic help the IT band tightness? Thanks for ANY HELP you can give me...im scared.

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