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Revision Knee Replacement Surgery
- Days In Hospital 3 days
- Outside Hospital Stay 7 days
- Success Rate 78%
Minimum Cost
$ 5000
Maximum Cost.
$ 8000
Overview of Revision Knee Replacement Surgery in India
In a revision of total knee replacement (TKR), also known as total knee arthroplasty (TKA), a surgeon repairs or replaces an existing knee prosthesis implant.
When your knee does not function very well due to the deterioration of the bone or cartilage, it could be detrimental to the overall functioning of your knee joint if those parts are replaced with a prosthesis. The procedure that restores normal function to your knee joint is called a "total knee replacement" when all structures of the knee are replaced; and "partial knee replacement", if only a part of the knee joint is replaced, at that time, also sometimes called a "partial knee arthroplasty". Your original knee replacement operation, when the damaged bones are replaced with implants, is also known as a “primary” knee replacement operation.
Unlike the bones in your knee and leg, your body cannot heal your own prosthesis. Your prosthesis can wear out over time with some activity. When your prosthesis becomes compromised, you may need to undergo another operation to repair the prosthesis, replace damaged parts, and assess the alignment. The operation to repair your prosthesis is called a revision operation, because your surgeon is "revising" or replacing knee replacement surgery.
If your artificial knee is not functioning as it should, it is possible you need to have a revision. Indications that your knee prosthesis is worn or damaged include:
- Increased pain and swelling
- Limited range of motion
- Unbearable instability
- Significant stiffness
The main reasons a total knee replacement is revised after it has been implanted include:
- Infection - 51%
- Mechanical loosening of the prosthesis - 28%
- Instability - 12.8%
- Wear of the plastic components - 4.7%
- Osteolysis (bone loss) - 2.0%
- Malalignment - 1.4%
When the implant is not anchored and not functioning correctly, we do not always know why. People who engage in high-impact sports and repetitive activity may put themselves at higher risk for mechanical failure. Loosening also occurs more frequently among people when the primary knee replacement surgery occurs at a relatively young age, based on the amount of time made available for wear and tear to affect the prosthesis.
Types of Revision Knee Replacement Surgery:
Partial Revision
During a partial revision only a portion of the knee prosthesis needs to be changed. For example, the shin bone or the thigh bone. A partial revision involves changing the affected part and leaving the rest of the components.
Complete Revision
In a complete revision, all components of the knee prosthesis are removed and replaced. A full revision is performed when there is significant damage, loosening, or failure of the original prosthesis.
Component Exchange
In a component exchange, only one component of the knee prosthesis, is exchanged. If there is a problem with the plastic spacer between the metal components it can be exchanged without taking off the entire prosthesis. If there is a problem with the metal component, it could be taken off without exchanging the plastic between the components.
Two-Stage Revision
This revision is done when there is an infection in the knee joint. In a two-stage revision, the infected prosthesis is removed, followed by a deep cleaning, a temporary antibiotic spacer is then inserted. After several weeks/months (note: it can vary) a new prosthesis is inserted.
Complex Revision
Complex revision total knee replacement is necessary when there are complications in the knee joint, that in addition to the initial reason for revision include severe bone loss, fractures, or previous revision surgeries have failed. These revisions will usually be more complex, and potentially use different techniques, such as bone grafting or contrived implants.
Procedure:
Medical Evaluation
A few weeks before revision surgery, you will be instructed to schedule a complete physical examination with your primary care physician. It is important to be healthy enough to proceed with surgery and healing. If you have chronic medical illnesses, such as heart disease or kidney disease, you may also be seen by a specialist such as a cardiologist or nephrologist before surgery.
Tests
Imaging Tests. Imaging tests are likely to be used by your physician to obtain a better understanding of the state of your knee.
X-rays. X-rays show dense structures like bone. Your physician may request X-rays of the joint replacement area to check for loosening or mislocation of parts.
Other imaging tests. A nuclear medicine bone scan may help assess if the prosthesis has loosened from the bone. In some cases, a magnetic resonance imaging (MRI) scan may be used to assess the reasons for knee replacement failure further and to further assess the bone. A computerized tomography (CT) scan may also be used.
Laboratory tests. Your physician may request blood tests and aspirate your knee to assess potential infection. In aspirating, joint fluid is removed with a needle and syringe. Then the knee fluid will be analyzed in a laboratory for infections.
Home Planning
Accessibility to mobility will be limited after your surgery and you may require assistance for a period of time up to several weeks. Tasks requiring assistance could include cooking, shopping, bathing, laundry, and other household chores.
If you live alone, your doctor's office, social worker, or a discharge planner at the hospital can help arrange for assistance to occur at home beforehand.
You may also need to stay for a time in a nursing facility or rehabilitation center after you are discharged from the hospital depending on your situation or the ability to have assistance at home. Your healthcare team will be able to also help arrange a short stay in an extended care facility to assist you during your recovery if necessary.
Procedure of Revision Total Knee Replacement
Revision Total Knee Replacement is generally described in the following way:
Pre-operative assessment: Patients undergo a general evaluation of their bony, prosthetic and surrounding soft tissue conditions. As part of this, both medical histories, x-rays and general health queries may be performed. The doctors also determine the procedure which should be performed.
Anesthesia: The incision is made under anesthesia, which numbs the area under surgery and eliminates pain. This makes the incision earlier and eliminates dignity issues for patients.
Removing the previous prosthesis: The surgeon removes components of the original knee prosthesis. This may involve separating the elements from the bone, as well as cutting out cement or necrotic portions of bone.
Implanting the new prosthesis: The doctor implants the latest components of the knee prosthesis into surfaces of the bone. The components may include a metal component for the thigh bone, a metal or plastic component for the shin bone, and a plastic spacer in between them.
Closure: the surgeon will close the incision with sutures and apply medications that prevent infections. A partial drainage bag may also be placed to drain the fluid.
Post-operative plan of care: the medications to prevent infections, blood clot formation and pain medications are part of the post-operative care plan. Physical therapy is essential to assist with recovery, restore joint motion and strength.
It is important to note that exact details of the procedure will vary according to individual patient factors and the surgeon's surgical skill.
Best Doctors in India
Cost of Revision Knee Replacement Surgery in India
The revision knee replacement surgery price in India might change with a number of factors including the city that the surgery is conducted, the hospital, the competence of a surgeon, the kind of implant applied, and other medical facilities. The price of revision knee replacement in India will however cost around 6,000 to 7,500 USD or even higher. The cost can be adjusted based on the specific Indian cities.
|
Treatment in different cities |
Min |
Max |
|
Bangalore |
5000 USD |
6500 USD |
|
Mumbai |
6000 USD |
7500 USD |
|
New Delhi |
5000 USD |
7000 USD |
|
Hyderabad |
4500 USD |
5500 USD |
|
Chennai |
4500 USD |
6000 USD |
Top Hospitals in India
Indications of Revision Knee Replacement Surgery:
Indications for Revision Total Knee Replacement:
- Aseptic loosening
- Infection
- Fractures
- Wear
- Implant failure or breakage
- Significant bone loss
- Bone loss
- Patellar tendon rupture
- Instability of components or dislocation
- Fracture of the implant itself or surrounding bone
- Instability due to ligaments
- Damage to one or multiple components
- Stiffness of the joint
- Instability of the patella
- Implant allergy
Risk Factors:
While Revision Total Knee Replacement is an effective procedure, it can carry major threats if not properly managed. Some of the threats are:
Implant Concerns
The artificial knee joint can deteriorate or outlive its usefulness, requiring a revision surgery for total knee replacement.
Infection
Infections can occur shortly after the initial knee replacement surgery or many years later. In either event if not correctly managed an infection can spread throughout the body.
Fractures
Fractures can show up around the knee joint. Fractures can occur from trauma or simply loading stress on the implant, leading to a revision surgery.
Loosening
The implant components can become loose over time, which leads to pain and instability requiring proper contingency plan to be put in place after transplant procedure.
Patellar Issues
Kneecap problems, which can include dislocations or wear can cause limited activities and restrict a patient's ability to participate in daily activities.
Loss of Bone and Fractures
The stability of the implant will be affected, which may lead to additional complications, if there is excessive bone loss or fractures around the knee joint.
Poor Placement of Components
Poor placement of the components during the primary surgery can lead to tissue damage surrounding the implant and cause serious complications.