Revision knee surgery:an epidemic waiting to happen says Dr Neeraj Bansal MS (Orth), M Ch, Orth (UK) Consultant Orthopedics

 

The trend of total knee joint replacement is increasing day by day and the procedure is helping lots of patients to improve their quality of life after the surgery. When successful, patient is able to perform his/her daily routine activities comfortably and without pain. Successful surgery gives the patient freedom to move.

As the number of surgeries and the surgeons performing the procedure are increasing, number of failed surgeries is going north. The main reasons for the failure of surgery are:

  1. Infection
  2. Aseptic loosening
  3. Wrong ligament balancing causing instability
  4. Osteolysis
  5. Peri-prosthetic fracture

Infection in joint is becoming one of the major causes of revision TKR surgeries in Punjab. The most important reason for the same is that surgery is being done at centers which are not hygienic, well-equipped, and standard of sterility is not maintained. Aseptic loosening and instability are two important reasons which have led to failure of joint replacement in recent times because the number of untrained surgeons performing knee and hip replacement has increased. It has been found that maximum failure is seen when surgeon is less experienced (doing less than 10 knee replacements/year). Peri-prosthetic fracture can happen due to trauma.

Few symptoms of failed knee tkr include pain in joint at rest or night time, instability or feeling of giving way in knee while changing position (sitting to stand or vice versa), deformity in knee, and swelling after 1 year of surgery.

Diagnosis depends on detailed history, thorough examination, and few investigations such as x-rays and blood investigations.

Treatment is expansive and involves frequent surgeries adding to mental and financial burden on the patient. In infection, 2 stage surgery is preferred in which 1st stage- the implant is removed, antibiotic laden cement spacer is put inside the knee and after six to 8 weeks, depending on symptoms and investigations, revision of knee with newer and bigger implants is done.

This procedure is costly and the last hope to make the patient walk again and lead an independent life. So the stress should be on improving condition of primary total knee joint replacement procedures keeping in mind place where the surgery is done, credentials of surgeon and his expertise, following the precautions advised by doctor after surgery religiously.

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