Total Knee Joint Replacement Revision Surgery

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Total knee arthroplasty.jpg

Clinically Relevant Anatomy[edit | edit source]

Total Knee Joint Replacement (TKR) revision surgery is an orthopaedic surgical procedure in which the prosthetic pieces(s) of the previous TKR surgery are removed. New prosthetic pieces are then replaced within knee joint joint. The components being; the femoral condyle component; the tibial plateau component; the polyethylene space; the patella component. All or some of these may be replaced depending on reason for replacement.

Revisional TKR surgery is a more complicated operation requiring longer time in theatre and rehabilitation is slower and takes a more cautious approach.[1]

Mechanism of Injury / Pathological Process[edit | edit source]

Many reasons exist for the failure of a TKR. A meta analysis in 2011 found that TKA for OA has a revision rate of < 5% within 10 years.[2] The reason for this failure can be classified into long or short term reasons.[1]

Short term pathological process or injury include

  • Infection
  • Mechanical failure
  • Implant loosening from failed procedure

Long term pathological process or injury include

  • Loosening due to wearing of the TKR ( life span of a replacement varies from approximately 10 to 20 years).
  • Stiffness
  • Pain
  • Dislocation

Other reasons include

  • Fall
  • Periprosthetic fracture
  • Metallosis

[3]

Clinical Presentation[edit | edit source]

[4]

Diagnostic Procedures[edit | edit source]

X-rays are essential

Blood tests to check no infection present

CT for closer visualisation of anatomy

Bone scans to look for any loosening

Outcome Measures[edit | edit source]

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Management / Interventions[edit | edit source]

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Differential Diagnosis[edit | edit source]

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Resources[edit | edit source]

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References[edit | edit source]

  1. ↑ 1.0 1.1 Healthline. What is Knee Replacement Revision Surgery. Available from: https://www.healthline.com/health/total-knee-replacement-surgery/revision#1 (last accessed 4.3.2019)
  2. ↑ Lützner J, Hübel U, Kirschner S, Günther KP, Krummenauer F. Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21258774 (last accessed 4.3.2019)
  3. ↑ Joseph Gondusky,M.D. Revisional Knee Replacement. Available from: https://www.youtube.com/watch?v=ayYTyUdRjrs (last accessed 4.3.2019)
  4. ↑ UMPC. Knee instability and complex revision surgery. Available from: https://www.youtube.com/watch?v=e9An0IzLypQ (last accessed 5.3.2019)
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