Revision Knee Replacement in Hauts-de-Seine
Knee Surgery
What Is Revision Knee Replacement?
Dr Simon Tournemine in Hauts-de-Seine (92)
There are three main types of knee replacement: total knee replacement, unicompartmental knee replacement, and patellofemoral knee replacement. These prostheses consist of several mechanical components designed to reproduce the normal anatomy and function of the knee: a femoral component fixed to the femur, a tibial component fixed to the tibia, and a patellar component attached to the kneecap.
Over time and with regular use, these prosthetic components may gradually wear or lose their fixation within the bone, a process known as implant loosening. Modern knee replacements generally have an expected lifespan of approximately 20 years, although older prosthetic designs may wear more rapidly.
Wear or loosening may affect the femoral component, the tibial component, the patellar component, or all three components. This may lead to pain, clicking sensations, limping and, in some cases, feelings of prosthetic instability. Replacement of the worn or loosened components may then become necessary. This procedure is known as revision knee replacement.
Infection, whether recent or longstanding, is another recognised indication for revision knee replacement surgery.
When and Why Is Revision Knee Replacement Recommended?
Knee Surgery Specialist in Hauts-de-Seine (92)
The natural progression of knee replacement wear or loosening is generally unfavourable, with gradual deterioration of the prosthesis and knee function.
Several conservative treatments may initially be prescribed to relieve pain, including lifestyle and dietary measures, pain-relieving medication, anti-inflammatory treatment and physiotherapy. However, when wear or loosening becomes too advanced and these treatments no longer provide sufficient relief, revision knee replacement may be considered.
The aims of surgery are to relieve pain, restore knee mobility and allow patients to return to their normal daily activities.
Revision Knee Replacement in Rueil-Malmaison
Knee Surgery in Hauts-de-Seine
Revision Knee Replacement Procedure
Revision knee replacement involves removing one or more worn, loosened or malpositioned components from the existing prosthesis and replacing them with new implants. Depending on the underlying problem, the femoral component, tibial component or patellar component may be exchanged. Any wear debris generated by the previous prosthesis is also removed during the procedure.
The same surgical approach as that used for the original knee replacement is generally reused, avoiding the need for an additional scar.
In some cases, wear of the existing prosthesis may have caused bone weakness or bone loss affecting the femur, tibia or patella. These defects may require metal reinforcement and, in some situations, bone grafting to restore bone support. The bone graft may be harvested from the patient or obtained from a donor.
Removal of the original prosthesis may occasionally require an osteotomy of the femur or tibia, in which part of the bone is opened to facilitate implant extraction. When this is necessary, the bone is subsequently stabilised using metal cerclage wires.
When revision surgery is required because of infection, all prosthetic components must be replaced and several weeks of antibiotic treatment will be necessary.
The duration of surgery varies considerably according to the number of components requiring replacement and the extent of bone damage. The operation may last between one and three hours.
It is performed under either general anaesthesia or spinal anaesthesia, in which only the lower limbs are anaesthetised. The choice of anaesthetic is made jointly with the anaesthetist during the preoperative consultation.
Hospitalisation generally lasts between two and seven days.
Recovery and Rehabilitation After Revision Knee Replacement
Following surgery, the dressing is generally changed every two days for approximately three weeks. Pain management is carefully monitored to maximise comfort and facilitate early rehabilitation. Anticoagulant treatment is prescribed for four weeks to reduce the risk of deep vein thrombosis.
In the majority of cases, the revised prosthesis is functional immediately after surgery, allowing patients to begin walking on the day of the operation. Enhanced Recovery After Surgery (ERAS) protocols are used, and a physiotherapist assists patients with walking and beginning rehabilitation on the day of surgery.
Early mobilisation combined with physiotherapy is a key factor in achieving a favourable recovery, as it helps preserve and improve muscle function and joint mobility.
No specific movements are routinely prohibited. Walking sticks or crutches may be useful initially but are generally discontinued after a few weeks.
Patients usually return home a few days after surgery. In some cases, a stay in a rehabilitation centre may be necessary for several weeks to regain sufficient independence before returning home.
Before discharge, your surgeon will provide all necessary prescriptions for dressings, pain medication, anticoagulants and physiotherapy. Rehabilitation should continue either at home with a physiotherapist or in a rehabilitation centre. Early resumption of everyday activities forms an important part of recovery.
Driving is generally possible around six weeks after surgery. Sick leave usually lasts approximately two months, although this depends on the patient’s occupation, and office-based work may often be resumed earlier. Sporting activities may be reintroduced progressively after the second postoperative month.
These timeframes are averages and are provided for guidance only, as recovery varies from one patient to another.
In some complex cases, reconstruction using metal reinforcement and bone grafting may be necessary. Removal of the original prosthesis may also require an osteotomy of the femur or tibia. In these situations, immediate full weight-bearing is not possible.
Approximately six weeks are required to allow the bone to heal. Walking remains possible during this period using two crutches while avoiding weight-bearing on the operated knee. Postoperative rehabilitation is therefore longer.
When revision surgery is performed because of infection, several weeks of antibiotic treatment will also be required after the operation.
Long-term clinical and radiographic follow-up remains essential to monitor the prosthesis and identify any potential abnormalities.
Risks and Complications Following Revision Knee Replacement
Every precaution is taken to promote a favourable recovery. Nevertheless, as with any surgical procedure, complications, although uncommon, may occur.
The principal risks include:
- Deep vein thrombosis and pulmonary embolism: uncommon complications, with the risk reduced by anticoagulant treatment prescribed for one month after surgery;
- Worsening of a pre-existing medical condition: such as heart failure or diabetes. Postoperative monitoring by the anaesthetic team is provided to reduce this risk;
- Prosthetic joint infection, affecting approximately 1% of patients: this may require further surgery to wash out or replace the prosthesis, followed by prolonged antibiotic treatment;
- Haematoma: postoperative bleeding may lead to the formation of a haematoma. Depending on its severity, drainage or blood transfusion may be required;
- Reduced knee mobility and postoperative stiffness: these may develop if rehabilitation is not carried out appropriately. Manipulation of the knee under anaesthesia may be proposed to release adhesions;
- Sensory nerve injury: small sensory nerve branches around the knee may rarely be injured, resulting in reduced sensation over certain areas of the knee;
- Complex Regional Pain Syndrome (CRPS): a painful and inflammatory condition that remains poorly understood. It is treated medically and may persist for several months or, in some cases, several years. It may require adapted rehabilitation, additional investigations and specific pain management. Its onset, progression and possible long-term effects, including stiffness, pain or a constricting sensation, are unpredictable;
- Sciatic nerve injury: this is a very rare complication that may occur following a haematoma, surgical trauma or a reaction to regional anaesthesia. Recovery may occur over several months in some cases;
- Injury to the blood vessels of the leg: this is extremely rare but may require an additional procedure or urgent further surgery to restore blood flow to the limb;
- Fracture of the femoral or tibial bone end: this may require an additional surgical procedure to stabilise and repair the affected bone.
These are the principal risks associated with revision knee replacement, but the list is not exhaustive. Other exceptional complications may occur. Not every possible complication can be specified. Your surgeon remains available to discuss the particular risks associated with your individual situation.
Results of Revision Knee Replacement
In the majority of cases, full weight-bearing and walking can be resumed immediately after surgery. Pain progressively subsides, stiffness improves and knee mobility is restored over the following weeks.
The final range of motion varies from one patient to another and depends on several factors, including preoperative stiffness, the cause of prosthetic wear, the condition of the muscles and tendons, the type of prosthesis, the surgical procedure and, above all, the quality of postoperative rehabilitation.
Revision knee replacement generally allows patients to resume their usual daily activities progressively after approximately six weeks.
The best results are generally observed after at least six months, although improvement may continue for up to two years after surgery.
Activities such as cycling, swimming, golf and hiking are possible and may be encouraged. Other sports, including skiing, tennis and recreational running, may also be possible at a moderate intensity in order to maximise the lifespan of the prosthesis.
The expected lifespan of the revised knee replacement is approximately 20 years. However, several factors influence its longevity, including the patient’s age, body weight and level of physical activity.