REVISION KNEE REPLACEMENT MELBOURNE

Revision Knee Replacement Melbourne – A patient’s guide

Dr Arash Riazi – MBBS, BSc (Med), FRACS (Ortho), F.A.Orth.A.
Orthopaedic Surgeon.

This guide is to help you understand the benefits and limitations of Revision Knee Replacement surgery.

It explains what Revision Knee Replacement surgery is, who could benefit, what to expect, potential complications and recovery information that may help you get the best results from your surgery.

If you have any questions about Revision Knee Replacement surgery, please contact my offices using the details below.”

 Dr Arash Riazi – Orthopaedic Surgeon.

If you have any questions please call
(03) 9898 4216

New patients welcome.
Please bring a referral from your GP or Specialist.

Revision Knee Replacement Melbourne

What is it

Revision knee replacement surgery involves removing the old prosthesis (artificial joint) and replacing it with a new one. It is a more complex procedure than the primary knee replacement and requires careful planning and specialised surgical tools and experience.

First the surgeon must remove the original prosthesis which may have loosened within the original setting in the bone. This generally results in less bone to implant the replacement prosthesis in. Dr Riazi is highly experienced in performing revision knee replacements and has a special interest in this particular type of surgery.

Why consider Revision Knee Replacement surgery

A primary knee replacement can last for around 15 – 20 years. A revision knee replacement may be required when an old knee replacement fails. This could be for a number of reasons including:

  • Wear and tear of the old artificial joint causing damage or loosening of components
  • Infection
  • Persistent pain
  • Conversion of a partial knee replacement to a total knee replacement.

The aim of a revision knee replacement is to improve stability, reduce pain, improve mobility and remove infection if present.

What happens during a Revision Knee Replacement

Dr Riazi will see you before the operation to answer any additional questions you may have and mark the site of surgery.

Your anaesthetist will assess you and decide on the most suitable form of anaesthetic. This may include a general anaesthetic so that you are completely asleep during the operation. However a spinal anaesthetic in combination with local anaesthetic and sedation is also another safe approach.

A revision knee replacement may involve replacement of one or all of the components of the original knee replacement. Prior to surgery, Dr Riazi will perform a series of tests that may include:

  • X-rays
  • 3 dimensional (3D) CT scan

This will help determine the extent of damage and make a personalised treatment plan for you. 3D printing technology has enabled the possibility of printing your bone structure so that careful preoperative planning can be undertaken.

Revision knee replacements take longer to perform than the primary knee replacement (2-3 hours) as they are a more complex surgical procedure.

An incision is made over the knee joint where the original prosthesis is located so that it can be removed. If there has been bone loss, extra pieces of bone (bone graft) can be used to fill in the voids. Metal augments (trabecular metal- interlaced metal) can also be used to support the implant. The area is cleaned and prepared for the revision implant.

Every knee is different and Dr Riazi takes this into account by having different size options available for your revision knee replacement dependant on your particular circumstances.

In some instances patient specific implants are specially made based on the complexity of your bone structure and amount of damage. Cell-saver technology may be used to give back to you the blood you lose during or at the end of the procedure to help reduce blood loss.

Pre-operative planning usually includes state of the art 3-dimensional modelling of the implant or the use of intraoperative computer navigation which enables Dr Riazi to align your revision knee replacement in the most optimal mechanical axis alignment.

Preparing for Revision Knee Replacement Surgery

Once the decision is made between yourself and Dr Riazi to have surgery, we will help guide you to prepare for the operation. It is often helpful to make a checklist for yourself.

1. Medical Conditions

Make sure that you let Dr Riazi know about any medical conditions you may have. It is a good idea to make an appointment with your GP so that they can perform a general evaluation prior to the procedure and assess fitness for surgery and anaesthesia. You may need to take some pre-operative tests such as blood tests, cardiogram and/or chest x-ray.

If you have any dental work planned, make sure that it is completed well in advance of surgery. It is important that any dental infections are dealt with prior to joint surgery, this is because of the risk of infection

2. Medication

If you are taking any medication, including herbal medicines please let Dr Riazi know. It is a good idea to bring in a list of your medication to the consultation and when you come into hospital for surgery. Medicines that thin the blood will need to be stopped before surgery. Also some other types of medication such as corticosteroids and insulin will also need to be managed before and after surgery. If you have any questions about your medicines please contact Dr Riazi.

3. Smoking

Smoking has a significant effect on your health and also increases your risks of problems during and after surgery, including risk of infection. Stopping smoking before your procedure and staying smoke free during recovery can substantially improve wound healing as well as your general health. If you are a smoker then now is a good time to quit for good, please contact your GP for help in quitting smoking.

4. Keeping fit

It is important to try and be as fit as possible before surgery to reduce the chance of complications and reduce the length of recovery. If it is difficult to move around then a gentle exercise such as swimming and hydrotherapy are good options.

5. Fasting

Dr Riazi’s team will advise you regarding the fasting recommendations. Generally speaking, for morning surgery we advise to fast from midnight the night before the procedure and for surgery scheduled for the afternoon patients should fast from 6am on the day of surgery. You can have clear fluids up until 4 hours before surgery.

6. Home Preparation

There are a number of measures you can take to prepare for coming home after surgery.

  • Furniture – Make sure you can easily move throughout your home
  • Trip hazards – Remove any rugs or throws that may cause a fall
  • Special equipment – Shower chair, handrails or raised toilet seat.
  • Single floor living space – Walking up and down stairs may be difficult during early recovery
  • Household chores assistance –  Plan ahead for cooking and shopping
  • Freeze some meals – Have food you can prepare quickly and easily  or arrange for someone to bring you meals.

Revision Knee Replacement Melbourne

Dr Arash Riazi – Orthopaedic Surgeon

If you have any questions about Revision Knee Replacement Surgery, please contact my offices:

CONTACT DR RIAZI

Revision Knee Replacement Melbourne

Possible complications

Dr Arash Riazi – Help centre

There are risks associated with any surgical procedure. I will discuss the risks with you before you make the decision to undertake revision knee replacement surgery.

The list below is not exhaustive but covers some of the more common complications:

Bleeding

There is a risk of blood loss during the procedure and sometimes a blood transfusion is required.

Venous Thromboembolism (VTE)

A VTE is when there is a blood clot inside a blood vessel. There are two types of VTE:

  1. Deep Vein Thrombosis (DVT) – This is a blood clot that forms in a vein, usually in the leg. Signs and symptoms include redness, swelling and pain but sometimes there are no symptoms at all.
  2. Pulmonary Embolism (PE) – Is when the blood clot becomes dislodged and travels to the lung. Symptoms of a PE include chest pain, breathlessness and coughing.

All patients are given measures to prevent a VTE from happening. These may include blood thinning medications and below the knee compression stockings. It is important to move around as soon as possible after surgery and the nurses and physiotherapists will help you do that.

Infection

There is a risk of infection in the wound site however you will be given antibiotics both during and after the procedure to help prevent this. If an infection does still occur, you will be given antibiotics to help clear it up.

Pain

As with any surgical procedure, you may experience some pain. We use various anaesthetic techniques to minimise this and provide you with painkillers to help manage your pain. It is important that you get adequate pain relief so that you are able to move around as soon as possible after your operation. Dr Riazi and his team use a multimodal pain management regimen with a combination of opioids and non-steroidal anti-inflammatory drugs (in those patients for whom it is safe and appropriate) to provide optimum pain relief whilst minimising side effects.

Anaesthesia risks

Your anaesthetist will meet with you before the operation and discuss the risks with you as well as the best option for you.

Knee stiffness

Some people may experience knee stiffness after surgery. This will usually improve with exercise and as the swelling is reduced.

Nerve, ligament and blood vessel damage

There is a very small risk that these structures can be injured during the operation. Usually they will recover but occasionally patients may experience extensive bruising or even have difficulty moving their foot up and down. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

Dislocation

There is an extremely small risk of dislocation of the knee where the ends of the knee joint lose contact with each other.

Leg length inequality

The corrected knee will be straighter than the other knee and can appear slightly  longer. This is unavoidable.

Please contact hospital staff or Dr Riazi immediately if:

(1) Your wound has become more swollen, red and/or hotter than before
(2) There is any discharge from the wound
(3) There is any new numbness, tingling or discolouration in your foot, which lasts for more than 24 hours.

After Revision Knee Replacement surgery

Your recovery and rehabilitation

Recovery and rehabilitation after revision knee surgery are very similar to primary knee surgery. Some patients may find they take longer to recover than they did with their original knee replacement surgery.

After the operation you will be transferred to recovery and then to a surgical ward where you will be looked after by nursing staff. We aim to have you out of bed as soon as possible after the procedure as this will really help speed up your recovery as well as reducing the chances of a blood clot.

You will be seen by a physiotherapist who will help get you out of bed and moving short distances. Some patients are able to start moving on the same day as the procedure whilst others start moving on day 1 post operatively. The physiotherapist will help you progress until you are moving independently.

Revision Knee Replacement Melbourne

Active recovery participation

As with the primary knee replacement, it is really important that you play an active role in your own recovery. You can contribute greatly to the success of the operation by following the advice of your healthcare team whilst in hospital and when you go home.

Our physiotherapist will teach you exercises that will help strengthen your muscles. These can cause some discomfort and swelling. You will be prescribed painkillers to take home and it is important to take these as instructed as managing your pain effectively will also help you mobilise and carry out these exercises to help aid your recovery.

Your recovery at home: (print out)

It is really important to follow the advice given to you by Dr Riazi and his team in order to expediate your rehabilitation and recovery.

After you leave hospital your knee may still be painful and swollen. Continue to take your prescribed painkillers, these will help manage your pain so that you can move your knee.

It is normal for your knee to be swollen for a few weeks after surgery. You can use ice packs to help reduce the swelling. Placing a pillow under your heel to raise your leg whilst you are resting can also help ease swelling but do not place it under the knee.

Try to change knee position every hour whilst you are awake so to reduce stiffness.

Wound healing

As the wound heals it may feel itchy, this is a normal part of the healing process and will ease with time. You should not submerge your knee in water (avoid swimming) until the wounds are completely healed which can take approximately 10-14 days. You will have sutures running along the wound which will dissolve on their own.

If your wound becomes more swollen, increasingly hot or red contact Dr Riazi. Also watch out for any tingling, numbness in your foot that lasts longer than 24 hours.

Exercises

You will be given a regimen of exercises to perform by your physiotherapist. You should aim to do 30 minutes of exercise two to three times a day. These are very important for your recovery.

Walking

By the time you are discharged you will be walking short distances safely with a walking aid which can either be a walker, crutches or a walking stick. You should start to move around freely and become less and less dependent on the walking aid that you are using. So that if you were initially using a walker, you can progress to a walking stick within a few weeks. Walking is a really good exercise for your knee and once your new knee becomes more comfortable you will be able to go for longer walks

Driving

You can normally start to drive around 6 weeks after surgery as this will be when most patients are comfortable walking

REVISION KNEE REPLACMENT MELBOURNE
IMPORTANT NOTE

This information is designed to be a guide only. Every patient has unique needs and will react differently to surgery, pain management and recovery approaches.

If you would like more details or have any worries or questions about Revision Knee Replacement surgery please contact my offices so I may address your concerns.

Revision Knee Replacement Melbourne

Dr Arash Riazi – Orthopaedic Surgeon

If you have any questions about Revision Knee Replacement surgery, please contact my offices:

CONTACT DR RIAZI
REVISION KNEE REPLACEMENT MELBOURNE

Dr Riazi consults with public and private orthopaedic patients from all over Melbourne in relation to Revision Knee Replacements. His current consulting locations include Epworth Eastern Hospital in Box Hill and Box Hill Hospital (Eastern Health) in Box Hill.