Knee Revision Surgery in Westchester County
What is knee revision surgery?
A knee revision, also called revision total knee replacement, is a reoperation of a total knee replacement (TKR). This reoperation may involve a partial or complete exchange of the prostheses that were implanted during the original TKR surgery. Some patients may only need to have their existing implants and underlying bone surfaces cleaned out and refixed, rather than replaced.
Who needs knee revision surgery?
About 85% to 90% of people who get a TKR, the artificial implants last for 15 to 30 years. This means that for elderly people, they may last for life. But in younger patients, especially those who maintain an active lifestyle, TKR prostheses may eventually fail, requiring another replacement later in life.
What are the reasons for undergoing knee revision surgery?
The most common reasons for knee revision are:
- Loosening of one or more prostheses due to friction over time
- Wear and tear, including loosening or breakage of prosthesis components
- Infection, while the risk of infection from a TKR is less than 1% when infections do occur, a knee revision of one kind or another is necessary
What are the benefits of having knee revision surgery?
The advantages of choosing to undergo knee revision surgery with one of our qualified surgeons at Specialty Orthopaedics include the following:
- Proven outcomes and metrics – Dr. Zelicof has been recognized by New York Magazine, Westchester Magazine and Castle Connolly Top Doctors in America for over 25 years
- Our Joint Solutions program was the first in Westchester to be recognized and reaccredited three times by the Joint Commission with Gold Seals in Hip and Knee Replacement
- Access to experienced and caring fellowship-trained, university-affiliated surgeons
- A commitment to evidence-based orthopedic techniques advanced minimally invasive approaches and pain management techniques
- Surgery performed at some of the best orthopedic hospitals in the country
- When considering revision joint replacement surgery, trust your hip or knee to someone who treats other physicians and healthcare professionals
What does the knee revision procedure involve?
Although primary total knee replacement and revision replacement have the same goal — to relieve pain and improve function — knee revision surgery is a longer, more complex procedure. This surgery usually takes from 2-3 hours.
Dr. Zelicof enters through the incision from your primary total knee replacement. He may need to extend the incision slightly to remove the old components. Next, he moves the kneecap and tendons to one side to gain access to the knee joint. He checks your soft tissues to be sure they are free from infection and then assesses the state of the metal and plastic components of your prosthesis. He’ll determine which parts of your original replacement have worn, become loose, or shifted out of position.
The original implant is removed. The goal is to preserve as much as much bone as possible. Bone cement, if used, will also be removed. With the implant removed, it’s time to prepare the bone surfaces for your new implant. In some patients, there has been significant bone loss, which may have been the cause of dictating revision. Dr. Zelicof can add metal augments and platform blocks to make up for this lost bone mass.
Now it’s time to insert your new specialized revision implant. At this point, Dr. Zelicof will repair any soft tissues that are damaged. He’ll return the kneecap and tendons to the front of the knee and then he’ll test the motion and mobility of your repaired knee joint. Satisfied, he then closes the incision. This ends the procedure.
What are the risks involved with knee revision surgery?
This surgery is longer and more complicated than your original replacement, so it has a greater risk of complications. Dr. Zelicof will discuss these with you during the lead-up to your procedure.
These are the typical risks involved with knee revision surgery:
- Reduced range of motion or stiffness in the knee
- Poor wound healing
- Infection in the wound
- Infection in the prosthesis
- Excessive bleeding
- Formation of blood clots
- Bone fracture during surgery
- Nerve damage
- Blood vessel damage
- Pulmonary embolism
- Heart attack or stroke
- Lung problems
What is the recovery process after knee revision surgery?
There are really two parts to your recovery after total knee replacement surgery with our team at Specialty Orthopaedics: planning and actual physical recovery. Your recovery from revision surgery is similar to that with your original replacement, but it usually heals more slowly.
You’ll need to plan your recovery before you even schedule your surgery. You will be able to walk on crutches or with a walker soon after surgery, but you’ll need help around the house for several weeks with tasks such as cooking, shopping, bathing, doing laundry, and the like.
You’ll need to make some modifications to your house in preparation. Consider these items:
- Adding safety bars in the shower
- Making sure stair handrails are secure
- Having a stable chair at a height of 18-20 inches with a firm back, two arms, and a footstool for intermittent leg elevation.
- A stable shower bench or chair for bathing
- Removing all throw rugs and loose carpeting
- A temporary recovery room on the ground floor, as walking up and downstairs will be very difficult in the early part of your recovery
What will my physical recovery be like?
In the hospital
You’ll likely stay in the hospital for a couple of days before heading home. You will have pain medication, but these will need to be managed to avoid possible addiction. We’ll also have you on a medication to prevent blood clot formation and decrease leg swelling. We may also use compression hose or even an inflatable leg covering. We’ll get you moving your foot and ankle immediately following your surgery to increase blood flow in your leg muscles to help reduce swelling and decrease the chances of developing a blood clot.
You will begin physical therapy the day after your surgery. Your physical therapist will teach you the specific exercises you’ll need to strengthen your leg and restore knee movement. A continuous passive motion exercise machine could be used to help with this.
We will provide you with instructions for recovery when you return home a couple of days after your surgery. You must follow these diligently, as this will largely dictate the successful return of full function in your new knee. These instructions will include wound care and bathing information.
Exercise is probably the most important part of your home care. Your activity regimen will include:
- A graduated walking program to slowly increase your mobility
- Resuming other normal household activities, such as climbing stairs
- Specific daily exercise plans that both restore movement and strengthen your knee. At first, you’ll have a physical therapist come to your home to help you with these.
- You should be able to resume most normal activities of daily living within 3-6 weeks of your surgery.
These surgeries with Dr. Zelicof are usually very successful at returning stability and function to your replaced knee. These revision procedures should add at least another 15 years to the lifespan of your new knee.
Is knee revision surgery more painful than my original replacement?
For most patients, recovery from revision knee surgery doesn’t involve any more, or less, pain than their original replacement surgery.
How long until I can drive after knee revision surgery?
The timeframe for returning to driving is usually about one month, but it can be longer. This is if you’ve had surgery on your right knee and your car is an automatic transmission. If you have a manual transmission, this applies to both knees. If you have an automatic and your left knee has had the revision surgery, you can begin driving as soon as you’re physically comfortable.
How long before I can exercise after knee revision surgery?
You will begin knee resistance exercises at about the four-week mark of your recovery. But for regular exercise and most sports, the minimum timeframe you can use as an estimate is three months. This may take as long as six months, however. Our team at Specialty Orthopaedics will work with you throughout your recovery to help you get back to exercise and activities you enjoy as soon as possible. Some high impact sports, such as running, singles tennis, volleyball, and basketball are probably out of the picture moving forward to help protect and extend the durability of your new prosthesis.
Your joint is special… Come to Specialty Orthopaedics for your care!
If you are interested in knee revision surgery, visit Specialty Orthopaedics. Our New York orthopedic practice is home to a team of fellowship-trained orthopedists in a variety of specialty areas. We offer comprehensive treatment for musculoskeletal disorders in a caring and responsive clinical atmosphere. Give us a call at 914.686.0111 or fill out the form on this page to schedule your appointment today.