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Revision Knee Replacement

Revision Knee Replacement​

Revision knee reconstruction is becoming common in India. Revision is required for patients whose primary replacement implants have failed due to varied reasons (wear and tear, infection, primary failure). Surgical experience is a critical ingredient while addressing to a variety of issues encountered during revision surgeries.

 

Complex revision joint replacement surgery is one of the most technically challenging interventions in orthopaedics.

 

Bone loss is a major challenge to overcome in fair percentage of revision knees. The reason for this bone loss could be due to many reasons like wear of the polyethylene, displacement of the loose components and fretting bone loss due to patients continuing walk with loose components.

 

Complexities in these surgeries are due the extent of the bone loss that does not allow firm fixation with the regular components. Small bone defects are often are addressed the use of metal augments. However, options to reconstruct major bone defects in the past were essentially use of bone from the Bone banks. But there are only few centres that have established bone banks, making availability of these structural grafts difficult. Besides, there have been concerns with regard to other biological issues.

 

The current reconstructive options since a decade have moved away to the use of integrating sleeves, wedges, etc. These are metallic devices that integrate to the remaining bone and thus provide the platform for a firm fixation of the revision knee components. There is enough data today to prove their longterm results of more than 10 years. In this regard the trabecular metal augments and cones have been a great boon in these situations.

 

Team AJRI has vast experience in complex revisions and reconstructions of the hip and knee involving the use of allografts, porous tantalum material, non cemented metaphyseal sleeves and custom revision components.

 

It also has the highest experience of revision for infected joint replacements.

 

Largest (>30 years) experience in revision hip and knee replacement surgery in India.

Case 1: Revision TKR for aseptic implant loosening

Preoperative Xray shows malalignment of implants with instability
Postoperative Xray of Revision Total Knee Replacement

Case 2: Revision TKR for infected knee

Preoperative Xray shows malalignment with tibial component loosening
Lateral view of the Xray
Antibiotic loaded cement static spacer for a period 4 to 6 weeks

Postoperative Xrays showing semiconstrain revision TKR system with tibial wedge augment on the medial side

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