Revision arthroplasty

 

What is the difference between primary and revision knee replacement?

A primary knee replacement or arthroplasty is the first time that patient has had their native joint cut away and replaced with metal and plastic.

A revision knee replacement is a procedure where all or some of the components of the original primary procedure are removed and replaced, because of complications.

 

• Quote from peer-reviewed paper:

  In the United States "...In accordance with the rise in number of primary TKAs [total knee arthroplasties], it is estimated that the annual volume of revision TKA (rTKA) will increase by as much as 600% from 2005 to 2030...."

  Citation: Upfill-Brown A, Hsiue PP, Sekimura T, Shi B, Ahlquist SA, Patel JN, Adamson M, Stavrakis AI. Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019. Arthroplast Today. 2022 May 21;15:188-195.e6. doi: 10.1016/j.artd.2022.03.004. PMID: 35774881; PMCID: PMC9237286.

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Why do some knee replacements fail?

Surgeons inform their patients that a knee replacement may have to be replaced every ten years or so, because the cements generally do not last longer than that, and the components may become loose, but there are other circumstances where a knee replacement may fail.

The common reasons for a failed knee replacement include -

• loosening - usually from degradation of the cement and/or wear of the plastic component. Bits of plastic may further lead to an immune response and lysis (dissolving away) of bone
• infection
• stiffness from arthrofibrosis
• instability
• bone breaks

Sometimes there may simply have been a technical issue with the original procedure, such as using a component that was not the optimum size.

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Is revision knee replacement more complicated?

Revision knee replacement is a much more complicated and risky procedure than the 'primary' or 'index' procedure.

The patient will be a bit older. The old components may be hard to remove. A fracture may complicate the removal of the old components. The surgery is likely to take longer, with the usual hazards of anaesthesia.

 

• Quote from peer-reviewed paper:

  "...Revision total joint arthroplasty is an immensely expensive procedure and costs on average 76% more than primary joint replacement, in large part due to longer operative time and hospitalizations, more expensive implants, and higher perioperative costs..."

  Citation: Upfill-Brown A, Hsiue PP, Sekimura T, Shi B, Ahlquist SA, Patel JN, Adamson M, Stavrakis AI. Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019. Arthroplast Today. 2022 May 21;15:188-195.e6. doi: 10.1016/j.artd.2022.03.004. PMID: 35774881; PMCID: PMC9237286.

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Forum discussions

• TKR 2 years later - EXTREME PAIN ALL THE TIME

  Soft tissue problems complicate a knee replacement.

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