Aftercare following knee revision surgery is essentially the same as for knee replacement, consisting of a combination of physical therapy, rehabilitation exercises, pain medication when necessary, and a period of home health care or assistance.
The length of recovery after revision knee surgery varies in comparison to the patient’s first knee replacement. Some patients take longer to recover from revision surgery, but others recover more rapidly than they did from TKR, and they experience less discomfort. The reasons for this variation are not yet known. As of 2003, the Hip and Knee Center at Columbia University is conducting a study of 100 knee revision patients at five different sites in the United States in order to evaluate the outcomes of revision surgery. The patients will be examined at three-month, six-month, 12-month, and 24-month intervals in order to measure their progress after surgery.
The complications that may follow knee revision surgery are similar to those for knee replacement. They include:
• Deep vein thrombosis.
• Infection in the new prosthesis.
• Loosening of the new prosthesis. The risk of this complication is increased considerably if the patient is overweight.
• Formation of heterotopic bone. Heterotopic bone is bone that develops at the lower end of the femur following knee replacement or knee revision surgery. Patients who have had an infection in the joint have an increased risk of heterotopic bone formation.
• Bone fractures during the operation. These are caused by the force or pressure that the surgeon must sometimes apply to remove the old prosthesis and the cement that may be attached to it.
• Dislocation of the new prosthesis. The risk of dislocation is twice as great for revision surgery as for TKR.
• Difference in leg length resulting from shortening of the leg with the prosthesis.
• Additional or more rapid loss of bone tissue.
Normal results of knee revision surgery are quite similar to those for TKR. Patients have less pain and greater mobility in the affected knee, but not complete restoration of the function of a normal knee. Between 5% and 20% of patients report some pain following either TKR or revision surgery for several years after their operation. Most patients, however, have considerably less discomfort in the knee after surgery than they did before the procedure. A recent British study found that revision knee surgery patients had the same positive results at six-month follow-up as patients who had had primary knee replacement surgery.
As with knee replacement surgery, patients who have had revision surgery may experience mild swelling of the leg for as long as three to six months after surgery. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.
Morbidity and mortality rates
The 30-day mortality rate following knee revision surgery is low, between 0.1% and 0.2%. The estimated rates of complications are as follows:
• deep infection: 0.97%
• loosening of the new prosthesis: 10–15%.
• dislocation of the new prosthesis: 2–5%.
• deep venous thrombosis: 1.5%
The American Association of Orthopaedic Surgeons (AAOS) has published a fact sheet about the effects of aging on the knee joint aimed at the baby boomer generation. Many adults in their 40s and 50s have been influenced by the contemporary emphasis on youthfulness to keep up athletic activities and forms of exercise that are hard on the knee joint. Some of them try to return to a high level of activity even after TKR. As a result, some surgeons are suggesting that adults in this age bracket scale back their athletic workouts or substitute low-impact forms of exercise. Good choices include water aerobics, tai chi, yoga, swimming, cycling, and walking.
COMPLEMENTARY AND ALTERNATIVE (CAM) APPROACHES.
Complementary and alternative therapies are not substitutes for knee revision surgery, but some have been shown to relieve physical pain before or after surgery, or to help patients cope more effectively with the emotional and psychological stress of a major operation. Acupuncture, chiropractic, hypnosis, and mindfulness meditation have been used successfully to relieve postoperative discomfort following revision surgery. Alternative approaches that have helped patients maintain a positive mental attitude include meditation, biofeedback, and various relaxation techniques.
Alternative surgical procedures
Arthroscopy is the most common surgical alternative to knee revision surgery. It is a procedure in which a surgeon makes three or four small incisions in the knee in order to insert a device that allows him or her to see the inside of the joint, insert miniaturized instruments to remove or repair damaged tissue, and drain fluid from the joint. Arthroscopy has been used successfully to treat stiffness in the knee following TKR and improve range of motion in the joint. It is not successful in treating infected prostheses unless it is used very early.
Other surgical alternatives to knee revision surgery include manipulation of the joint while the patient is under general anesthesia, and arthrodesis of the knee. Arthrodesis is a procedure in which the joint is fixed in place with a long surgical nail until the growth of new bone tissue fuses the knee. It is generally considered a less preferable alternative to knee revision surgery, but is sometimes used in the treatment of elderly patients with infected prostheses or weakened bone structure.