Total Knee Replacements may require revision surgery for a number of reasons. These include infection, stiffness, loosening of implants and periprosthetic fractures.Dr Bipin gets revision hip and knee cases referred from around the region. Dr Bipin is one of fellowship trained in revision knee replacements. Revision surgery is more complex than primary total joint replacements.

These should be done by surgeons specialized in revision surgery. The hospital also should have facilities for after care such as intensive care. Special instruments are required to remove the original implants without causing additional damage to the remaining bone.

Reconstruction of the joint is carried out using special revision implants. In cases with extreme bone loss allografts were traditionally used for reconstruction. How ever, the availability of porous trabecular metal implants has revolutionized revision surgery cases with extensive bone loss. Trabecular metal augments are available in different shapes and sizes. With these implants it is possible to reconstruct large defects without the need for allograft. This also provides primary stability and patients can often resume early weight bearing.

If a replacement gets infected, simple antibiotics are often ineffective to cure this. The only way to clear a deep infection is by removing the components. Sometimes it is possible to re-implant a new knee in the same sitting. More often the surgeon will decide to leave the patient with a temporary antibiotic impregnated spacer instead of a full replacement (sometimes the patient is left without a knee) for a period of about 2-3 months. This period without a knee is used treat any remaining infection with antibiotics.

This is called a two stage revision and this is the most accepted way of elimination infection with 90-95% success rate. In spite of all this, if the pathogen (bug causing infection )is particularly virulent it is difficult for any surgeon to guarantee that the infection will get cleared. It is exactly for this reason that all precautions are taken at the primary surgery to ensure that infection does not get into the new joint- antibiotics, rigid aseptic technique, antibiotic loaded bone cement, laminar flow theatres and so on.