Revision Knee Replacement Surgery Cost in India

“The cost of Revision Knee Replacement starts from USD 6000 – USD 6500 in India. The knee replacement hospitals in India promise unparalleled revision treatments at low-cost.

Knee Replacement

Revision surgery is frequently necessary when a knee replacement no longer performs as intended. A surgeon replaces the outdated gadget with a fresh one during this surgery.

It’s important not to take revision surgery lightly. It is more difficult and carries many of the same hazards as a primary (or initial) total knee replacement (TKR).

Surgery to replace a patient’s knee is typically quite successful and gives those with degenerative knee disease new hope. Before the surgery, those who had problems getting out of bed could no longer do so, but now after the surgery, they can start walking, climbing stairs, etc.

The results of knee replacement typically persist for more than 15 to 20 years without any problems, but occasionally the implant can come loose or lead to additional issues. The patient might require a second knee replacement procedure in such circumstances.

An entirely new knee implant is placed in place of the existing prosthetic during a revision knee replacement procedure. Although the process and goal are similar to total knee replacement, the second operation is lengthier and more involved since it entails substantial bone loss.

A metal and plastic implant, or prosthesis, is used in primary complete knee replacement to replace the knee joint. Even though complete knee replacements generally have excellent success rates, issues like implant wear and loosening over time may necessitate a revision treatment to replace the original components.

Revision surgery comes in a variety of forms. Sometimes only one implant or prosthesis component needs to be changed. In other cases, the femoral, tibial, and patellar components must all be removed or replaced, and the bone surrounding the knee must be repaired using bone grafts or augments (metal inserts that fill in where the bone is missing).

For more support, the patient would typically employ customized implants with longer, thicker stems that fit deeper inside the bone.

The objectives of the revision total knee replacement are:

1. To reduce pain
2. To provide more stability
3. To improve quality of life

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When is a Second Knee Replacement Surgery Necessary?

More preoperative planning, specialized equipment, and advanced surgical skill are needed for the treatment. Compared to a primary first knee replacement, the surgery takes longer to complete.

A revision knee replacement procedure is typically advised in the following circumstances:

Implant loosening over time as a result of wear:
The implant needs to be firmly anchored to the bone for optimal knee movement after replacement surgery. Thus, the surgeon will either cement the implant to the bone during the original knee replacement surgery or let the bone develop over the implant.

However, with time, the bone-implant connection may deteriorate, resulting in the implant becoming loose and the patient experiencing pain. The following are the most typical causes of implant loosening:

  • Traumatic activities
  • Unhealthy body weight
  • The plastic spacer deteriorating
  • Patient outlives the original implant’s useful life
  • Osteolysis and bone deterioration around the implant due to an autoimmune response to the implant

Implant infection following primary knee replacement surgery:
The infection may develop right away following the procedure or even years later. An infected implant will hurt, stiffen the joints, and possibly even cause the implant to come free.

There are two techniques to undertake revision surgery in the event of an infection.

  • The plastic spacer is changed, and the metal implants are cleaned to get rid of the infection, in the first method, known as debridement and implant retention.
  • Staged surgery is the second approach. The implant is taken out during surgery, and the joint is cleaned. An interim spacer is then inserted, and the patient is then given intravenous antibiotics to treat the infection. A new prosthetic is inserted when the infection has been treated.

Joint instability:
The implant may become unstable and impair normal joint movement and function if the ligaments supporting it suffers injury.

Implant stiffness: The connections around the implant may occasionally develop scar tissue, resulting in a constrained range of motion. If this occurs, the surgeon has two options

  • either try to remove the scar tissue
  • or replace the implant parts that have the most scarring surrounding them.

Fracture of the implant or bone:
Fractures of the bone surrounding the knee prosthetic (periprosthetic fracture) may require revision surgery for the patient. Implant or bone fracture. In rare circumstances, the entire broken bone fragment may be removed and replaced with a bigger implant.

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Preparing for Revision Surgery

Diagnostic Procedures May Include:

  • X-Rays, Mri, and Ct for Closer Visualization Of Anatomy
  • Joint Aspiration To Analyse Joint Fluid For Infection
  • Blood tests To Check No Infection Present
  • Nuclear bone scans To Look For Any Loosening

Standard evaluations, such as x-rays, laboratory tests, and maybe additional imaging modalities like bone scans, CT scans, or Magnetic Resonance Imaging (MRI) investigations, are carried out when the decision to undergo a revision knee replacement is taken.

X-rays could reveal a change in the components’ position or state.

Before surgery, CT/MRI can help identify the source, location, and degree of bone loss. If an infection is detected, aspiration of the knee may be necessary (joint fluid is extracted with a needle).

The precise infection type will subsequently be determined by analyzing the aspirated fluid in a laboratory.

One should adhere to the following advice to get ready for a knee replacement revision surgery:

  • Have a thorough physical check to ensure that you are in good enough health to have surgery, especially if there’s an ongoing health issue.
  • Prepare the home accordingly since mobility is significantly restricted for a few days following the procedure. Ensure all that’s needed is within easy reach.
  • In the days following surgery, make arrangements for professional assistance or a family member to assist with basic duties like cooking, shopping, taking a bath, etc.
  • To learn about one’s physiotherapy needs and to begin planning, get in touch with a suitable physiotherapist as soon as possible.

During A Revision Knee Replacement Surgery

  • A detailed diagnostic analysis precedes the surgical procedure. A thorough physical examination is required to make the diagnosis of revision knee replacement, which is then followed by imaging studies like X-rays, MRI scans, or CT scans. To make sure you don’t have an infection and can have revision surgery without risk, one could also need blood tests and vital sign checks.
  • On the day of the procedure, patients will be admitted to the hospital. The anaesthesiologist delivers the anaesthesia once the pre-surgery inspection is cleared. Either general anaesthesia or local anaesthesia might be used throughout the treatment.
  • The type of revision surgery performed and the cause for it will determine how long the procedure takes and how long the incision will be. A procedure will take longer the more complicated it is. In order to preserve as much bone and soft tissue as possible, the surgeon will make the incision and remove the old implant.
  • If there has been a severe loss of bone, a bone augment will be attached around the prosthetic, or bone grafting will be done. Bone grafts can be either autograft (your own bone taken from another site of your body) or allograft (bone tissue from another person obtained from a bone bank). In some cases, metal wedges, wires or screws may be used to strengthen the bone.
  • The incision will then be stitched and closed before the new prosthetic is attached in its place.
  • In order to collect any fluids or blood that may remain following surgery, temporary drains are typically installed.

Recovery in the Hospital

Pain Management- Patients have some soreness after the procedure. This comes as a by-product of healing naturally.

After surgery, medications are frequently administered for momentary pain relief.

Physical Therapy– A physical therapist prescribes specific exercises to strengthen the leg and restore range of motion in order to initiate the walking process and resume other daily activities as soon as possible after surgery.

  • Patient goals with physical therapy prior to hospital discharge:
  • Independent walking on a flat surface with a walker
  • Independent and safe bed, chair, and automobile transfers
    Stair climbing (if necessary)
  • Near 90 degrees of knee flexion
  • Near full knee extension
  • Proper performance of exercises

Blood Clot Prevention– The doctor may recommend one or more treatments to reduce leg edoema and avoid blood clots. In order to improve blood flow to your leg muscles and reduce swelling and blood clots, it is also advised to move your feet and ankles right after surgery.

Preventing Infection– Infection is one of the most dangerous issues that patients who have revision surgery must deal with. Despite the fact that infection only happens in a small number of patients, it can delay or prevent full recovery. Patients are given antibiotics before and, in certain situations, after surgery to stop infection.

Recovery at Home

Wound Care– On the front of the knee, one may have sutures under the skin or stitches or staples going down the wound. After a few weeks, the staples or stitches will be taken out. It is not necessary to remove a suture that is under the skin.

Physical Therapy– After getting back home, it’s crucial to keep moving and working out the knee. To make sure the leg could be straightened and then bend the knee to at least 90 degrees of flexion, a skilled therapist is required.

Preventing Complications– Follow your doctor’s instructions carefully to reduce your risk of developing complications, including blood clots and infection, during the first several weeks of your recovery. He or she may recommend that you continue taking the blood-thinning and antibiotic medications that you started in the hospital.

After the patient is discharged from the hospital, heed the following advice to hasten your recovery:

  • Unless patients feel confident walking without support, are advised to use a cane, crutches, or walker to get around.
  • Keep the wound tidy and dry. As instructed, change the bandages as needed. Until the wound has healed and the stitches have been taken out, avoid immersing the knee in water.
  • As directed by the physiotherapist and doctor, continue regular physical treatment.
  • Make sure to get in touch with the physician as soon as any concerns are discovered.
  • Maintain a balanced diet and drink enough water to strengthen the immune system.

Types Of Revision Knee Replacement Surgery

Depending on the implant components that need to be replaced, there are various types of knee replacement revision surgery. There are various revision knee replacement models:

  • Partial revision replacement: Only a portion of the knee implant will be changed during this procedure. The patient does not require significant bone restoration because this is a little more conservative than the entire revision.
  • Total revision replacement: The femoral, tibial, and patellar components of the knee implant must all be removed or changed. Furthermore, a second prosthesis or bone graft must be used to rebuild the bone around the joint.

The patient’s surrounding bone has typically been severely damaged during revision replacement, necessitating substantial bone repair or specialist implants. In order to provide more support, these particular implants have longer, thicker stems that fit deeper into the bone.

Risks Associated with Revision Knee Replacement Surgery

Each surgical procedure may result in problems. Surgery problems are more likely because revision knee joint surgery is more complicated. Potential issues include:

  • Infection in the wound or the new prosthesis
  • Poor wound healing
  • Reduced range of motion or stiffness in the knee
  • Bleeding
  • Damage to nerves or blood vessels
  • Intra-operative fractures
  • Deep Vein Thrombosis (DVT) or blood clots. Blood clots in the legs, which may travel to the lungs (pulmonary embolism)
  • Bone fracture during surgery
  • Damage to nerves or blood vessels
  • Medical problems such as heart attack, lung complications, or stroke
  • PE (Pulmonary Embolism)

A revision procedure may exacerbate pre-existing medical issues, such as complications with the heart, lungs, or brain from a stroke. Those who have undergone revision surgery may also develop these diseases.

Death may very seldom occur. When the advantages of pain alleviation and functional improvement outweigh the risk of probable problems, revision joint surgery is chosen.

Success Rate Of A Revision Knee Replacement Surgery

The overall survival rate is approximately 90% at 5 years and 75-80% at 10 years decreasing progressively over time.

Long Term Outcomes

The majority of patients who undergo revision surgery benefit in the long run, with pain reduction as well as improved stability and function. However, complete pain alleviation and function recovery are not always possible, and some patients may continue to feel discomfort or stiffness after revision surgery.

Joint failure may show up as certain indications and symptoms, such as an increase in pain or a decline in knee function. Knee implants can fail for a variety of causes, including wear, loosening, infection, fracture, or instability.

However, this may not always be practicable, modern methods and materials for revision knee surgery typically enable significant pain alleviation and better function. To get satisfactory results with revision TKR, a skilled surgeon and careful preoperative preparation are essential. Revision knee replacement surgery types.

Ensuring Good Results From Knee Replacement Surgeries

Patients should be ready and motivated to endure a 6-week recovery period at home after having a knee replacement, which should be performed at the appropriate hospital, at the right time, and by the right surgeon. Many individuals who undergo surgery at a less advanced stage of arthritis are typically dissatisfied with the results. For positive results, a professional pain management team should administer multimodal analgesia and nerve blocks after surgery.

Also, the patient should be in generally good health and be physically capable of engaging in both physiotherapy and exercise for the duration of their recuperation.

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