27488 Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee

Name of the Procedure:

Removal of Prosthesis, Including Total Knee Prosthesis, Methylmethacrylate with or without Insertion of Spacer, Knee

Summary

This procedure involves the surgical removal of a total knee replacement prosthesis. The cement used to hold the prosthesis in place (methylmethacrylate) is also removed. Depending on the patient's condition, a temporary spacer may be inserted to maintain knee alignment and function until a new prosthesis can be implanted.

Purpose

This procedure addresses issues such as infection, prosthesis failure, or severe wear of the knee prosthesis. The goal is to eliminate infection, relieve pain, improve knee function, and prepare for potential re-implantation of a new prosthesis.

Indications

• Persistent infection around the knee prosthesis
• Mechanical failure or loosening of the knee prosthesis
• Severe wear and tear of the prosthesis
• Pain and dysfunction not resolved by other treatments

Preparation

• Patients may need to fast for several hours before surgery.
• Adjustments in medication, including stopping blood thinners, may be required.
• Preoperative tests may include blood work, X-rays, or other imaging studies.
• Patients should arrange for someone to drive them home and assist post-surgery.

Procedure Description

1. The patient is given anesthesia—general or spinal.
2. An incision is made in the knee to access the prosthesis.
3. The existing knee prosthesis and cement (methylmethacrylate) are carefully removed.
4. Any infected or damaged tissue is also removed.
5. If necessary, a temporary spacer, often impregnated with antibiotics, is placed to maintain knee alignment and fight infection.
6. The incision is closed, and a sterile dressing is applied.

Duration

The procedure typically takes 2-3 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Scrub technician
• Possibly an infectious disease specialist

Risks and Complications

• Infection
• Blood clots
• Nerve or blood vessel damage
• Bleeding
• Prolonged pain or stiffness
• Risks related to anesthesia
• Complications related to the temporary spacer

Benefits

• Removal of infected or failed prosthesis
• Pain relief
• Improved knee function
• Preparation for future prosthesis replacement (re-implantation)

Recovery

• Hospital stay of several days
• Pain management with medications
• Physical therapy to improve mobility
• Temporary restrictions on activity
• Follow-up appointments to monitor healing and plan further treatment

Alternatives

• Antibiotic therapy without surgery (limited success in certain cases)
• Partial removal of prosthesis components
• Non-surgical management with pain medications and physical therapy

Patient Experience

During the procedure, the patient will be under anesthesia and won’t feel pain. Post-surgery, there will be some pain and discomfort, which will be managed with medication. Patients will need to follow a rehabilitation program to regain mobility and strength in the knee.