Name of the Procedure:

Revision of Total Knee Arthroplasty, with or without Allograft; Femoral and Entire Tibial Component

Summary

In a revision of total knee arthroplasty (TKA), the surgeon replaces or repairs components of a previously implanted knee prosthesis. This specific revision focuses on replacing both the femoral (thigh bone) and the entire tibial (shin bone) components, and may involve the use of donor bone (allograft) if needed.

Purpose

This procedure addresses issues such as wearing out, loosening, or infection of the knee prosthesis. The goal is to restore knee function and alleviate pain, ultimately improving the patient's mobility and quality of life.

Indications

• Persistent knee pain after initial TKA.
• Instability or malfunction of the knee prosthesis.
• Infection around the knee implant.
• Severe wear or damage to the prosthetic components.
• Bone loss around the knee joint.

Preparation

• Patients may need to fast for several hours before surgery.
• Medication adjustments might be required, especially blood thinners.
• Preoperative tests such as blood work, imaging (X-rays, CT scans, or MRI), and a complete medical evaluation are typically conducted.

Procedure Description

1. Anesthesia: The patient is given general or regional anesthesia.
2. Incision: The surgeon makes an incision over the knee to access the joint.
3. Removal: The damaged femoral and tibial components, along with any bone cement or scar tissue, are removed.
4. Bone Preparation: The remaining bone is cleaned and prepared; if there's severe bone loss, an allograft may be used.
5. Implantation: New femoral and tibial components are fitted and secured in place. Bone cement may be used if necessary.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2-3 hours.

Setting

This surgery is performed in a hospital surgical suite.

Personnel

The surgical team usually includes:

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Blood clots
• Implant loosening or dislocation
• Nerve or blood vessel damage
• Complications from anesthesia

Benefits

• Relief from chronic knee pain
• Improved knee function and stability
• Enhanced mobility and quality of life

Recovery

• Hospital stay of a few days for monitoring and initial physiotherapy.
• Pain management with medications and ice packs.
• Gradual return to activities with the help of a physical therapist.
• Follow-up appointments to monitor recovery and implant function.
• Full recovery may take several months.

Alternatives

• Conservative treatments like physical therapy, medications, or knee braces.
• Partial knee revision or arthroscopic surgery if less extensive intervention is suitable.
• Pros and cons: Alternatives are generally less invasive but may not be as effective for severe cases.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-surgery, pain and swelling are common but managed with medication. Recovery involves physical therapy, and patients can generally expect significant improvements in pain and mobility over time.