Revision Knee Replacement Surgery
A second knee replacement procedure performed to address complications, implant wear, or failure
While total knee replacement surgery often provides long-term relief from chronic knee pain, there are situations where the initial implant may not perform as expected. Some people may continue to experience pain, swelling, instability, or reduced function, which can significantly affect daily life. When this occurs, a second operation known as revision total knee replacement surgery or revision knee arthroplasty may be recommended.
This procedure involves carefully removing and replacing part or all of the original knee implant with new components. Revision surgery is typically more complex than a first-time knee replacement and may be performed in one stage or two stages, depending on the underlying issue and the patient’s overall health.
In the sections that follow, you’ll find information about why a revision may be necessary, the surgical techniques used, the types of implants involved, and the expected recovery process. Understanding these aspects can help you feel more informed and supported as you explore your treatment options.
- REASONS WHY YOUR KNEE REPLACEMENT MIGHT FAIL
- BENEFITS OF REVISION TOTAL KNEE REPLACEMENT SURGERY
- TYPES OF REVISION TOTAL KNEE REPLACEMENT PROCEDURES
- THE PROSTHETIC IMPLANTS USED IN REVISION TOTAL KNEE REPLACEMENT SURGERY
- REVISION KNEE REPLACEMENT SURGERY IMPLANT TYPES BASED ON SPECIFIC NEEDS
- YOUR REVISION KNEE REPLACEMENT SURGICAL PROCEDURE
- YOUR REVISION KNEE REPLACEMENT SURGICAL PROCEDURE WITH AN INFECTION
- RECOVERY AFTERREVISION KNEE REPLACEMENT SURGERY: WHAT TO EXPECT
- ADAPTING YOUR LIFESTYLE POST-TOTAL KNEE REVISION: TIPS AND GUIDANCE
REASONS WHY YOUR KNEE REPLACEMENT MIGHT FAIL
While knee replacements are designed to improve mobility and relieve pain, some implants may not function as expected over time. Several factors can contribute to implant failure, leading to discomfort, instability, or reduced function:
Knee implants are built to last, but over time, the materials particularly the polyethylene (plastic) components can gradually wear down. This can lead to tiny particles being released into the joint, causing inflammation and potential loosening of the implant, which may result in pain and reduced mobility.
Implant loosening is one of the most common reasons for revision surgery. This occurs when the bond between the implant and the bone weakens, which may be due to natural bone changes, wear, or insufficient initial fixation. Loosening can cause instability, discomfort, and difficulty walking.
Infection around a knee implant can develop soon after surgery or years later. If bacteria enter the joint, they can damage surrounding tissue and bone, leading to pain, swelling, and implant failure. In these cases, revision surgery is often required to remove the infected implant, treat the infection, and replace the knee replacement.
If the components of the knee implant are not positioned correctly during the initial surgery, uneven pressure may be placed on certain areas of the joint. This can lead to pain, restricted movement, and premature implant wear, sometimes requiring revision surgery to correct alignment issues.
A fracture near the knee implant, known as a periprosthetic fracture, can compromise the stability of the replacement. This may occur due to a fall, an accident, or weakened bone around the implant. Depending on the severity, surgery may be required to repair the fracture or replace the implant.
Excessive scar tissue can develop around the knee after surgery, leading to stiffness and restricted movement. In severe cases, this may interfere with the function of the implant and require a procedure to remove the scar tissue and restore mobility.
Although rare, some individuals may experience an allergic reaction to the metal components in a knee implant. This can lead to pain, swelling, and persistent inflammation, potentially contributing to implant failure.
Your lifestyle, overall health, and activity levels can influence how long your knee replacement lasts. High-impact activities, obesity, or conditions like osteoporosis can increase stress on the implant, potentially leading to complications over time.
If you’re experiencing ongoing pain, swelling, or difficulty with your knee replacement, Dr Martin can assess your situation and discuss possible treatment options, including revision knee replacement if necessary.
BENEFITS OF REVISION TOTAL KNEE REPLACEMENT SURGERY
Revision total knee replacement surgery offers several significant benefits for those experiencing complications or failures from a previous knee replacement. Key benefits may include:
This type of surgery is more physically demanding than a single knee replacement. It is generally reserved for patients who are in otherwise good health and able to tolerate a longer operation and the intensive rehabilitation that follows. Dr Martin will assess your overall medical condition, including:
Heart and lung health
Kidney function and circulation
Diabetes control (if applicable)
Nutritional status and weight
Mental health and support system
People with poorly controlled medical conditions, frailty, or a history of serious complications from surgery may not be suitable for a bilateral procedure.
While there is no strict age cut-off, bilateral total knee replacement is typically not recommended for people over the age of 75 due to a higher risk of complications and slower recovery. Suitability is assessed on an individual basis, taking into account your physical fitness rather than age alone.
Yes. A body mass index (BMI) over 40 can increase the risk of complications such as wound healing problems, infections, and difficulty with rehabilitation. In some cases, Dr Martin may recommend weight loss and lifestyle changes before proceeding with surgery.
If you have significant issues in your hips, spine, or upper limbs, these may interfere with your recovery after bilateral knee replacement. Dr Martin will carefully assess your entire musculoskeletal system to make sure you will be able to safely complete your rehabilitation.
For some patients, it may be safer and more manageable to have each knee replaced in separate operations, spaced weeks or months apart. This staged approach reduces the physical load on the body and may be preferred in patients with moderate health concerns or less home support.
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Understanding whether you’re a suitable candidate for bilateral knee replacement is an important first step. Ultimately, the decision to proceed is personal and depends on how much your symptoms impact your daily life, independence, and overall wellbeing. Dr Martin will guide you through this decision with a thorough assessment and personalised advice tailored to your health, goals, and recovery potential.
TYPES OF REVISION TOTAL KNEE REPLACEMENT PROCEDURES
In revision knee replacements, the type of surgery you undergo depends significantly on whether or not an infection is present in the joint. If an infection is detected, a two-stage revision procedure is typically performed. This involves initially removing the infected implant and inserting an antibiotic spacer, followed by a period of targeted antibiotic treatment. Once the infection is controlled, a second surgery is performed to place the new implant.
If there is no infection, a single-stage revision surgery may be sufficient, where the old implant is removed, the joint is cleaned, and the new implant is placed during the same operation. This distinction is crucial as it influences the surgical approach, recovery timeline, and overall treatment plan to ensure the best possible outcome for you.
Implant Exchange: In this procedure, Dr Martin removes your old implant and replaces it with a new one, which may be of the same or a different design, depending on your needs. This type of revision is typically chosen when the implant itself is failing but the surrounding bone and soft tissues are in relatively good condition.
Implant Exchange with Reconstruction: In this approach, Dr Martin not only removes your old implant but also reconstructs the damaged bone and soft tissues. This may involve the use of bone grafts, augments, or specific types of constrained prostheses. Revision with reconstruction is often necessary when there is significant bone loss or extensive damage to the soft tissues, requiring a more complex reconstruction to ensure the stability and function of the knee joint.
In cases where an infection is present:
Debridement and Implant Retention: In some cases, the infection can be managed without removing the existing implants. This procedure involves thoroughly washing out the bacteria from the joint, replacing the plastic spacer, and retaining the metal components of the knee replacement. This approach is typically considered when the infection is detected early and the bacteria are less aggressive.
Staged Revision: When the infection is more severe or has been present for a longer time, a staged approach is usually required.
This involves two main types of surgery:
Two-Stage Revision Surgery:
First Stage: The infected implant is completely removed. The joint is then meticulously cleaned and debrided to eliminate all infected tissue. A temporary cement spacer, which is impregnated with antibiotics, is placed in the knee. This spacer maintains the space and function of the joint while delivering high local concentrations of antibiotics directly to the infected area. During this period, the patient also receives systemic intravenous antibiotics to further combat the infection. This stage typically lasts several weeks to a few months, allowing time for the infection to clear.
Second Stage: Once tests confirm that the infection has been eradicated, a second surgery is performed to remove the antibiotic spacer and insert a new permanent prosthesis. This stage focuses on restoring knee function and stability with the new implant.
One-Stage Revision Surgery:
In select cases, a one-stage revision may be performed, which involves removing the infected implant, thoroughly cleaning the joint, and immediately placing a new implant within the same surgical session. This method is less common and generally reserved for specific types of infections and patient conditions. Following this surgery, the patient continues to receive intravenous antibiotics to ensure the infection is fully treated.
The choice between these types of revision surgeries depends on your specific condition, the extent of bone loss or soft tissue damage, and your overall health. Dr Martin will conduct a thorough assessment to determine the most appropriate surgical approach for you. This careful planning aims to provide the best possible outcome, restoring function, stability, and comfort to your knee joint.
REVISION KNEE REPLACEMENT PROSTHETIC IMPLANTS
If you’re considering a revision knee replacement, you may be wondering what goes into the new implant and how it can help restore your movement and comfort. Modern knee implants are designed to improve stability, durability, and flexibility, helping you regain confidence in your knee function.
Dr Sam Martin carefully selects each component of your implant based on your unique anatomy and the challenges of your revision surgery. Below are the key parts of a revision knee replacement and how they contribute to better movement and long-term success.
The femoral component replaces the damaged or worn-out part of your thighbone (femur) and helps your knee move smoothly. It is made from strong materials like titanium or cobalt-chromium, designed to last for many years. This component is carefully shaped to match the natural contours of your femur while preserving as much healthy bone as possible.
If your kneecap (patella) is worn down, resurfacing it with a polyethylene (plastic) component can help reduce pain and improve how your knee moves. This part of the implant improves the connection between the patella and the femur, helping to prevent friction and making everyday activities like walking and climbing stairs feel more natural.
The tibial base plate sits on top of your shinbone (tibia) and supports the knee implant. It can be cemented or mechanically fixed to ensure a secure hold. This component is important because it provides a strong foundation for the knee replacement, allowing for both immediate stability and long-term durability.
The polyethylene insert acts as a shock absorber between the metal components of your knee implant. It cushions movement and helps your knee bend and straighten smoothly. The insert can be adjusted in thickness to fine-tune alignment and improve stability, which is especially important in revision knee replacement.
The tibial inlay helps your knee move naturally while maintaining stability. It comes in two designs:
- Fixed-bearing inlays – These remain in place, providing extra stability for those with ligament weakness.
- Mobile-bearing inlays – These allow slight movement, helping distribute pressure evenly and reduce long-term wear on the implant.
Offsets help customise the position of your implant to better match your natural knee anatomy.
- Tibial offsets fine-tune how the tibial component sits on your shinbone, preventing overhang or soft tissue irritation.
- Femoral offsets adjust the position of the femoral component to optimise joint alignment and comfort.
These small adjustments can make a big difference in how your knee replacement feels and functions.
If your bone quality has changed due to previous surgeries or osteoporosis, extension stems may be added to your implant. These long metal rods extend into your bone, giving the implant extra support and helping it stay securely in place.
Intramedullary stems work similarly to extension stems but are anchored deeper into your bone to provide additional reinforcement. This is particularly important in revision knee surgery, where extra stability is often needed.
If you have bone loss from previous surgeries or arthritis, metal augments (fillers) can be used to rebuild the shape of your femur. These augments help restore proper joint alignment and improve knee balance, making movement feel more natural.
In some cases, tibial wedges or blocks are used to fill bone gaps in the shinbone (tibia). This ensures your implant has a stable and secure fit, reducing the risk of implant loosening.
If your knee ligaments are weak or have been damaged, special CCK components may be used. These extra supportive implants help keep your knee stable while still allowing for some natural movement.
In cases where your knee joint is severely unstable, a rotating hinge knee implant may be recommended. This implant mimics natural knee movement while keeping the joint from moving in ways it shouldn’t. It provides maximum stability, which is essential for maintaining balance and strength after revision surgery.
Every revision knee replacement is unique, and the implant components are carefully selected based on your individual needs. Dr Martin uses advanced imaging and surgical planning to determine the best combination of implants to restore your knee function, improve comfort, and enhance long-term success.
YOUR PATH TO REVISION KNEE REPLACEMENT SURGERY WITH DR SAM MARTIN
Choosing to undergo revision knee replacement surgery with Dr Sam Martin means a tailored, detailed approach to address your specific needs and achieve the best possible outcomes for your knee health. You will require all of the routine investigations that were needed for your total knee replacement surgery (blood tests, ECG and other x-rays), as well as specific investigations to establish the cause of failure of your knee replacement.Here’s a step-by-step overview of what you can expect, whether it is Implant exchange only, knee replacement revision with reconstruction or a two-staged procedure:
- INITIAL CONSULTATION: COMPREHENSIVE EVALUATION AND DISCUSSION
The first step is a consultation with Dr Martin in the rooms.
During this visit, Dr Martin will:
Review Your Medical History: He will gather detailed information about your health, previous surgeries, and any of the complications or symptoms you have experienced with your primary knee replacement.
Conduct a Physical Examination: Dr Martin will assess your knee’s range of motion, stability, and any signs of infection or inflammation.
Order Diagnostic Tests: To accurately diagnose the cause of your knee replacement failure, Dr Martin may request X-rays, MRIs, CT scans, blood tests, or joint aspiration to evaluate the condition of the implant and surrounding tissues.
- YOUR PERSONALISED TREATMENT PLAN IS DEVELOPED
Based on the findings from your consultation and diagnostic tests, if you and Dr Martin decide that revision knee replacement surgery is the right option, Dr Martin will develop a personalised treatment plan tailored to your specific needs.
This plan may include:
Infection Management: If an infection is detected, Dr Martin may prescribe antibiotics and closely monitor your condition.
Metal Allergy Testing: To ensure that metal sensitivity is not a contributing factor to implant failure, Dr Martin may conduct tests to check for allergies to the materials used in the implants.
Diagnostic Imaging: Dr Martin may arrange for further CT scans of your knee. During the scan, the radiologist will ask you to lie on your back with your leg completely straight. It is important to avoid placing anything under your knee or ankle & ensuring your foot is positioned straight up and perpendicular to the table is crucial for accurate imaging. To maintain this position, your foot will be secured to prevent any movement that could affect the scan’s results and the assessment of your knee’s alignment.
If you have a knee implant in the opposite leg, it is recommended to keep that leg bent during the scan to avoid any interference with the image quality of the affected knee.
3 images will be taken: your hip, the affected knee and of your ankle.
These detailed images aim to provide a clear view of your knee’s structure, helping Dr Martin plan your procedure with precision.
Typically, the CT scans are scheduled within 1-2 weeks following your initial consultation and at least 6 weeks prior to your surgery date.
Surgical Analysis Using your detailed CT scans, Dr Martin may utilise advanced 3D preoperative planning tools such as the MykneeR interactive web planner to develop a comprehensive surgical plan for your revision knee replacement. This 3D planning process allows him to visualise the precise alignment and orientation of the new implant components and considers the condition of the surrounding tissues, the extent of any bone loss or damage, and your overall health. In revision surgery, special attention is given to addressing previous complications and ensuring that the new implant integrates well with the remaining bone and soft tissues. This comprehensive assessment ensures that all aspects of your knee’s condition are addressed, contributing to a more effective and successful procedure.
Your Surgical Guides are manufactured: Once Dr Martin has validated your surgical plan, the MyKneeR surgical guides are manufactured in Switzerland using 3D printing, in-house sintering technology. They are then checked and then shipped across to the hospital in time foryour surgery.
- PRE-OPERATIVE PREPARATIONS | GETTING HEALTHY FOR SURGERY
Improving your health before revision knee replacement surgery can significantly enhance your recovery. Here are key steps to prepare:
Exercise:Maintaining or improving your general fitness before surgery will accelerate your recovery. Focus on exercises that strengthen the muscles around the knee and maintain joint mobility, as these can improve your pain and stiffness. Consult with a physiotherapist for a tailored exercise program suited to your condition.
Occupational Therapy:Occupational therapists (OTs) can recommend equipment to help you perform daily tasks safely and independently. Common aids include shower chairs, transfer benches, raised toilet seats, and long-handled aids. Our practice manager, Emma, can assist with sourcing these aids: 02 6675 0737.
Eating Well: Proper nutrition is crucial. Maintain a healthy weight and focus on a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy. Amino acid supplements may aid recovery. Stay hydrated and limit sugary drinks. For health coaching, contact Get Healthy at 1300 806 258.
Heart Health:A heart health review is advisable, especially if you have a heart condition or pacemaker. Ensure you’ve had a specialist review in the last 12 months. Dr martin can refer you if required.
See Your General Practitioner: Your GP can help manage chronic health conditions and prepare you for surgery. Regular consultations can optimise your preoperative health.
Stop Smoking:Quitting smoking before surgery can reduce risks and improve recovery. Smoking increases the likelihood of blood clots and infections. Seek assistance from your GP or resources like Quitline (www.quit.org.au /13 78 48) or Helping U 2 Quit Clinic (07 5506 7010).
Help at Home:If you need assistance at home, arrange it early. Support can help ensure a safe return home and ease your concerns. Contact My Aged Care for assistance (1800 806 258 or My Aged Care).
By taking these steps, you can improve your health and ensure a smoother recovery process following your revision knee replacement surgery.
- PRE-OPERATIVE PREPARATIONS | PHYSIOTHERAPY FOR ENHANCED RECOVERY
Enhancing your strength and fitness before revision knee replacement surgery can accelerate recovery and prepare you both physically and mentally for the procedure. A physiotherapist can create a personalised exercise plan tailored to your needs, ensuring comprehensive care by considering your overall health.
You’ll receive valuable information to improve your health as you prepare for surgery. There are numerous public and private physiotherapy providers in the Clarence Valley that we can connect you with to support your pre-surgery preparation. Preoperative exercises help strengthen your muscles, facilitating a smoother recovery post-surgery.
Our physiotherapist, Amanda, is available to answer any questions about prehabilitation or your upcoming surgery. You can contact her at 02 6675 0737 or 0402 624 526.
The Knee and Hip Arthritis Service at the Grafton Base Physiotherapy Department and Maclean Community Health can also assist. For more information, contact the Knee and Hip Arthritis Service at 02 6641 8770.
By engaging in these preparations, you can enhance your readiness for surgery and support a more efficient recovery process.
- PRE-OPERATIVE PREPARATIONS | INFORMED CONSENT
Informed consent is a vital step in your pre-operative journey for revision knee replacement surgery. It involves a detailed discussion between you and Dr Martin about the specifics of the revision procedure. During this conversation, Dr Martin will explain the procedure in detail, including the potential benefits, risks, and complications associated with revision knee replacement surgery.
Potential Risks and Complications
As with any major surgery, revision knee replacement carries potential risks. The decision to proceed with surgery is made because the benefits outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery:
MEDICAL COMPLICATIONS
Medical complications can arise from anaesthesia and your overall health. Although rare, almost any medical condition can occur.
These may include:
Allergic Reactions: To medications used during surgery.
Blood Loss: You may require a transfusion, which carries a low risk of disease transmission.
Serious Conditions: Such as heart attacks, strokes, kidney failure, pneumonia, and bladder infections.
Nerve Block Complications: Including infection or nerve damage.
Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, or, in rare cases, death.
LOCAL COMPLICATIONS
Local complications specific to the knee may include:
Stiffness or Pain: Ideally, the knee should bend beyond 100 degrees, but occasionally it may not bend as expected. Sometimes manipulation under anaesthesia is required. Ongoing oain is also a risk after revision knee replacement.
Wound Issues: Skin nerves are cut during surgery, leading to numbness around the wound. Vitamin E cream and massaging can help reduce scar discomfort. Rarely, reactions to sutures or wound breakdown may require antibiotics or further surgery.
Infection: Can be superficial or deep, with rates around 1%-5% for revision surgery depending on the situation. Treatment may involve antibiotics or further surgery, and very rarely, the knee prosthesis may need to be removed.
Blood Clots: Deep vein thrombosis (DVT) can form in the calf muscles and may travel to the lungs (pulmonary embolism), which can be life-threatening. Notify Dr Martin if you experience calf pain or shortness of breath.
Nerve or Blood Vessel Damage: Rare but can lead to weakness or loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing. Severe bood vessel damage can result in amputation.
Wear and Tear: The plastic liner of the implant may wear out over time (usually 10 to 15 years) and may need to be replaced.
Cosmetic Changes: The knee may look different post-surgery due to correct alignment for proper function.
Dislocation: Extremely rare, where the knee joint loses contact, or the plastic insert loses contact with the tibia or femur.
Patella Problems: The kneecap can dislocate, break, or loosen.
Ligament Injuries: Surrounding ligaments can tear during or after surgery, potentially requiring further surgical intervention.
Fractures: Bones can break during or after surgery, potentially requiring additional surgery to fix.
Understanding these risks and complications is essential for making an informed decision about revision knee replacement surgery. Dr Martin encourages open communication to ensure you feel confident and well-informed about your procedure.
Once all your questions have been answered and you fully understand the procedure, risks, and benefits, you will be asked to sign a consent form, which includes whether or not you would be willing to have a blood transfusion if necessary. This form confirms that you have been adequately informed about the surgery and agree to proceed.
- PRE-OPERATIVE PREPARATIONS | SCHEDULE IN YOUR APPOINTMENTS
Schedule in the following appointments:
- Schedule in your surgery date
- 2 Weeks pre-op: complete your hospital admission
https://mycare.ramsayhealth.com.au/#/?facility=BAR&form=GENERAL_ADMISSION
- 1-week post-op: Physiotherapy appointment
- 7-10 days post-op: GP appointment
This is in case you have any medication requirements or other issues after the surgery.
- 2 weeks post-op: Dr Sam Martin appointment & wound check
For patients that live further away, 4-6 weeks post-op is also reasonable
- 6 weeks postop: x-ray assessment of healing and your progress
- PRE-OPERATIVE PREPARATIONS | ANAESTHESIA CONSULTATION
Prior to surgery, your anaesthetist will conduct a thorough phone consultation with you.
Dr Martin and his anaesthetic team excel at preparing patients for surgery, so most patients typically do not need a formal in-person consult. Dr Martin may, however, for revision knee replacement surgery, recommend additional tests or specialist appointments to ensure you are fully prepared for the anaesthesia used during your procedure, often after discussing your case with his anaesthetist.
During the phone consultation, your anaesthetist will discuss a tailored anaesthetic plan. This plan will consider your medical history, general health, any risk factors, and your personal preferences to ensure the best possible outcome. Your anaesthetist will provide you with pre-operative instructions about your medications and it is important to inform them of your most up-to-date medication list, including blood pressure medications, blood thinners, diabetes medications, and over-the-counter herbal supplements. To ensure all your concerns are addressed during the phone consultation, please write down any questions you may have about the anaesthetic at least a week before your surgery date.
To get you back on your feet as soon as possible, most patients receive a combination of a low-dose spinal anaesthetic and a nerve block, along with a light general anaesthetic for a revision total knee replacement. If you are unable to have a spinal anaesthetic due to medical reasons, alternative pain control methods will be available through to ensure you can still be up and moving as quickly as possible post-op.
Potential Complications of Spinal Anaesthetic: while complications from spinal anaesthesia are rare, they can still occur. Your anaesthetist and their team take every precaution to prevent these complications:
Bleeding: A haematoma may form near the spinal cord, potentially causing spinal nerve damage and paralysis. This is very rare. To minimise this risk, your anaesthetist will give you instructions on when to stop taking blood thinners prior to surgery. Depending on the type of blood thinner and your medical history, this may be a reason why a spinal anaesthetic might not be offered to you.
Infection: There is a risk of infection at the puncture site and the region surrounding the spinal cord. The procedure is performed in a sterile fashion to minimise this risk.
Allergic Reactions: Allergic reactions to local anaesthetic are very rare.
Understanding these potential risks and discussing any concerns with your anaesthetist can help ensure you are fully informed and comfortable with the anaesthetic plan for your revision knee replacement surgery.
- FINAL PRE-OPERATIVE PREPARATIONS
SURVEY COMPLETION: In the lead-up to your surgery, you will receive an email or text message with a link to a survey. You will also receive the same link multiple times in the weeks and months following your procedure. Please complete the survey each time, as it helps us keep track of your health and surgery outcomes.
PRE-SURGERY TAKE HOME PACK: The Specialist Orthopaedic Team will provide you with a pre-surgery pack, which includes:
- Skin preparation sponges
- Movicol (if required)
- DEX drinks
- Post-op surgery instructions
GOLDEN STAPH SCREENING: As a precaution, Dr Martin screens all patients for Staphylococcus aureus (golden staph) prior to elective joint replacement. This bacterium can exist as a common type or a rare superbug and lives on the skin or in the nose of up to 1 in 4 healthy people. If it enters the body through a surgical incision, it can cause a serious infection. If your screening result is positive, we will recommend clearance therapy, which includes using a nasal ointment and a body wash starting seven days before your surgery. Dr Martin will also test your urine to ensure there are no current infections that could pose a risk during surgery.
MEDICATIONS: Stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. You should also discontinue any naturopathic or herbal medications during this period.
SKIN CARE: Avoid activities that carry a high risk of scratches, such as gardening or playing with pets. Any cuts, scratches, or infections on the leg to be operated on can lead to postponement of your surgery until they have fully healed. Notify the Baringa Hospital Day Surgery Unit at 02 6659 4444 or Dr Martin’s rooms at 02 6675 0737 if you become unwell or experience any new health issues in the two weeks leading up to your surgery.
SKIN PREP: Three days before surgery, you will be given sponges to use in the shower to reduce the risk of infection. For the two days before surgery, use one sponge in the shower each day. On the morning of the surgery, use the final sponge. Wash thoroughly, paying special attention to the knee area, feet, and toenails on the leg to be operated on. Avoid contact with your eyes, ears, mouth, and body cavities. If you experience a rash or itching, stop using the sponge and wash the soap off completely. Do not shave any areas on the leg being operated on; these areas will be carefully clipped on the day of surgery.
BOWEL PREP: You may be given three sachets of Movicol, a gentle stool softener, to help prevent constipation after surgery. Take one sachet each day for the three days leading up to the surgery, but not on the day of the surgery.
ALCOHOL: Avoid drinking alcohol for at least 24 hours before your anaesthetic. Alcohol can impede your body’s healing process and increase your resistance to anaesthesia. To ensure the best outcome for your surgery and recovery, it’s crucial to abstain from alcohol in the lead-up to your procedure.
CALL THE HOSPITAL: Contact the hospital after 8 am the day before your surgery to find out the time you need to arrive and when to start fasting (stop eating and drinking). If your surgery is on a Monday, you should contact them on the Friday before. If you haven’t heard from the hospital by 2 pm the day before your operation (or by Friday for Monday surgery), please call the Day Surgery Unit on 02 6659 4444.
PACK YOUR BAG FOR HOSPITAL: Ensure you pack a small bag with essentials for your hospital stay. Include your regular medications, clean clothes, a toothbrush and toiletries, walking aids, hearing aids, and reading glasses. Typically, the hospital stay following a revision total knee replacement is 3-5 night, but it may be longer depending on your individual situation.
- HOSPITAL ADMISSION: THE DAY OF YOUR SURGERY
On the day of your surgery, you will be admitted to the hospital with all necessary pre-surgery protocols in place. Most patients are admitted on the same day as their surgery, ensuring a smooth transition into the procedure.
TAKE YOUR DEX DRINKS:A Dex drink is a pre-operative alkaline complex carbohydrate drink designed to improve recovery after surgery, facilitate intravenous cannulation, and decrease insulin resistance post-operatively. You will receive two sachets in your take-home pack from the rooms.
If your surgery is in the morning:
Stop eating at midnight.
Drink the first Dex drink when you wake up.
Drink the second Dex drink 90 minutes before your admission time. You can drink both at the same time.
You are also encouraged to drink up to 600mL of water until 90 minutes before your admission.
If your surgery is in the afternoon:
Stop eating at 7am.
Drink the first Dex drink at 11am.
Have the second Dex drink 90 minutes before your admission time. You can drink both at the same time.
You are also encouraged to drink up to 600mL of water until 90 minutes before your admission.
FASTING: Fasting before your surgery is crucial for your safety. You must stop eating solid food at least six hours before any type of anaesthetic to prevent the risk of aspirating stomach contents while you are asleep, which can be life-threatening.
YOU ARE PREP’D FOR SURGERY: You will be given a hospital surgical gown to wear and your clothes and other belonging will be bagged, and marked clearly with your name. These will be waiting for you on the ward post-surgery. Sometimes, your leg will be shaved and cleaned, and a betadine skin prep will be applied to the area above operation site and wrapped.
All x-rays are sent with you to theatres.
YOUR REVISION KNEE REPLACEMENT SURGICAL PROCEDURE
Your procedure begins with you being wheeled into the operating bay, where you will meet a member of the anaesthesia team. Most patients undergoing revision knee replacement surgery receive a combination of a low-dose spinal anaesthetic and a light general anaesthetic.
Spinal Anaesthetic: The spinal anaesthetic involves your anaesthetist injecting a local anaesthetic drug into the fluid surrounding your spinal nerves. This is done while you are sitting on the edge of the bed, hugging a pillow, and arching your lower back. The anaesthetist will numb a small area of your lower back where the spinal needle will be inserted to ensure the procedure is comfortable. This step is performed in the anaesthetic bay before you go to sleep.
During the procedure, it is important that you remain awake enough to inform the anaesthetist of any unusual sensations, such as “electric shock” feelings down your legs, similar to hitting your funny bone. If this occurs, the anaesthetist will readjust the needle to ensure the injection remains safe.
Once the spinal injection is complete, you will be numb from the waist down. This reduces the amount of painkillers needed during the operation and minimises their side effects. The spinal anaesthetic is designed to wear off by the time you leave the recovery room, allowing you to get back on your feet as soon as possible.
This combination of anaesthetic techniques is designed to ensure you are comfortable during surgery and to help you recover more quickly afterwards.
For revision knee replacements, the type of surgery you undergo depends significantly on whether or not an infection is present in the joint. If an infection is detected, a one or two-stage revision procedure is typically performed. This involves initially removing the infected implant and inserting an antibiotic spacer, followed by a period of targeted antibiotic treatment. Once the infection is controlled, a second surgery is performed to place the new implant. If there is no infection, a single-stage revision surgery may be sufficient, where the old implant is removed, the joint is cleaned, and the new implant is placed during the same operation.
This distinction is crucial as it influences the surgical approach, recovery timeline, and overall treatment plan to ensure the best possible outcome for the patient.
Once anaesthesia has effectively numbed the nerves supplying your leg, a tourniquet will be applied to your upper thigh, and your leg will be painted with an antiseptic solution. Sterile sheets will be used for routine draping to expose the knee. Dr Martin will then begin the surgery usually by following the incision line from your previous knee replacement, carefully removing any scar tissue buildup.
The knee joint will be thoroughly examined for signs of infection or adverse reactions to the metal components, and the condition of the existing implant will be inspected for wear, loosening, or movement. If necessary, the incision may be extended to facilitate the careful removal of the existing knee replacement, preserving as much residual bone as possible. Specimens will be sent to pathology to confirm the absence of infection.
If no infection is present, the bony surfaces of the knee are meticulously cleaned, and the prosthesis and any remaining cement around the knee is removed, preserving as much bone tissue as possible. This is a time-consuming and meticulous process.
In some patients, there may be a significant lack of bone in the knee area due to complications from the previous surgery. Dr Martin may use the patient-specific instruments (PSI) that can be created from 3D modelling before surgery to position the new knee replacement. These instruments guide the implant into the optimal position, addressing any bone deficits with metal sections known as augments, which attach to the main prosthesis. The femoral and tibial components are anchored to the bone with cement and extensions called stems, which run into the bony canals. These high-precision surgical techniques help to ensure accurate placement of the revision knee implants. This may involve the femoral and tibial components, patellar resurfacing, and other specialised implants tailored to your specific needs. Achieving optimal joint stability and range of motion is a key focus here, which may also involve ligamentous balancing and adjustments to ensure the knee functions correctly.
Once the new implant is securely positioned, your knee will be checked for stability, alignment, and range of motion. Often, a small drain will be left in the knee for 24 hours after the surgery to remove unwanted blood. Dr Martin will meticulously close the surgical site with dissolving stitches, and your knee will be wrapped in a well-padded sterile bandage.
The entire surgery typically takes between 2 to 3 hours, depending on the complexity of the knee replacement being removed and your specific situation.
YOUR REVISION KNEE REPLACEMENT SURGICAL PROCEDURE WITH AN INFECTION
If the specimen that was sent to pathology confirms the presence of an infection the procedure would be performed in one of two ways, depending on the type of bacteria, how long the infection has been present, the degree of infection, and patient preferences:
Debridement and implant retention: In some cases, the bacteria can be washed out, the plastic spacer can be exchanged, and the metal implants can be left in place.
Staged surgery. In other cases, the implant must be completely removed.
There are two types of staged surgery:
In a 2-stage surgery, the existing knee replacement components are carefully removed. Preserving as much healthy bone as possible is crucial, so Dr Martin takes great care during the removal process. The infected tissue and any remaining cement are meticulously cleaned out from the knee joint. This step is critical to reducing the bacterial load and preparing the area for the new implant. The joint is washed out, and a temporary cement spacer is placed in your knee. This spacer is treated with antibiotics to fight the infection and will remain in your knee for several weeks. During this time, you will also receive intravenous antibiotics and then the incision is closed.
When the infection has been cleared, Dr Martin will perform a second surgery to remove the antibiotic spacer and insert a new prosthesis.
In a 1-stage surgery, which is less commonly performed, the implant is removed, the joint is washed out, and the new implant is placed during the same surgery. This is then followed by intravenous (IV) antibiotics.
This meticulous approach aims to eradicate the infection, restore knee function, and improve your overall quality of life.
RECOVERY AFTERREVISION KNEE REPLACEMENT SURGERY: WHAT TO EXPECT
After undergoing revision knee replacement surgery, the recovery phase marks the beginning of your journey towards regaining mobility and improving your quality of life. Dr Martin places a strong emphasis on ensuring that you are well-informed about the recovery process, providing you with the knowledge and support needed for a successful outcome.
WHEN YOU WAKE UP FROM YOUR SURGERY
You will wake up in the Recovery Unit, although you may not remember this. An X-ray will be taken to confirm that everything looks as expected. Nurses will carefully monitor you to ensure you have recovered well from the anaesthetic. The IV tubes attached to you can usually be removed at this time.
Once these steps are complete, you will be taken back to the surgical ward. Upon arrival, it will be time to eat and drink something to regain your energy. Try to drink 2 or 3 cups of water at a minimum.
Your legs will have stockings on them to prevent blood clots, and your feet may have foot pumps as well. A foot pump is a Velcro shoe device that squeezes your feet to encourage blood flow and prevent blood clots.
Your leg will be bandaged, and there will be a small anaesthetic infusion device attached near your knee that looks like a ball. Your leg will be a bright pink colour from the surgical preparation.
After eating and drinking, get dressed in your own clothes, which should be loose and comfortable. If necessary, ask the nurses for help with this.
On the day of your surgery, it is normal to experience minimal or no pain for the first 24 hours or so after a knee replacement. Despite the lack of pain, it is still important to rest, ice, and elevate your knee to prevent swelling and soreness later. If you do have some pain, there are various methods to manage it effectively. Simply ask your nurse or doctor for assistance.
Apply the ice pack or a cooling knee brace to your knee frequently.
PAIN MANAGEMENT
Immediately after surgery, managing your pain is a priority. You’ll be given medication to help control pain levels, allowing you to start moving and walking as soon as possible. Please let the hospital team or Dr Martin know if your pain isn’t well controlled. Pain relief medications, along with swelling management, play a significant role in your recovery. Rest, ice, elevation, and compression all contribute to reducing swelling also. The pain medication schedule involves:
Paracetamol/Panadol Osteo: Take regularly as per instructions on the packet. This should be the last pain reliever you stop using.
Non-Steroidal Anti-Inflammatory Drugs (e.g., Celebrex): If you know you can take them safely, use them regularly as per instructions on the packet. Aim to stop them after one week.
Pantoprazole: Take this medication when you are taking non-steroidal anti-inflammatories regularly to prevent stomach upset. You can stop taking it when you stop the anti-inflammatories.
Palexia: A strong painkiller, take it regularly as prescribed. It can be stopped early if not needed, but it is reasonable to take it for a few weeks if necessary.
Endone: Another strong painkiller, take it as a breakthrough medication if regular Palexia is not sufficient.
MONITORING AND WOUND CARE
Your healthcare team will closely monitor your recovery, paying particular attention to your wound, ensuring it’s healing properly and showing no signs of infection.
GETTING UP TO WALK
When the feeling in your feet returns to normal and you don’t feel dizzy, you can get up to walk. Make sure a nurse or a physiotherapist is present the first time you get up to supervise. Initially, you will use a frame, crutches, or a stick for balance—whichever aid works best for you. You will be allowed to put your full weight on your leg.
Additionally, you can use ice or an ice pack for pain relief. Be sure to wrap the ice pack in a clean towel and never apply frozen material directly to your skin to avoid frostbite or skin damage.
PHYSIOTHERAPY AND REHABILITATION
Starting physiotherapy early is crucial. Under guidance, you’ll begin exercises to improve your knee’s range of motion and strength right from the hospital.You are encouraged to start moving your leg right from the beginning with exercises that focus on getting your leg straight and bending it.
If you can already get your leg straight and bend it to 90 degrees or more, you may not need to do the exercises many times as you are doing well already! Your physiotherapist will guide you on how to do the exercises and how often to perform them:
Quadriceps exercises – Rest your knee over a rolled towel, then straighten your leg so that your heel lifts off the bed. Hold for 5 seconds, then slowly lower your foot.
Repeat 10-20 times
Straight leg raise – Tighten your thigh muscle and keeping your leg straight lift your leg 10cm off the bed and hold for 3 seconds.
Repeat 10 times.
Straight knee stretch – Place rolled towel under your ankle and place a bag of rice on top of your operated knee. Relax in this position for 5 minutes.
Repeat 3 times per day.
HOSPITAL STAY
Typically, patients stay in the hospital for about three nights, depending on the complexity of the surgery, overall health, and individual recovery progress. In some cases, you may even be able to go home the day after your surgery if your recovery is progressing well.
During your recovery, it is important to monitor the brown elastic bandage. It should be removed if it digs in, if you experience excess pain, or if your ankle doesn’t move normally.
THINGS THAT ARE NORMAL
- It is quite normal for your knee to be warm for weeks or months after a knee revision.
- It is common to experience some clicking or clunking sensations in the knee.
- Swelling for weeks or months is normal, as is a numb patch on the outside of the incision.
- Bruising up or down your leg is reasonably common. This occurs when some blood tracks under the skin, causing a bruise, which can be painful when it happens.
- It is common for patients to have a tough week or experience a period where they feel like they are going backwards for a little while. As long as things improve again, this is okay.
- Night pain can be an issue for a period after the surgery.
- People who have had both knees done often find differences between the recovery in each knee.
ALERTS AND THINGS TO WATCH OUT FOR
- Excess pain or trouble with movement can be a sign that something is wrong. Severe pain can indicate an emergency and is a reason to go to the hospital.
- Signs of infection, such as fever, pain, redness, or fluid/pus leaking from the incision, should not be ignored. If you suspect an infection in your knee replacement, it is best to see an Orthopaedic Surgeon or go to the emergency department rather than your GP. Antibiotic tablets alone will not be sufficient to treat an infected knee replacement.
- Significant leg or foot swelling can be a sign of a dangerous blood clot.
- Difficulty breathing or chest pain can be a sign of a clot in the lungs, which is an emergency.
These issues, or any other concerns, are reasons to contact Dr Martin, attend a local emergency department, seek other urgent medical assessment, or call an ambulance if you are unwell.
AT-HOME RECOVERY
- Ensure your living space is prepared for your return, with trip hazards removed and daily necessities within easy reach. You may also need assistive devices like a walker or handrails in the bathroom.
- Consider ergonomic adjustments at work and home to ease the strain on your knee, like using a footrest to maintain proper sitting posture or choosing supportive, cushioned footwear.
- Don’t hesitate to use canes, walkers, or handrails, especially in the early stages of recovery or when navigating uneven surfaces, to prevent falls and protect your knee.
- Pay attention to signs of overexertion or discomfort and adjust your activities accordingly.
If you experience swelling, prolonged pain, or any unusual symptoms, contact Dr Martin or the hospital without delay.
Days 2-3 after surgery
It’s very common for the knee to become a bit sorer and feel heavier 2-3 days after your surgery. It will normally get easier from here, so don’t be disheartened if you feel like you’ve gone a bit backwards after the first day.
This is typically the hardest time. Your leg may feel heavy and more swollen. Sometimes, people’s thigh muscles temporarily shut down or “go to sleep” after knee replacement surgery. If that happens, they are usually the “sleepiest” around 48 hours after the surgery. Pain is also often more noticeable around this time, but it will decrease again. People’s energy levels and emotions are often at their lowest during this period. Don’t be disappointed if you feel like you have gone backward or are feeling a bit low 2 days after the surgery; both of these things are common.
The elastic bandage and the anaesthetic infusion are usually removed 48–72 hours after surgery. You will need to keep your wound dry. To do this in the shower, you can wrap your knee in plastic wrap or use a plastic bag and surgical tape.
Keep working at your rehab as instructed by your physiotherapist. It’s important to take enough painkillers and control the swelling in your knee at this time. Rest, ice, elevation, and compression all play a role. Use the thermoactive knee brace if you have one.
If you went home within the first 24 hours after your surgery, you may have an appointment with one of Dr Martin’s team 2 to 3 days post-op. This is for a check-up and to remove the pain buster.
Days 4-7 after surgery
Things should be getting easier again. It is still important to keep on top of pain and swelling. By now you may have started to get a feel for what activities or exercises work for you. If your knee comes out straight, you can walk reasonably well, and you can bend it to 90 degrees or more then you are doing fine.
Your rehabilitation plan will include a set of prescribed home exercises focusing on knee mobility, gentle strengthening, and maintaining joint flexibility.
SEE HERE FOR EXERCISE PLAN
AMBULATION AID: You may continue using a walker or crutches as recommended by Dr Martin until you regain sufficient strength and balance.
Days 7-14 after Surgery
- Regular physiotherapy sessions will continue to progress your exercises, incorporating more challenging activities to enhance strength and range of motion.
- This is often a good time to catch up with your GP, in case there are any medication or other issues that need addressing. Book this appointment in advance, before your surgery.
- Depending on your progress, Dr Martin may advise a gradual increase in weight-bearing activities.
2 WEEKS after Surgery
Some patients will have an appointment with Dr Martin at this time. This appointment will typically involve a wound check and a discussion about your rehabilitation progress so far. You may also discuss topics like returning to work and driving.
After 14 days, the dressing can be removed, and the wound can get wet. If you haven’t seen Dr Martin, you may remove the dressings yourself after 14 days. There are no stitches or staples to remove as they will dissolve on their own. Beneath the main dressing, there is a sticky, slightly rubbery strip. If possible, keep this strip on for a bit longer than two weeks, as removing it early can tear the wound slightly.
Your prescription for blood thinner medication will typically last for 15 to 30 days after you go home from the hospital. Continue taking this medication for the prescribed duration. Additionally, continue using the compression stockings for two weeks following your surgery.
2 -6 WEEKS after Surgery
This is a time to continue making progress with rehabilitation under the supervision of your Physiotherapist. You can gradually return to more strenuous activities as they are comfortable. Many people will start to feel better than before the surgery by 6 weeks. At 6 weeks after surgery, many people are also able to undertake the same activities as they could do before the surgery. Some people get better faster, and some people recover more slowly.
It is totally normal not to feel 100% for months after the surgery.
As your knee continues to heal, emphasis will be placed on more advanced strengthening exercises. These may include stationary biking, leg presses, and other controlled resistance exercises.
Physiotherapy will shift towards incorporating functional activities such as stairs, getting in and out of chairs, and simulating real-world movements.
12 WEEKS &Beyond after Surgery
With the guidance of your physiotherapist and Dr Martin, you’ll gradually resume normal activities. This may include low-impact exercises, recreational walking, and light recreational sports.
ADAPTING YOUR LIFESTYLE POST-TOTAL KNEE REVISION: TIPS AND GUIDANCE
After undergoing total knee replacement surgery, adapting your lifestyle to accommodate your new knee is important for ensuring a successful recovery and maintaining the longevity of the implant. Dr Martin is committed to supporting his patients through every step of their post-operative journey, providing expert advice on how to best adjust your lifestyle for optimal outcomes.
Here are some practical tips and guidance to help you navigate life after your knee replacement:
- Avoid High-Impact Activities – While rehabilitation aims to restore function, high-impact activities and sports may need to be avoided to protect the longevity of the knee replacement.
- Maintain a Healthy Lifestyle – Incorporate a balanced diet, proper hydration, and overall healthy lifestyle choices to support the healing process.
- Stay Active but Be Mindful – Incorporate low-impact activities such as walking, swimming, or cycling into your routine. These exercises strengthen the muscles around your new knee without putting undue stress on it. High-impact sports and activities that place excessive strain on the knee, such as running, jumping, or heavy lifting, should be avoided to protect the longevity of your knee implant.
- Maintain a Healthy Weight – Keeping your weight within a healthy range is essential. Excess weight can increase the wear on your knee implant, potentially leading to complications or the need for revision surgery in the future.
- Follow Your Physiotherapy Regimen – Adhering to the physiotherapy program prescribed by Dr Martin and your physiotherapist is key to regaining strength and mobility in your knee. Even after formal therapy sessions end, continuing with recommended exercises at home can further enhance your recovery.
Adjusting your lifestyle post-knee replacement surgery involves making mindful choices to support your recovery and the durability of your knee implant. With Dr Martin’s expert guidance and a commitment to these adjustments, you can look forward to resuming an active, fulfilling life post-surgery.
