Our Summary

This research paper discusses the issues faced by patients who have had multiple knee replacement surgeries, known as total knee arthroplasty (TKA). As the number of these surgeries rises, so does the number of revision surgeries, which are surgeries to correct problems with the original knee replacement.

However, after multiple revisions, some patients may not have many options left, and doctors may have to consider more drastic measures, such as leg amputation above the knee (transfemoral amputation) or limb salvage, which aims to save the leg.

The paper suggests that it’s important to consider modern surgical techniques for these hard-to-treat cases. These include replacing the lower part of the thigh bone (distal femur replacement), replacing the entire thigh bone (total femur arthroplasty), fusing the knee joint (knee arthrodesis), and amputation above the knee.

FAQs

  1. What is Total Knee Arthroplasty (TKA) and why is it popular?
  2. What are the alternative procedures for patients who have undergone multiple failed revision TKAs?
  3. What is the difference between limb salvage and transfemoral amputation as options after multiple failed revision TKAs?

Doctor’s Tip

One helpful tip a doctor might tell a patient about knee replacement is to follow a comprehensive rehabilitation program after surgery. This program typically includes physical therapy, exercises to strengthen the muscles around the knee, and gradually increasing activity levels. Adhering to a rehabilitation program can help improve range of motion, reduce pain, and speed up the recovery process. It is important to work closely with a physical therapist and follow their guidance to ensure the best possible outcome after knee replacement surgery.

Suitable For

Patients who are typically recommended for knee replacement surgery include those with severe knee pain that limits daily activities, difficulty walking or climbing stairs, knee stiffness or swelling that does not improve with rest or medication, and knee deformity such as bowing in or out. Additionally, patients with advanced arthritis, previous knee injuries or surgeries, and failed non-surgical treatments like physical therapy or medications may also be candidates for knee replacement. It is important for patients to discuss their individual symptoms and medical history with their healthcare provider to determine if knee replacement surgery is the right treatment option for them.

Timeline

Before knee replacement:

  1. Patient experiences chronic knee pain, stiffness, and swelling that does not improve with conservative treatments such as medication, physical therapy, or injections.
  2. Patient undergoes imaging tests such as X-rays, MRI, and CT scans to assess the extent of damage to the knee joint.
  3. Patient consults with an orthopedic surgeon who recommends total knee replacement as a treatment option.
  4. Patient undergoes pre-operative preparation, including medical evaluations, blood tests, and physical therapy to strengthen the surrounding muscles.

After knee replacement:

  1. Patient undergoes total knee arthroplasty surgery, where the damaged knee joint is replaced with artificial components made of metal and plastic.
  2. Patient stays in the hospital for a few days for post-operative care and physical therapy to regain strength and mobility.
  3. Patient continues physical therapy and rehabilitation at home or in a rehabilitation facility to improve range of motion and functionality of the new knee joint.
  4. Patient gradually resumes normal activities with reduced pain and improved mobility.
  5. Patient follows up with the orthopedic surgeon for regular check-ups and monitoring of the knee replacement for long-term success.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with knee replacement surgery?

  2. How long is the recovery process after knee replacement surgery?

  3. What type of rehabilitation or physical therapy will be necessary after the surgery?

  4. How long can I expect the knee replacement to last before needing a revision surgery?

  5. Are there any restrictions or limitations on activities I should be aware of after the surgery?

  6. What are the alternatives to knee replacement surgery?

  7. What is the success rate of knee replacement surgery in patients with my specific condition or circumstances?

  8. How many knee replacement surgeries have you performed, and what is your success rate?

  9. What type of implant will be used for the knee replacement surgery, and why is this specific implant recommended for me?

  10. What is the expected outcome of the surgery in terms of pain relief and improved mobility?

Reference

Authors: Kugelman D, Robin J, Aggarwal V, Seyler T, Levine B, Schwarzkopf R. Journal: Instr Course Lect. 2024;73:183-194. PMID: 38090897