Possible Treatments Page

Alexander P. Sah

There are different types of revision surgery. In some cases, only one implant or part of the prosthesis has to be revised. Other times, all of the components need to removed and replaced.  In general, every effort is made to retain as much of the functioning joint as possible, to minimize surgical trauma and complications.

Infection is unusual, but is a serious complication.  Having surgery at facilities with low infection rates is of paramount importance. Revision for infection can be done 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. 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. If the implant is removed to treat the infection, your doctor will perform the revision in two separate surgeries. In the first surgery, he or she will remove the implant and place a temporary cement spacer 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. When the infection has been cleared, the surgeon will perform a second procedure to remove the antibiotic spacer and insert a new prosthesis. In general, removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery.

If hip or knee instability cannot be treated through nonsurgical means such as bracing and physical therapy, revision surgery may be needed. Sometimes the plastic liner can be changed in isolation to a more stable construct, but in other cases the metal components need to be revised also.

For stiff knees after knee replacement, a rare treatments is a knee manipulation.  In this procedure, the patient is given anesthesia so that there is no pain. The doctor then aggressively bends the knee in an attempt to break down the scar tissue. In most cases, this procedure is successful in improving range of motion. Sometimes, however, the knee remains stiff. If extensive scar tissue or the position of the components in the knee is severely limiting, revision surgery may be required.

For fractures, in determining the extent of the revision needed, the doctor will consider several factors, including the quality of the remaining bone, the type and location of the fracture, and whether the implant is loose. When the bone is shattered or weakened from osteoporosis, the damaged section of bone may need to be completely replaced with a larger revision component.

Leadership Role

Persona Revision Knee Evaluation Team 2018