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Knee and Hip Revision Surgery

Knee revision surgery

Description of the surgery

Total knee replacement (TKR) is one of the more successful orthopaedic surgery procedures because it allows people to resume an active life without chronic pain in the knee. Even though most total knee prostheses perform perfectly and definitively, over time, problems such as wear or loosening of the implant may require a revision to replace the original components with a second surgery. In this procedure, the doctor removes some or all parts of the original prosthesis and replaces them with new ones. Although both procedures have the same goal – to relieve pain and improve function – revision surgery is different from primary total knee replacement. It is a longer and more complex procedure that requires thorough planning and specialized implants and tools to achieve a good result. In some cases, only one implant or one component of the prosthesis needs to be revised. Other times, all three elements – femoral, tibial, and patellar – must be removed or replaced, and the bone around the knee must be reconstructed with modular augments (pieces of metal that replace the missing bone) or bone graft. During the surgery, the old prosthesis is removed, the knee is cleaned and the second prosthesis is put in place.

Classification

Invasive

Duration of the surgery: approximately 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as soon as four hours after surgery following the Fast Track protocol and the hospital stay can last 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, followed by a single crutch or a walking cane, and then it is possible to walk independently within a short time.

In the weeks following the surgery, physiotherapy is essential to obtain the best result combined with painkillers to control pain and proper rehabilitation exercises.

Daily activities are possible within 3-6 weeks, with a complete reduction in pain after the first 6-12 weeks. Regular functions are possible in three months.

LEFT KNEE PROSTHESIS MOBILIZATION
LEFT KNEE TOTAL PROSTHESIS REVISION

Knee revision surgery

LEFT KNEE PROSTHESIS MOBILIZATION
LEFT KNEE TOTAL PROSTHESIS REVISION
Description of the surgery

Total knee replacement (TKR) is one of the more successful orthopaedic surgery procedures because it allows people to resume an active life without chronic pain in the knee. Even though most total knee prostheses perform perfectly and definitively, over time, problems such as wear or loosening of the implant may require a revision to replace the original components with a second surgery. In this procedure, the doctor removes some or all parts of the original prosthesis and replaces them with new ones. Although both procedures have the same goal – to relieve pain and improve function – revision surgery is different from primary total knee replacement. It is a longer and more complex procedure that requires thorough planning and specialized implants and tools to achieve a good result. In some cases, only one implant or one component of the prosthesis needs to be revised. Other times, all three elements – femoral, tibial, and patellar – must be removed or replaced, and the bone around the knee must be reconstructed with modular augments (pieces of metal that replace the missing bone) or bone graft. During the surgery, the old prosthesis is removed, the knee is cleaned and the second prosthesis is put in place.

Classification

Invasive

Duration of the surgery: approximately 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as soon as four hours after surgery following the Fast Track protocol and the hospital stay can last 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, followed by a single crutch or a walking cane, and then it is possible to walk independently within a short time.

In the weeks following the surgery, physiotherapy is essential to obtain the best result combined with painkillers to control pain and proper rehabilitation exercises.

Daily activities are possible within 3-6 weeks, with a complete reduction in pain after the first 6-12 weeks. Regular functions are possible in three months.

RIGHT HIP PROSTHESIS MOBILIZATION
RIGHT HIP TOTAL PROSTHESIS REVISION

Hip revision surgery

Description of the surgery

During the primary total hip replacement surgery, the hip joint is replaced with an implant or prosthesis made of metal, plastic, and/or ceramic components. If the first prosthesis implantation fails or there is wear, it is recommended to proceed with its removal and replacement. Damage to the bones and compromise of the soft tissues around the hip can make revision surgery more complicated. In most revisions, the surgeon uses specialized implants designed to compensate for damaged bone and soft tissue. Among the reasons that make the replacement necessary are: the wearing down of the prosthetic components; aseptic loosening; infection; instability; and fracture of the bone surrounding the prosthesis. After a careful analysis of the limb’s neuro-vascular condition, the length of the limbs and the extent of bone loss, the failed implant is removed, the debris cleaned and the new prosthesis put in place. In the case of infected prostheses, they will proceed with the septic prosthetic mobilization which requires further intervention.

Classification

Invasive

Duration of the surgery: from 1 to 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as soon as four hours after surgery following the Fast Track protocol and the hospital stay can last 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, followed by a single crutch or a walking cane, and then it is possible to walk independently within a short time.

In the weeks following the surgery, physiotherapy is essential to obtain the best result combined with painkillers to control pain and proper rehabilitation exercises.

Daily activities are possible within 3-6 weeks, with a complete reduction in pain after the first 6-12 weeks. Regular functions are possible in three months.

Hip revision surgery

RIGHT HIP PROSTHESIS MOBILIZATION
RIGHT HIP TOTAL PROSTHESIS REVISION
Description of the surgery

During the primary total hip replacement surgery, the hip joint is replaced with an implant or prosthesis made of metal, plastic, and/or ceramic components. If the first prosthesis implantation fails or there is wear, it is recommended to proceed with its removal and replacement. Damage to the bones and compromise of the soft tissues around the hip can make revision surgery more complicated. In most revisions, the surgeon uses specialized implants designed to compensate for damaged bone and soft tissue. Among the reasons that make the replacement necessary are: the wearing down of the prosthetic components; aseptic loosening; infection; instability; and fracture of the bone surrounding the prosthesis. After a careful analysis of the limb’s neuro-vascular condition, the length of the limbs and the extent of bone loss, the failed implant is removed, the debris cleaned and the new prosthesis put in place. In the case of infected prostheses, they will proceed with the septic prosthetic mobilization which requires further intervention.

Classification

Invasive

Duration of the surgery: from 1 to 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as soon as four hours after surgery following the Fast Track protocol and the hospital stay can last 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, followed by a single crutch or a walking cane, and then it is possible to walk independently within a short time.

In the weeks following the surgery, physiotherapy is essential to obtain the best result combined with painkillers to control pain and proper rehabilitation exercises.

Daily activities are possible within 3-6 weeks, with a complete reduction in pain after the first 6-12 weeks. Regular functions are possible in three months.

Numero di interventi di revisione delle protesi

Gli interventi di revisione delle protesi all’anca o al ginocchio sono procedure
che richiedono un attenta pianificazione da parte del chirurgo.

Interventi di revisione

Timeline

for hip and knee revision surgery

1. First visit

A thorough clinical evaluation of the patient is performed together with the examination of X-rays. If further tests are necessary, a second visit is scheduled.

2. If surgery is necessary

The patient is informed about the type of surgery required and the hospitalization period. Upon agreement, the patient is added to the waiting list and will be contacted by the hospital clerk.

3. Eve of surgery

The patient is hospitalized and has to bring personal belongings such as undergarments, pyjamas, etc.

They have to fast from midnight.

4. Surgery day

The patient is accompanied to the operating room and put under anaesthesia before surgery is performed. At the end of surgery, he/she is kept under observation for some time in the recovery room before being transferred to the ward. Fast Track protocol begins.

5. Hospitalization

In average, hospitalization lasts 3 to 5 days. In most cases, the patient can be discharged to their own home. In some specific cases, the patient is sent to a rehabilitation centre for additional therapy.

6. Discharge

Physiotherapy should be continued as indicated in the ward. Crutches are used for walking and prophylaxis for deep vein thrombosis (DVT) is performed for 35 days.

7. Follow-up visits

7-10 days after discharge:
first medications

20 days post-surgery:
removal of sutures

6 weeks post-surgery:
checkup and x-rays

8. Further check-ups

3 months post-surgery:
checkup and x-ray

1 year post-surgery:
checkup and x-ray

Checkup and x-ray at 2, 5, 10, 15, 20 years. If there are complications, checkups will become more frequent.

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