77 years old lady operated case of bilateral total knee replacement done elsewhere in 2004. Since 2016 she was having pain in right knee with difficulty in walking and bearing weight. On examination there was joint effusion, tenderness and instability. Preoperative X-Ray was showing aseptic loosening of tibial component.
We ruled out infection and planned for revision total knee replacement using hinge knee prosthesis. Intraoperatively the femur was also loose and there were huge bone defects both in the tibia and femur. Patient underwent revision total knee replacement with hinge knee prosthesis with augments to overcome the bone defects. Now patient is comfortable and walking with support.
77 years old obese gentleman who underwent bilateral knee replacement (left in 2016 and right in 2018) fell at home and sustained injury to right knee and right ankle 2 months ago. He was treated with plate osteosynthesis for fracture right distal tibia and knee injury was managed conservatively. Patient came to us with pain and instability of right knee. On clinical examination the knee was unstable and dislocatable. Pre operartive X-Ray was showed avulsion fracture of medial condyle of femur. At surgery the whole medial collateral ligament had avulsed along with the medial condyle making the knee unstable. We repaired MCL avulsion using suture anchor and ethibond. Constrained spacer was used for additional stability . Post operative X-Ray shows perfectly balanced knee with suture anchor in situ. Patient is now able to bear full weight with the help of knee brace and we have allowed range of motion exercises.
65 year old female undergone bilateral TKR done in 2005. Presented to us with c/o pain in left knee with inability to bear weight over left lower limb and was wheel chair bound for the past 5 months . On examination skin condition was normal , no sign of inflammation with mild effusion Varus instability present with Passive Rom 10 to 120 degree Current xray shows tibial tray subsidence with loosening with varus collapse of proximal tibial bone Blood infection markers were within normal limits. Plan for revision TKR left knee. Intraop medial defect was found on tibial side with uneven tibial surface after removal of the component Femur side component was also found to be loose with ligamentous imbalance. So RHK revision TKR was performed using medial half block on tibial side to augment the defect with stem extension and while on femur side normal component with stem extension used and inserted with cement. After the surgery, the deformity of knee has been corrected and balanced and she has regained full and stable range of movement. She is walking comfortably.
Surgeons and manufacturers have made remarkable advances in jointreplacement technology over the last few years. The materials are long lasting and durable. The surgical methods have been fine tuned and standardized. As a result, the chances for a successful outcome are excellent. The operation will provide pain relief for at least 10-15 years. The majorlong term problem is loosening of the prosthesis. This occurs because either the cement crumbles (as old mortar in a brick building) or thebone loosens away (resorbs) from the cement. By 10 years, 25% of totalknee replacements may look loose on X-ray, and about 10% will be painful and require reoperation. By 15 years possibly 20% may requirere-operation. These complications are more likely in very obese or hyper active people and really depends upon how careful you are about your artificialknee joint.
Once your new joint has completely healed, you will reap the benefits of the surgery. These include: Reduced joint pain dramatically (may be no pain) Increased movement and mobility Correction of deformity Improved quality of life – the ability to return to normal activities Running, jumping, jogging or other high impact activities arediscouraged. However, you can resume playing golf, walking, bicycling, swimming and other low impact sports