Revised Total Knee Replacement Surgery by Dr. Debashish Chanda

Background

A 71-year-old male patient came to Dr Debashish Chanda at the Orthopaedic Department of the CK Birla Hospital, Gurugram complaining about pain in his Right leg. The patient had undergone total knee replacement in both his legs: the left leg surgery was done in 2011 and the right leg surgery was done in 2013. The Right knee was causing more pain making it difficult for the patient to walk without the help of painkillers.

Investigation & Analysis

When the patient came to us, he had already undergone knee replacement, but despite his problems in alignment, he was discouraged to not undergo a revisional surgery saying that it makes the joint more fragile and weak. Also, there’s a myth that 2nd surgery is risky in redo cases. But that is not the case at all.

Given the age and previous history of Total Knee Replacement, the patient got a full screening done to help the surgical team isolate the problem. A varus knee alignment test was also performed to check for alignment errors. Upon physical examination, the alignment error was confirmed as the patient was experiencing limping and shorting on the right leg. With proper evaluation and due respect to the patient’s age, the team decided to proceed with Joint Transplant Surgery or Revised Total Knee Replacement Surgery.

Treatment and management

Varus Knee can happen when the natural alignment of the bones shifts or moves by as low as a millimetre which shows up in the patient’s stride when he limps or uses a stick to walk. So, the whole approach to revised knee replacement was simple: rectify the alignment defects, and transplant the knee joint completely.

From the standpoint of an aged patient, the benefits of this joint transplant surgery are:

• No pain: An end to a long-suffering from chronic and excruciating pain.
• Restored mobility: Helps resume activities and hobbies the pain sidelined them from.
• Improved quality of life: Overall improvement will reflect a good mood and good fitness above all else.

Joint replacement over time has become more safer and effective. The advancements in this procedure are known to lead to a better level of postoperative outcomes. The operation was successful and the team finally performed alignment correction and redid the joint transplant.

Post Operative Care

Post-surgery, the patient did not need any ICU stay. He was able to stand & walk within 24 hours of surgery & was safely discharged as normal primary (1st time) knee replacement within 48 hours.With regular physiotherapy and rehab exercises, his reviews revealed that his problem had completely healed within 3 weeks of the surgery. Now he leads a happy and content life doing everything he always missed, he can now even sit with crossed legs after this surgery.