INFORMATION & PROTOCOLS
Failure of a knee joint replacement is a disappointing and has great significance for a patient in terms of pain, mobility and function.
Knee joints, like any mechanical structure, will eventually suffer wear and become more unstable and possibly uncomfortable. Patients will appreciate that the knee joint is not functioning as well and they may experience more discomfort on performing normal activities such as walking, sitting and climbing stairs. The joint may become puffy or swollen and sore.
Failure of the knee joint through wear is a gradual process and current implants would normally be expected to last between 12-15 years, depending on the age and activity of the patient. However, a knee joint resurfacing or replacement is indeed a demanding technical procedure for the surgeon, and there are a small group of patients for whom knee surgery itself has not been immediately successful and it is recognised that occasionally technical errors in implanting the complex knee prosthesis may result in a sub-optimal or disappointing clinical result for the patient. Occasionally patients may feel they have not gained enough movement in the knee, the knee joint remains more painful or indeed is not as functional as the patient would wish. In these occasions where implantation of the knee joint or the performance of the knee joint surgery has been less than satisfactory or sub-optimal, occasionally it is necessary to remove the implant and re-perform the surgery.
Professor David Barrett has a recognised referral practice over the last 16 years at the University of Southampton Hospital and in his established private practice. The development of the knee revision services at the Southampton has grown over the years as consultants from the surrounding Wessex area have referred cases in to Southampton for expert consideration and remedial or revision surgery where unsatisfactory prosthesis are removed and replaced with a revision or further replacement prosthesis. In recognition of this expertise there is an established revision service at the University Hospital of Southampton set up by Professor Barrett and he runs a similar parallel practice in the Spire Hospital Southampton for private patients.
The recognition of technical failure within the replaced knee is a complex and challenging role and relies on a degree of expertise and experience in this field.
Professor Barrett relies on a detailed clinical examination and a history from the patient as well as a series of radiographs and scans taken of the failed knee joint replacement. There are often many options and Professor Barrett will offer the option of a full or partial revision if this is indicated or indeed further conservative or non-operative treatment.
The performance of revision surgery of the knee to re-do an unsatisfactory total knee replacement is extremely demanding and technically complex. Professor Barrett is an acknowledged expert in this field and lectures widely internationally on the complexities and difficulties involved to other orthopaedic surgeons interested in developing their expertise in this field.
The procedure is often a fairly lengthy operation with removal of the unsatisfactory implant from the knee and the building of a modular or custom built knee prosthesis in theatre around the patient’s own specific requirements for movement and stability. This requires the use of a specialised prosthetic system to re-align the knee and correct any technical issues that may have been present in the first surgery or indeed to address the wear that has occurred in any knee joint that has failed through natural usage.
Revision surgery of course, is a more significant undertaking for our patients and recovery therefore is often longer than what one might expect for standard primary ‘first time’ knee replacement surgery. However, often results can be very encouraging, particularly if it the primary knee joint was less than satisfactory in the first instance.
Before embarking on revision knee surgery Professor Barrett will fully counsel the patient as to the reasons for failure of the primary implant and the possibilities and percentages of beneficial outcome of revision surgery.