As with any major surgery, there are potential risks and complications you should be aware of before you have
total knee replacement surgery. A major cause of failure in
total knee replacement
is loosening of the prosthesis, either mechanical or by bacterial infection.
There is a very small chance of infection in a total knee replacement
(1 out of 100 in first time knee replacements and 4 out of 100 for
revision knee replacement), but if infection does occur it is extremely difficult to treat. If infection occurs, salvage of the
prosthesis is dependent on several factors including:
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Type of bacteria.
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Patient health.
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Length of time from knee replacement surgery.
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How long the infection has been present. |
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In late or chronic infections, removal of the prosthesis is usually necessary. A spacer made of antibiotic loaded cement is placed and re-implantation of a new
prosthesis is planned after several weeks of intravenous antibiotics. This “two stage” procedure is usually successful in eradicating the infection.
Great measures are taken to help reduce infections, which include:
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The use of sterile instruments, drapes, gowns and gloves.
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The patient’s leg is thoroughly cleaned with an antiseptic agent and all other areas are covered with sterile drapes.
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“Space Helmets” (body exhaust filtration systems) are worn by the surgical team, mainly during revision surgery.
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The patient is given prophylactic antibiotics prior to surgery and is generally continued for 2 days following surgery longer in cases of revision surgery.
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Because a bacterial infection from your mouth could infect your new joint, complete all dental work before surgery and always consult your physician before scheduling any post-operative dental work. |
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Mechanical loosening is when the implant loosens from their boney attachment, the motion between the bone and implant will cause pain, bone destruction and ultimately failure. The ideal candidate has approximately a 3% chance of loosening in a 10 to 15 year period. In non-ideal candidates such as patients who are younger and excessively over weight, chances of loosening increase. Excessive wear can contribute to loosening and leading to revision surgery.
Other complications include the formation of blood clots in the leg or pelvis. Blood clots can cause chronic swelling in the affected leg and even travel to the lungs causing a
pulmonary embolism, a potentially life threatening problem. Be assured your doctor will take all necessary precautions to avoid blood clots that include:
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The use of blood thinning medications.
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Elastic stockings.
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The use of plastic boots that inflate with air to compress the muscles in your leg.
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Early mobilization beginning on the first day after surgery. |
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Over 90% of patients having total knee replacement surgery will be able to completely extend the knee and bend it beyond 90 degrees. In a small percentage of patients internal scarring can result in reduced motion and some pain.
Other risks include strain on the heart and lungs resulting in heart attack, stroke or death; anesthetic risks, and possible damage to nerves, arteries and veins that can affect the circulation and function of the leg.
Overall, the risks are usually quite low and the chances of success greatly outweigh a chance of failure. If you have any concerns, always be sure to speak with your doctor.
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Dr. LaButti is an orthopedic surgeon in Tulsa specializing in
hip replacement,
knee replacement, and revision surgery of the hip and knee. Dr.
LaButti practices with Central States Orthopedic Specialists, Inc.; the largest
private group of orthopedic surgeons in Tulsa, Oklahoma.
Hipandkneedoc.com was designed as a resource for patients considering total hip replacement,
total knee replacement or revision surgery to help them make an informed decision about surgery.
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