NAVIO Robotic System

Xray of Knee replacement prior to revision.Pain from loose Tibial component (the bottom T shaped implant)

After revision surgery – new knee replacementwith bigger implants providing more stability.

Robotic Revision Knee Replacement

When might I need a revision of my total knee replacement? 

Improved techniques in knee replacement surgery [including robotic techniques], mean knee replacements last a very long time now. We can expect that they’re going to last at least 20 years. 

However, occasionally we outlive that knee replacement, and it may need ‘revising’. This means the old components are removed and replaced with new ones. In the past this used to be a very big undertaking, but now it is much more straightforward. 

How do I know if my knee replacement is failing and it might need revising?  

Most patients will generally describe an increased stiffness and discomfort in their knee. Quite often there may be some associated swelling that’s new. The symptoms may be very similar to those that would have led you to have your knee replaced the first time around. 

You might also have a sensation that the knee doesn’t seem as stable as it used to be.  

Revision knee replacement surgery tends to require that slightly bigger replacement components are used, but provided you have good bone stock (i.e. no osteoporosis or thinning of the bones) the operation should go very well.  

I am one of the few surgeons who enjoys doing revision knee replacement surgery and I’m very happy to see people in need of a second opinion.  

How does Robotics help?  

I am one of the few surgeons in the world using Navio robotics in revision knee replacement surgery. I have used my experience with primary (or first) knee replacements, and combined this with my revision surgery expertise, to improve the accuracy of my revision surgery. This means that you are more likely to have a precise reconstruction with better alignment and soft tissue balance. I can tailor the surgery to fit the bone damage found at surgery. This should be the key to a better recovery and final outcome. 

What’s it like to go through knee replacement revision surgery? 

The experience of knee revision surgery is very similar to that of ‘primary’ knee replacement surgery. You’re likely to need some x-rays,or maybe some CT scans to plan the surgery and it may be that you need to be in hospital a little longer, for example, three to five days. 

Sometimes after the surgery I might ask you to protect the knee using the support of crutches, just whilst it settles in, and obviously physiotherapy and rehabilitation is very important.  

Revision knee replacement surgery is a great option if you’ve got on well with your first knee replacement, and now it’s no longer continuing to serve you. 

If you’re concerned about your knee, or if you’ve a knee replacement that is troubling you, please don’t hesitate to book a consultation. 

General complications of surgery
ENHANCED RECOVERY
Prevention of blood clots

NAVIO Robotic System

Xray of Knee replacement prior to revision.Pain from loose Tibial component (the bottom T shaped implant)

After revision surgery – new knee replacementwith bigger implants providing more stability.

FAQs

Please call Angela my secretary on 02074869323 

No 

We are happy to discuss options for you to selffund. This will include fixed fee for different treatment options as required.  

If you are paying for your own treatment, then a referral is not necessary. The majority of insurers will require a GP referral before authorising a consultation, investigations or any treatment. Many of my referrals come from physiotherapists and some insurers will now accept that mode of referral. Please contact me if you are unsure! 

I will endeavor to see you as soon as possible and I will allow ample time to discuss your symptoms and organise investigations as needed. These can often be carried out on the same day. 

I appreciate that face to face appointments at this time are more challenging and I am happy and experienced in carrying out video consultations if preferred. This can reduce travel and exposure in public if you are shielding or concerned. 

 

I appreciate that face to face appointments at this time are more challenging and I am happy and experienced in carrying out these initial consultations virtually if that is your preferred option. 

 

I work in several hospital and clinic sites. There are new higher standards of hygiene and infection control in all these facilities.  

To minimise the risk of infection, it will be necessary to follow proven guidelines: on arrival for face-to-face appointments or surgery you will be questioned about symptoms of Covid and recent exposure to people who are ill. You will have a temperature check and will be required to wear a mask. Sensible hand sanitisation and keeping your distance in the clinic or hospital is required.  

For surgical treatments more formal Covid testing is carried out in the preceding days and it is sensible to self-isolate to avoid exposure to infection in the pre-surgery period. Surgery is carried out through a “Green pathway” where all staff and patients are screened, and movement is controlled to minimise risk of infection. You will receive all information specific to your journey to help you understand these procedures. 

I am recognised by all the major insurance companies. There are a large number of policies that cover differing aspects of care and I would recommend you ensure that you understand what is and is not covered under your particular policy. 

I will inform you of all fees in advance of treatment. All my fees will be transparent to you at all stages and Angela will be happy to discuss any questions you may have.  

Whether or not you have private medical insurance my contract is with you and you are ultimately responsible for any fees incurred for consultations, investigations and surgery.   

 

I will schedule a time to talk to you about your scan results as soon as possible after your initial consultation. This gives you the reassurance of knowing when I will contact you and allows you to ask any questions that you have at that time.  

If there is further discussion of treatment required, I will arrange a face to face or virtual follow up appointment to go through the details of your results and options to formulate your best course for recovery. 

I increasingly see patients for this reason. I request that you notify me if you are seeking a second opinion so that an appropriate time and access to imaging can be arranged. 

Please ask questions if you are unsure or need more clarification as it is important that you have enough information to fully weigh up the benefits and risks of surgery.  

General risks of surgery include: 

  • Allergies to anaesthetic agents, antiseptic solutions, suture materials or dressings 
  • Pain and discomfort around the incisions  
  • Nausea, typically from the anaesthetic, this usually settles down quickly  
  • Bleeding from the incisions  
  • Separation of wound edges  
  • Slow healing – most likely to occur in smokers and people with diabetes  
  • Wound infections 
  • Blood Clots (Deep Vein Thrombosis or DVT, Pulmonary Embolism or PE) 

 

What are the side effects and risks of revision knee replacement surgery?  

We define a side effect as an inevitable consequence of the operation but not necessarily of benefit to the patient. The obvious example being the scar which will be about six to eight inches long down the front of the knee. Another inevitable consequence of knee replacement surgery is some degree of numbness around the scar, which may be permanent. Because of this and the site of the scar, people’s ability to kneel after knee replacement varies. About 50% of people find they can manage it with some degree of comfort but it is never as easy as it was before the operation.  

Revision knee replacement is a bigger operation than a primary knee replacement, with a number of rare but well recognised risks. In general, the profile of risks and complications for this surgery are similar to those for primary surgery but the incidence is slightly higher. 

The most serious and common are outlined below:  

Infection:  

A serious deep infection occurs in approximately 1% of cases although superficial minor infections around the scar are a little more common but usually do not lead to long term trouble and can normally be managed with antibiotics alone. In deep infection, the joint replacement almost always has to be removed and another one put in some time later. This is called a two-stage revision.  

At the first stage the joint replacement is removed, the knee is washed out, and the infection tested so that we know which antibiotics to use. The antibiotics are then given either by mouth or by intravenous drip and treatment might need to continue for at least six weeks, and possibly a lot longer, depending on the type of infection and response to treatment. Treatment is monitored by blood tests which indicate whether or not the infection has been cleared. As soon as there is no evidence of any infection the second stage of the operation is done in which a new joint replacement is put in place.  

However, even taking these precautions, the risks of a further infection are significant and the whole process might need to be repeated. The success of a two-stage revision is about 80/20, with a 20% chance of either replacing the joint again or having to treat the infection indefinitely with antibiotics. In exceptional cases, the joint has to be fused and ultimately the whole limb is at risk from ongoing infection if it cannot be treated.  

The overall amputation rate after total knee replacement for a complication such as this is about one in one thousand.  

Deep vein thrombosis and pulmonary embolus:  

Deep vein thrombosis (DVT) is a relatively common complication after major lower limb surgery, particularly total knee replacement. It is caused by the blood clotting in the veins of the leg in the deep muscles and leads to pain and swelling of the leg, normally between ten days and six weeks after surgery but occasionally occurring sooner.  

Post-operative calf pain, tenderness and swelling are regarded as a serious risk and it requires immediate investigation and treatment. Normally, this can be done with simple ultrasound scanning and medication. If it occurs at home postoperatively, it needs emergency hospital treatment. It is not a situation to leave to the next clinic appointment. 

The risks of deep vein thrombosis are:  

  1. Long term pain and swelling in the leg (the post-phlebitic syndrome) which may last indefinitely or 2. The clot can move from the leg into the lung, leading to pulmonary embolus. In extreme cases this can be a cause of sudden death, but more often gives rise to chest pain and shortness of breath. Patients who develop a pulmonary embolus don’t always get the typical symptoms of calf swelling first (a silent DVT). Because of the severe nature of deep vein thrombosis, we go to significant lengths to reduce its incidence by chemical means with drugs, and with pneumatic calf pumps which are used in the pre and post-operative period. We also aim to get patients mobile as quickly as possible after the operation. 

Patients already on blood thinning medication, such as Warfarin, should temporarily stop taking this so that a more reversible form of treatment can be used during surgery. The Warfarin can be restarted a few days after the operation. Unfortunately, despite all precautions, it is not always possible to prevent every clot or pulmonary embolus. 

Stiffness:  

Stiffness is a well-recognised complication of surgery. Our goal is to achieve at least 0 to 100° of flexion (action of bending), which is well over a right-angle bend and permits most normal activities. Sometimes we fail to achieve this range of movement despite appropriate surgery and physiotherapy.  

There are a number of causes for stiffness, the most common of which is that the joint was particularly stiff before surgery which means that movement is more likely to be restricted indefinitely. We hope to achieve 70° to 80° of movement in the first few days after surgery and about 90° by six weeks and if these milestones are not met we would recommend a manipulation under anaesthetic (MUA). This requires a general or spinal anaesthetic; it is not usually particularly painful and can often achieve the desired range of movement in the majority of cases. However, permanent stiffness is a recognised complication and can be the cause of an unsatisfactory result.  

Persistent pain:  

Persistent pain is a recognised complication occurring in about 5% of patients and in a few cases leads to a disappointing result in the long term. There are many causes of this and, as knee replacement is done for pain relief, it is a complication that we take seriously. If the kneecap was not replaced this may be necessary as a later operation.  

We investigate persistent pain with X-rays, scans and blood tests. Normally we would initially check for infection and then consider loosening the prosthesis on the bone ends. However, in a few individuals, after an apparently successful knee replacement (from a technical point of view), the knee continues to be painful and gives a disappointing result without any easy solution.  

Rare and extreme risks  

Other rarer complications include fracture at the time of surgery, circulation and/or nerve damage to the foot and lower leg, persistent swelling, instability of the knee and dislocation of the joint replacement.  

The overall mortality (risk of dying) is 1 in 300 and is usually caused by a pulmonary embolus or heart attack soon after the operation. The risk of complications leading to amputation of the leg is 1 in 1000.

Talk To An Expert Now

Talk To An Expert Now

If you’re somebody who’s struggling at the moment with pain or being active, please do book in to see me.

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