Q: I would like to know more about total knee replacement. My husband had a replacement in December 2009. Four months later the knee became loose so he had a revision. Now it is loose again due to the spacer being too small. Is this common following this type of surgery? What can we do?
A: Knee replacement is considered when a patient has a painful, stiff knee that makes it extremely difficult to perform even the simplest of other activities and when medication and other treatment fails to work sufficiently. The procedure is commonly reserved for individuals over the age of 50 who have been diagnosed with severe osteoarthritis; however, there are always exceptions to the rule.
During the surgery, an incision up to 12 inches is made in the front of the knee. The damaged portion of the joint is then removed and the surfaces are shaped to hold either a plastic or metal joint. This artificial joint is attached to the shin and thigh bone either with cement or other material. Similar to a jig saw puzzle, the pieces all fit together properly to form a new joint with the muscles and ligaments that surround them providing support and allowing normal function. When a minimally invasive procedure is performed, the incision is only about five inches, allowing for less tissue damage. The rather new, less invasive procedure causes less pain, faster recovery and better motion because of less scar tissue formation. Patients who undergo either procedure are advised not to pivot, squat or kneel for at least six weeks to allow the muscles and ligaments to strengthen sufficiently. Stair climbing should also be kept to a minimum. Knee replacement has been performed since the 1970s and the technique improves constantly; however, there are risks that include infection, bleeding, blood clots, nerve damage from swelling and pressure, and the replacement parts that can loosen or break.
Replacements that were once good for about 10 years are now lasting 20 years or longer. Having said this, some patients may require a repeat surgical procedure only a few years following the original surgery. Known as revision knee replacement, the second procedure is a major undertaking with results that aren’t typically as successful as the initial procedure. Surprisingly, only about two to three percent of all procedures require a second procedure be performed within five years of the original surgery. The advantage of a second go-round is that some of the parts previously inserted may be functioning just as they should and only minor revision may be necessary. I do not know why your husband’s spacer was too small. This is a question best left to his surgeon to answer. Perhaps something else is going on in there that needs attention. I am sure your husband is not running in marathons, although some individuals do following replacement. If he isn’t putting undue stress on his knee, he should not be having to look forward to another procedure but my assumption is that he is having difficulties ambulating and something must be done to improve his quality of life. Accompany your husband to his surgeon’s office for a frank talk to determine why the problem has occurred yet again. If you have confidence in the specialist who initially worked on him, you may feel comfortable sticking with him or her. If not, you may even feel it is time for a second opinion. Often a new set of eyes can see a great deal more. Good luck.
Other readers who would like related information can order Dr. Gott’s Health Report “An Informed Approach To Surgery” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.