Revision Knee Replacement Surgery

Revision Knee Replacement Surgery: Patients with knee prostheses may experience loosening of the prosthesis after a certain period. This loosening can occur due to various reasons such as infection, instability, wear of the polyethylene (special plastic between two metals), or fractures. In such cases, the prosthesis needs to be replaced with special prostheses, which is referred to as revision knee replacement surgery.
Before revision knee replacement surgery, it is crucial to determine the cause of the prosthesis loosening. This involves examining the patient’s knee films, possibly a CT scan, and analyzing blood tests for infection and rheumatological markers. The primary distinction to be made is whether the loosening is due to infection or instability. To achieve this, special tests may be required, including blood samples, cultures from the knee, bone scintigraphy, or leukocyte-labeled bone scintigraphy, and alpha-defensin testing. The results of these tests will guide the chosen approach. If there were prolonged wound healing issues and discharge after your initial surgery, the likelihood of long-term infection-related loosening is higher.

The most important reason for revision knee replacement is polyethylene wear or loosening of the metal surface, leading to instability and causing pain and mechanical issues (such as noises from the knee and reduced range of motion). In such cases, the old prosthesis is removed, and a new one is inserted in a single surgery, allowing the patient to quickly return to daily life and improve their quality of life.

In the case of infection, things can be more complex. Your doctor may decide on a single or two-stage surgical approach based on the type of bacteria causing the infection and its extent. The generally accepted approach is a two-stage surgery. In this process, the first stage involves removing the infected prosthesis, cleaning the joint, and temporarily placing an antibiotic-prepared spacer in the knee joint. During this surgery, tissue samples are taken to identify the type of bacteria causing the infection and which antibiotics are effective. The patient receives antibiotic treatment based on these results between the two surgeries. Once the doctor is sure that the infection has resolved (by checking blood tests and examining the wound), they will decide on the second stage. At this stage, the spacer is removed, and special prostheses are placed in your knee, allowing you to return to daily activities. If the cleaning in the first stage did not adequately control the infection, it may need to be repeated several times.

This two-stage surgery takes a minimum of four weeks and may be extended depending on the extent of the infection and the antibiotic therapy provided.

Revision knee prostheses are generally larger than primary knee prostheses. They may have extensions that go into the bone to increase the contact surface and stability. In very advanced cases, where there is significant bone loss and the collateral ligaments are not intact, partially restrictive prostheses may be preferred.

Post-Operative Care

Patients are taken to the ward for rest after surgery. Many patients are supported to walk the day after surgery. After revision knee replacement, patients typically stay in the hospital for about 4-5 days for wound care and intravenous antibiotic treatment. Unfortunately, due to the size of the surgery and the repeated surgical nature, the infection rate in revision knee replacements is higher than in primary knee replacements, requiring close monitoring.
Patients may walk with support for about a month and then can walk without assistance. The expectation after revision knee replacement is for the patient to walk pain-free, perform daily activities independently, and sit and stand comfortably. Due to the restrictive nature of revision knee prostheses, strenuous sports are not recommended after surgery. Patients can engage in lighter activities such as walking and swimming.

Questions and Answers

It has been a long time since I had my knee prosthesis, and I am experiencing pain. Can it be determined if it is loose from the films?

Yes, a simple X-ray can provide a lot of information regarding the loosening of the knee prosthesis. In particular, comparing follow-up images (with your previous films) can show changes in the prosthesis position or the formation of gaps between the prosthesis and the bone, indicating loosening.

I previously had a knee prosthesis revision. However, I am now experiencing pain again, and it has been suggested that it needs to be changed again. Is a revision possible?

A revision can be performed after revision knee replacement; however, more significant bone loss and losses in ligaments and soft tissue may require larger and more restrictive prostheses.
For detailed information, you can visit my YouTube channel: @profdrhalukcabuk.

Prof. Dr. Haluk ÇABUK

Patient Comments

Our meeting with my teacher Haluk started 3 years ago when I had a knee problem. I'm glad we made an appointment with Haluk Hodja and got to know him. In addition to achieving great work in his field, the care he gives to his patients is beyond amazing. Trusting him blindly, we decided to go and have surgery for my wife's illness 1 month ago. It has been a month since my wife's surgery and we are going through a much more advanced process than we thought. We feel like he is a member of our family. May God always bring success to your work...

Pelin K.

Happy Patient

We met Haluk Hodja thanks to my grandmother's knee surgery. Compared to other doctors, he detected my grandmother's knee pain, which had been going on for years, only with a manual examination, instead of performing thousands of tests, and successfully performed the Robotic Knee Prosthesis surgery in June 2023. After the surgery, we could easily reach him whenever we needed him and he gave us advice and support. He is a very helpful and successful surgeon. Thanks.

Melis Y.

Happy Patient

Haluk is a really caring and expert doctor. I applied to him because of a tumor on my arm. He helped me a lot in this process and supported me a lot in overcoming my fears. My surgery was very successful. I went through the process very easily, thanks to my doctor. I continue my check-ups with teacher Haluk. I am very pleased with my doctor. I recommend it wholeheartedly to everyone.

Irmak B.

Happy Patient

Throughout the entire process of my mother's illness, he had an incredibly comfortable process, thanks to his warm-hearted approach and the most accurate guidance. First of all, we would like to thank him and then his team. He gave my mother's quality of life back to her again ❤️ We are grateful to you as a family, teacher Haluk 😊🙏🏻

Demet A.

Happy Patient

My foot was broken in a traffic accident and I had to have surgery. I am very lucky in this regard, Haluk Bey performed my surgery and he is a real professional in this field. The healing process is also followed very closely. I would like to thank him again from here.

Uğur Ş.

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Prof. Dr. Haluk ÇABUK

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Prof. Dr. Haluk ÇABUK

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Private Health Insurance Information

Medical procedures with private health insurance are carried out as follows:

If you have individual health insurance (private health insurance), you can receive a reimbursement from your insurance by submitting the invoice for the medical examination and your insurance evaluation card. Similarly, any necessary radiological and blood tests can also be claimed from the insurance with the corresponding invoice.
If you have hybrid insurance, since our institution does not have an agreement with SGK, you can claim the invoice amounts from your insurance based on the terms of your insurance contract. (Many complementary health insurances fall under this category. Please review your health insurance policy.)
If you have complementary health insurance (TSS), it will not be valid because we do not have an agreement with SGK.

The process for surgeries with private health insurance proceeds as follows (both individual and hybrid insurances are included):

If you require surgery, our doctor will fill out the necessary forms, and your insurance application will be processed through the hospitals we are affiliated with.
During the application, the costs for the hospital surgery, the materials used during the surgery, and the doctor’s surgery fee determined by the Turkish Medical Association will be submitted to the insurance for approval.
Once your insurance approves, the hospital processes and the material invoices are paid directly to the hospital by the insurance.
You will need to first pay the doctor’s fee and then submit the invoice and approval from the doctor to reclaim the amount from your insurance.

For more detailed information, please contact us.

Revision Knee Replacement Surgery