PNN
New Delhi [India], June 2: In a landmark event held at Max Hospital Shalimar Bagh leading Indian Orthopaedic & Robotic Joint replacement Surgeon Dr Simon Thomas collaborated with world-renowned specialist in Revision Knee replacement surgeon Dr Wolfgang Klauser, Chief in Surgeon & Medical Director, at Ostseeklinik Damp, Germany for a workshop to achieve excellence in Revision knee replacement.
What is revision knee replacement:
Revision knee replacement is a surgical procedure to replace a previously implanted knee prosthesis that has failed or developed complications. It is more complex than the initial (primary) knee replacement due to factors like scar tissue, bone loss, and altered anatomy.
Revision is typically required due to:
1. Implant Loosening: Aseptic failure where the implant detaches from the bone over time.
2. Infection (Periprosthetic Joint Infection): Bacterial colonization of the implant, often requiring staged surgery.
3. Periprosthetic Fracture: Bone break near the implant, often due to trauma or osteoporosis.
4. Instability: Imbalance in ligaments or soft tissues causing joint dysfunction.
5. Wear & Tear: Polyethylene component degradation over decades.
6. Implant Malalignment: Improper positioning leading to uneven stress and pain.
7. Stiffness: Severe loss of motion unresponsive to conservative treatment.
Dr Simon Thomas at Max Hospital centre of excellence for revision knee replacement informs about factors that determine the best outcomes of revision knee replacement, they are:
1. Accurate Diagnosis:
* Identify failure cause (e.g., infection via synovial fluid analysis, imaging).
* Use advanced imaging (CT, MRI, radiographs) to assess bone loss and implant position.
2. Preoperative Planning:
* Customized surgical approach based on bone defects (e.g., bone grafts, augments).
* Select appropriate revision implants (e.g., constrained designs, stems, tantalum cones).
3. Surgical Expertise:
* Surgeon experience in complex revisions to manage technical challenges (e.g., bone loss, ligament balancing).
* Use of technologies like navigation or robotics for precise alignment (where applicable).
4. Infection Management:
* Multidisciplinary care with infectious disease specialists.
* Staged approach: Remove infected implant, administer antibiotics, then re-implant.
5. Patient Optimization:
* Control comorbidities (diabetes, obesity), encourage smoking cessation, and improve nutrition.
* Address osteoporosis to enhance bone-implant fixation.
6. Intraoperative Techniques:
* Ensure proper implant fixation (cemented vs. hybrid).
* Address ligament instability and restore joint line alignment.
7. Postoperative Care:
* Aggressive physical therapy to restore mobility and strength.
* Infection prophylaxis and anticoagulation to prevent clots.
* Long-term monitoring for signs of failure.
“Our vision is to deliver one of the best revision knee replacements centres in the country and joint workshops with international faculty is of great value to that” said Dr Simon Thomas. www.drsimonthomas.com
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