ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Two Stage Revision Surgery For Total Knee Replacement

Updated on July 10, 2011

Why Do You Need A Two Stage Revision?

Knee revision surgery is usually required when the replacement wears out - either through component wear or loosening. This is a common procedure and is usually very successful in restoring function. A Two Stage Revision is a different operation that is sometimes required because of infection.

Infection is an unfortunate complication of knee replacement surgery. Although rare, it occurs in around 1 - 2% of cases depending on the hospital.There are also different degrees of infection.
Firstly, there is a superficial wound infection that remains isolated at the surface. These often respond well to antibiotics and may not increase the length of hospital stay.
The much more serious type of infection is a deep infection at the level of the prosthesis. It often becomes impossible to treat these infections with antibiotics. As long as the metal remains the infection remains.
The treatment for this is drastic and is known as a Two Stage Revision.

StageOne of a Two Stage Knee Replacement Revision

 The first stage is the removal of the knee prosthesis. The "joint" is then washed out and any non-viable tissue removed (known as debridement). Joint is in quotation marks here because it is no longer a true joint. When the replacement was originally put in, the ends of
the bone were removed to shape the knee for the prosthesis. At this point there is nothing to hold the bones apart to maintain the normal leg length. This is important to prevent the soft tissues from contracting and causing significant problems in the future. This issue is solved by inserting a spacer into the joint.

The spacer can be either pre-made or shaped out of bone cement by the surgeon. Once the joint is washed out, debrided and the spacer is in place, the wound is closed and antibiotic treatment continues.


The knee needs to be kept immobilized in a fully extended position so it is fixed with a splint or cast. As there is no joint surface inside the knee, no weight is to be taken through that leg so crutches or a walking frame are required.
Antibiotic treatment continues over the coming months with periodic blood tests to measure how the fight against the infection is progressing. When the blood tests suggest that the infection has been resolved, it is time for stage two. It is not uncommon for Stage One to take between three and six months.

Stage Two of a Two Stage Knee Replacement Revision

 Stage two is inserting a new knee replacement. This is not as easy as the original operation as there has often been more bone and soft tissue loss. The operation usually take much longer than the original and the same complication and risks are evident. There is the chance of another infection. There is a chance the original infection was not completely cleared and may return.

The rehabilitation is also much more difficult. Because the knee was immobilized for months while the infection was cleared, it is extremely stiff and there are soft tissue contractures. After a normal knee replacement, the goal for knee flexion is for at least 90 degrees of bending. It is extremely unlikely a knee will bend this far after a two stage revision.Stiffness is likely to be a permanent complication and some people are left with a knee that only bends a small amount. There has also been a lot of muscle wasting leaving the leg very weak from lack of use. Rebuilding this muscle bulk takes months or even years.

When Do You Have A Two Stage Revision?

 When you have to.

A Two Stage Revision is a salvage operation. It is not done by choice but when the situation demands it. It requires two large operations, months of antibiotic treatment and a significant period of disability hopping on crutches or a frame.

A Two Stage Revision is a necessary response to a serious situation. It is unfortunate that they are required but deep joint infections are a fact of life and are likely to remain so in the future.

Two Stage Revision Feedback

Was This Article Helpful?

See results

Revision Knee Surgery

Comments

    0 of 8192 characters used
    Post Comment

    • profile image

      Bonnie Arnold 6 years ago

      I had a knee replacement revision in May of this year (2011) and it has been the worst surgery I have ever been thru. I had both knees replaced due to osteoarthritis. The first in 2000 and it hurt every day it was in. I didn't have a lot of bend in the knee. I could not get the dr. to say anything. So I went to a new dr. for the second replacement , it was great before I left the hospital I had a 120 degree bend. Then I finally found a Dr. who would do the revision after another Dr. did it the first time but the dr. that did the second knee that was wonderful moved out of state. So I found after searching for years a Dr. to do the revision and it ias terrible pain every day. I can't let a sheet or anything but water run down it in the shower because it hurts so bad and I can't sleep becaause of the pain and I see a pain management Dr. also to help with the pain but I don't want a pain pump put in. I go to water arobics to try and bend my knee. Little help with bending. No help with pain.

      I am so stressed out due to a constant pain. I don't know what to do anymore. ANY SUGGESTIONS?????.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: "https://hubpages.com/privacy-policy#gdpr"

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)