There he spent 6 months treating a variety of patients referred from all over England and internationally with complex joint replacements requiring revision (“re-do”) total knee replacement.
If your knee replacement is painful or unstable after a previous knee replacement, you may require review with Dr Connon to discuss your options.
First, Dr Connon would like to work out why your existing knee replacement is causing you pain, instability, stiffness etc. This often requires numerous tests, including but not limited to plain Xray to look at implant positioning, CT scan to look at bone loss, bone scan to look for loosening, white cell scan and/or aspiration and/or blood tests to look for infection.
Dr Connon will examine your knee to assess stability and range of motion. Once the cause of difficulty with your knee replacement is established, Dr Connon will talk to you about the options to address your symptoms and the risks and potential likelihood of success from addressing it surgically. Not all painful knee replacements can be fixed surgically.
If the cause of the problem with your knee replacement is found, the CT scan mentioned above can be used to help plan out your revision operation if you choose to proceed down that path.
Anaesthesia for revision knee replacement surgery usually involves spinal anaesthetic or general anaesthetic and many patients actually have some of each to optimise their pain relief and post-operative recovery. Dr Connon and your anaesthetist can discuss the most appropriate anaesthetic options for you.
To begin, Dr Connon will make an incision over the knee through your old scar. He will then remove the existing implants and place new ones (usually with longer stems) in their place. Samples will be taken to diagnose or exclude infection. A vacuum dressing may be placed over the wound to minimise postoperative wound issues and you will receive postoperative antibiotics as a precaution.
The time spent in hospital following revision knee replacement surgery varies according to your needs and personal circumstances as a patient. To go home we need to ensure your pain is well controlled and you are able to safely get around your own home with the use of crutches or another gait aid to assist you as required. The majority of patients spend about 4-7 days in hospital, but some people are keen and suitable to go home earlier and some patients can stay for longer- it is dependent on your specific circumstances.
After your anaesthetic has worn off, you should be able to place full weight on your knee, with crutches or a frame to aid you. It is preferable that if your operation is done earlier in the day, you stand up on the same day as surgery to get used to being upright again.
We will try to get you walking, sometimes with a frame, sometimes with only crutches as an aid.
When you are comfortable and once you are able to walk independently and tackle stairs, that’s when you are safe to head home. Everybody is a little different and this timeframe is tailored to you as an individual.
After 2-3 weeks, your wound will be checked (usually by a specialist wound nurse). Dr Connon will normally use dissolving suture and glue so no suture removal is likely to be required. After your wound review you should arrange to see your physiotherapist to begin post-operative exercises. We recommend against seeing your physio before the wound review to allow the wound to settle first.
From 6 weeks post-surgery, you should be able to return to many normal activities though your knee will definitely still be swollen and a little sore. Please note that the 6 week check-up is to ensure you on-track; you will not be fully healed by this stage. Some patients may be able to drive earlier, notably following a left knee replacement if you have an automatic car.
Please note that certain risks such as infection are unfortunately higher following revision knee replacement surgery than first-time “primary” knee replacement. Swelling and postoperative discomfort may also be greater than following your original procedure due to the bigger operation required.
Dr Connon will always put your health first and will discuss the potential risks of surgery with you before you book in for any procedure. Before surgery, Dr Connon will assess any risks involved with your current medications, medical history, and require your skin to be healthy. He will also organise a review by a perioperative doctor to optimise your general medical health and monitor you postoperatively.
Some risks present themselves only after surgery, such as infection and DVT. Please don’t hesitate to call Dr Connon’s rooms if you have any postoperative concerns.
Your priority is to maximise your range of movement, both bending and straightening your leg. After a week or two, you can slowly begin increasing your walking distance and building your strength and stability. Note that although the swelling starts to settle after 1-2 weeks it can persist for over 3 months so the use of ice and/or a compression bandage can aid with this and thus improve range of motion.