Failed Knee Surgery/ Miscellaneous

FAILED KNEE SURGERY

There are many factors which can lead to a failed knee surgery causing knee pain, swelling, stiffness, instability and inability to perform activities of daily living even after the knee surgery. Following symptoms are displayed when the knee surgery was unsuccessful or partially successful:

• Instability
• Irregular knee movements
• Severe pain in and around the knee
• Swelling and inflammation in the knee joint
• Warmth around the knee

In such scenarios, the surgeon may recommend a second knee surgery consisting of revision total knee replacement alone with removal and replacement of some or most of the parts of the original prosthesis to relieve pain and improve knee function. The failed knee surgery procedure is more complex and requires extensive planning, and specialized implants and surgical tools to accomplish the best possible result.

Conventional treatment methods for a previous failed knee surgery include usage of implants, usually use stems that go inside the shaft to gain fixation. Bone graft from another area of the patient body, a processed cadaveric bone or a synthetic bone is also used. The cadaveric bone is the most common type of implant used and is readily available and safe method.

ALTERNATIVE TREATMENT METHODS AT BETH YEHUDAH ARTHRITIS CENTER, PULLAD & DAYSTAR CLINIC, ALAPPUZHA FOR FAILED KNEE SURGERY-

There are many causes of failure of total knee replacement, some of which might need revision knee replacement; however a few of the apparently failed cases may be treated non-surgically, if the underlying cause of failure of knee replacement is namely

1) Inflammation and swelling due to Rheumatoid/ Inflammatory Arthritis (after ruling out infection).

2) Inadequate ligament balancing resulting in loose and unstable TKR.

3) Post surgical lengthening of ligaments and subsequent joint instability due to inflammatory enthesopathy (after ruling out implant wear/ loosening).

4) Patellar (knee cap) subluxation after surgery (after ruling out patellar implant loosening).

5) Anterior knee pain & Patellar tracking abnormalities after surgery.

6) Pain after knee replacement due to extra-articular knee enthesopathy.

7) Unexplained Pain in knee after knee replacement which could be due to referred pain from hip or spine condition.

At Daystar Star Clinic we provide a variety of minimally invasive treatment options for patients suffering from failed knee surgery. We tailor a customized treatment plan to treat patients suffering from different causes of failed knee surgery as mentioned above.

A) Extra-articular Dextrose Prolotherapy after Total Knee Replacement: Prolotherapy is a natural and cost effective alternative method to revision total knee replacement surgery in specific situations namely:

1. Inadequate ligament balancing resulting in loose and unstable TKR.
2. Post surgical lengthening of ligaments and subsequent joint instability due to inflammatory enthesopathy (after ruling out implant wear/ loosening).
3. Patellar (knee cap) subluxation after surgery (after ruling out patellar implant loosening).
4. Anterior knee pain & Patellar tracking abnormalities after surgery.
5. Pain after knee replacement due to extra-articular knee enthesopathy.

Prolotherapy is an almost painless injection technique under local anesthesia where very thin needles are used to inject high concentrations of dextrose solution (sugar similar to glucose) in to loose and damaged ligaments, tendon and muscle attachments around the knee joint. Prolotherapy works by increasing the glucose concentration in the fluid outside the cells. This results in movement of fluid from inside the cells to the outside of the cells thereby shrinking the cells and causing temporary cell damage (hyperosmolar damage). As the cells are temporarily damaged, they release many biosignals to the body which results in stimulation of the immune system of the body to accelerate the inflammatory process locally resulting in increased local blood circulation, fibroblast (fibrous cell) proliferation, ligament regeneration, tightening and repair. Prolotherapy is an effective non surgical treatment method used successfully in osteoarthritis/ degenerative joint disease condition to tighten loose ligaments. This treatment method has the ability to strengthen the existing intact, but weakened, ligamentous and tendinous structures in the joint. Along with the treatment technique, it is important to perform series of movement and muscle strengthening exercises to strengthen the already weakened muscles due to osteoarthritis as well as due to surgery.

Patient Benefits of Prolotherapy:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Avoid if not delay revision Joint Replacement Surgery (conditions apply)
• Significantly reduces the symptoms of Post surgical knee pain due to above mentioned causes.
• Reduced risk of adverse events
• Repairs and tightens ligaments improving joint stability and ease of walking
• Safe and effective treatment method
• Faster healing and recovery
• Prolotherapy results in safe, significant,effective, progressive improvement of knee pain, function and reduction of stiffness.
• The pain is reduced by stimulating healing mechanism at the source of the joint.

B) Neural (Juxta-neural) & Soft Tissue Infilteration Therapy (NESTIT) is an Injection based treatment originally developed by Dr Tejaz in 2010 in Guyana, South America. He has used it extensively for the past 8.5 years with great success. It consists of injecting small amounts of diluted anti inflammatory steroid solution indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip regions, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites in the Lumbosacral Spine / Hip causing pain referrals (referred pain) to the knee; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb. No steroid is injected in to the knee joint directly in case of failed knee surgery. It can be used to treat knee pain after failed knee replacement surgery due to the following causes:

1) Inflammation and swelling in knee due to Rheumatoid/ Inflammatory Arthritis in patient with failed total knee replacement (after ruling out infection)
2) Unexplained Pain in knee after knee replacement which could be due to referred pain from hip or spine condition.

It is preferably given for those patients who have persistent knee pain after knee replacement due to one or both of the above mentioned causes: Rheumatoid Arthritis, Inflammatory Arthritis, Synovitis, Inflammatory Low Back Pain and those with Knee/ Trochanteric/ Hip bursitis. It is not a substitute for DMARDS (Disease modifying anti rheumatoid drugs), however when given with low dose DMARDS, it can result in significant reduction of local inflammation, pain and improvement of joint function (indirectly reducing side effects of high dose DMARDS) in most cases.

To know more about treatment plans and treatment costs at Beth Yehuwdah Arthritis Centre, Pullad and Daystar Clinic, Alappuzha book an appointment now.