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Need to replace plastic cartilage in the replaced knees. Can this be done without total replacement surgery?

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
User rating for this question
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
Question
I NEED TO REPLACE THE PLASTIC CARTILAGE IN MY REPLACED KNEES. CAN THIS BE DONE WITHOUT TOTAL REPLACEMENT OF THE KNEES?

WHAT ARE THE RISKS % IF I REPLACE BOTH KNEES TOTALLY. WOULD I BE ABLE TO CONTINUE PLAYING DOUBLES TENNIS?
MY KNEES ARE 14 YEARS OLD. XRAYS STILL LOOK GOOD BUT I HAVE DEVELOPED PAIN IN THE SIDE AREA OF THE KNEE. WHAT CAN BE DONE TO RELIEVE THE PAIN I HAVE NOW.
Posted Sun, 17 Nov 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. K. Naga Ravi Prasad 1 hour later
Brief Answer:
Only Plastic exchange can be done.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

Yes, It is possible to replace the plastic (Polyethylene insert) or the Liner in an already replaced Knee joint. Having said this, it is done only in very rare situations where there is wear of the Polyethylene leading to instability of the knee.
The only prerequisite for the Liner (Polyethylene) exchange is that the knee joint should be free from INFECTION inside the joint, and this should be confirmed by all means (Hematological,Clinical, biochemical & radiological investigations should confirm the absence of infection in the joint).

You have not clearly asked in your query whether you are asking about a SIMULTANEOUS BILATERAL TOTAL KNEE REPLACEMENT, during which both knees are replaced at the same time; or a STAGED BILATERAL TOTAL KNEE REPLACEMENT, during which each knee is replaced at a different time—often days or weeks later.

There are both Merits and Demerits of Simultaneous Bilateral Total knee Replacement (TKR) surgery.
The potential benefits of simultaneous bilateral TKR include
* decreased overall length of hospitalization
* shorter anesthesia time
* decreased rehabilitation time in addition to a decreased cost to both the patient and the institution.

However,these benefits may be offset by the potential increase in morbidity and mortality that is associated with simultaneous bilateral TKR's.
Minor complications that may occur after Simultaneous Bilateral TKR include peripheral vascular complications, more blood loss, Infections, phlebitis or nonhealing surgical wounds.

The Major complications include DVT (deep vein thrombosis) and Pulmonary Embolism and Central Nervous system complications.

It is a generally accepted fact that Patients of elderly age groups (like you) and presence of associated medical comorbidities are not fit candidates for Bilateral simultaneous total knee Replacement surgery.

Generally, the standard practice is to perform Staged Bilateral TKR's in patients who are of elderly age groups (this may vary from surgeon to surgeon and on the institutes where the surgeries are being performed).

No, You are not supposed to involve in any IMPACT SPORTS (like playing tennis) after a TKR as the chances of Early failure in the form of loosening is very common.

Simple analgesics like Acetaminophen will suffice in providing relief from arthritic pain. If the pain in of severe intensity, you have to use a Narcotic analgesic. Which pain medication better suits you will be decided by your treating doctor.

Hope I have addressed your query. Happy to help further

Regards
Above answer was peer-reviewed by
 
Follow-up: Need to replace plastic cartilage in the replaced knees. Can this be done without total replacement surgery? 19 hours later
1. can the 14 year old inserts i have still be found or can something else be substituted?
2 is this procedure any different than total knee replacement - pain-rehab time etc
3. prior to this replacement of th inserts--what test other than xrays and bone scans should be done
4 can exrays tell my dr the % of wear of the insert?

AT 75 I AM VERY FIT 14 % BODY FAT MUSCULAR-I PLAY TENNIS 4 TIMES A WEEK AND LIFT WEIGHTS SERIOUSLY 4-6 TIMES A WEEK. I BICYCLE 4 TIMES A WEEK.
WOULD I BE A CANDIDATE AT 75 FOR SIMULTANEOUS BILATERAL REPLACEMENT GIVEN MY PHYSICAL CONDITION I AM IT THE UPPER 1% OF 75 YEAR OLD MEN IN TERMS OF PHYSICAL CONDITION. I AM STRONGER AND IN BETTER CONDITION THAN 30 YEAR OLD'S

1 WHEN THEY DO SIMULTANEOUS BILATERAL REPLACEMENT DOE EVERYTHING ELSE REMAIN AS IS?
2 WOULD THIS MAKE THE PROCEDURE DIFFERENT THAN TOTAL REPLACEMENT LIKE I HAD 14 YEARS AGO.
3 WHAT WOULD THE REHAB ENTAIL-I WOULD LIKE A TIMELINE FOR WALKING WITHOUT PAIN--PLAYING TENNIS AGAIN.

1 WHAT IS LOOSENING? IS IT DIFFERENT THAN INSERT WEAR?
2 IS REPLACEMENT FOF REPLACED KNEES EASIER/HARDER--REHAB-MORE/LESS--SUCESS RATE-HIGHER/LOWER
 
 
Answered by Dr. K. Naga Ravi Prasad 5 hours later
Brief Answer:
Please find the answers & Explanation.

Detailed Answer:
Hi, Nice to hear from you.

1. This depends on which company implants are used and whether they provide only the polyethylene insert for that specific type of implant that was used in you or any compatible substitute. You have to check this either with your surgeon (who has operated upon you) or with the company personnel.
2. This procedure involves the same steps as that of a TKR but the rehab will be faster as this will not involve extensive bony cuts and soft tissue releases.
3. Xrays and Bone scans, both are important to assess the current status of the implants, implant-bone interface and polyethylene wear and presence of periprosthetic lysis of bone. Apart from these, clinical examination is also very important in assessing the presence of instability.
4. Though not exactly, xrays will give a gross idea about the narrowing of space in one compartment (one side of knee joint) which indicates the amount of polyethylene wear.

Whether or not you are a fit candidate for Bilateral simultaneous TKR's will be determined by the Anesthesiologists and the Operating surgeon after a thorough assessment.

1. This depends on the XXXXXXX status of the implants and their stability. If only the polyethylene is found to be worn, then only it will be replaced (which is very unlikely) or else, they will revise all the components and insert newer ones. The operating surgeon judges what to be done in a particular case.
2. The surgical technique and procedure remains the same, only the implants differ (when compared to 14 yrs back)
3. The rehabilitation period will be a bit lengthy in case of a revision TKR, when comparted to the Primary TKR. This will be dictated by the physiotherapist.

1. Loosening implies "failure of interface between the implant and the bone" or simply said "Bone cement interface failure". Insert wear refers to the "thinning of the thickness of the polyethylene plastic over a period of years" generating polyethylene debris which results in periprosthetic bone lysis and loosening.
2. Definitely, performing a REVISION TKR is a difficult procedure than operating on a virgin knee. Also, the rehabilitation protocol will be of a longer duration. The success rates are inevitably lesser when compared to primary TKR.
Above answer was peer-reviewed by
 
Follow-up: Need to replace plastic cartilage in the replaced knees. Can this be done without total replacement surgery? 2 days later
i need a recommendation of a dr anywhere hear my calif zip 0000 or where i can GO on the internet to evaluate the rating of the DOCTORS
2 WHAT ARE THE MOST IMPORTANT 3 THINGS TO LOOK FOR IN A DR TO DO MY REVISITATION OF BOTH KNEES.
3 WHAT IS THE BEST INSERT TO USE IN THIS CASE,
4 WHAT IS THE LIFE EXPECTANCY OF THIS PROCEDURE
5 WHAT IS THE EXACT % OF SUCCESS??
6 WHAT IS THE MOST COMMON TWO PROBLEMS WITH THIS SURGERTY
7 HOW LONG IS THE HOSPITAL STAY
8 WHAT IS THE COST IF I PAY OUT OF POCKET
9 WOULD YOU DO THIS IF YOU WERE ME?
 
 
Answered by Dr. K. Naga Ravi Prasad 7 hours later
Brief Answer:
Practical & reasonable answers for your queries.

Detailed Answer:
Hi, Please find below your answers -
1. Follow these links to find a best knee replacement doctor in your locality :
WWW.WWWW.WW
WWW.WWWW.WW
WWW.WWWW.WW
WWW.WWWW.WW 2. The most important things (that I feel) to look for in a doctor are EXPERIENCE in years, EXPERTISE in that field and PATIENT SATISFACTION rate.
3. There is nothing like a best insert. There are few companies which makes revision implants of international standard like DEPUY, ZIMMER, STRYKER, XXXXXXX & NEPHEW, BIOMET etc. The choice of the implant to be used with be decided by the operating surgeon
4. It’s important to note that a Revision knee replacement does not provide the same lifespan as the initial replacement (usually about 10 years rather than 20).
5. The percentage of success in Revision surgeries is always lower than the primary owing to the complexity of the procedure. Various studies indicate that about 80 percent of patients that undergo a Revision surgery experience excellent results.
6. Deep vein thrombosis (DVT) & Infection are the two most common problems followed by Lack of good range of motion.
7. The general hospital stay could be around 5-7 days
8. The cost of a Revision knee replacement can vary substantially (even within the same geographical area) owing to multiple variables involved. Roughly, You may be expected to pay $60,000 – $70,000 at a typical hospital ,if you are not insured.
9. I will definitely do, provided if the procedure is absolutely indicated & necessary.

Have a great day
Above answer was peer-reviewed by
 
Follow-up: Need to replace plastic cartilage in the replaced knees. Can this be done without total replacement surgery? 16 hours later
1 do my existing metal parts stay as is--especially the one up my femora?
2 which DR WOULD YOU HAVE DO YOUR KNEE REPLACEMENT AND WHY?
3HOW DO I ASK A QUESTION ABOUT CARDIOLOGY?
4 I MUST TAKE PLAVEX--WOULD I HAVE TO STOP PLAVIX FOR ANY TYPE OF REPLACEMENT AND FOR HOW LONG BEFORE AND AFTER?
5IF I DO NOTHING AND THE PAIN IS BEARABLE IS MORE DETERIORATION AS A MORE RAPID RATE AT THIS STAGE.
5 THIS IS VERY IMPORTANT TO ME---IN JULY 13 MY DOCTOR SAID THE WAS NOT MUCH WEAR IN MY INSERT AND MY PAIN WA DUE TO A SLIGHT SEPARTION OF THE INSERT ON THE RIGHT SIDE.--3 MONTHS LATER LOOKING AT THE SAME X-RAYS HE SAID THE PAIN WAS DUE TO THIN INSERTS. HOW DOES ANYONE EXPLAIN THIS. MY TENNIS ACTIVITIES ARE EXACTLY 5O % OF WHAT THEY WERE IN JULY??
6 WHICH TYPE OF INSERT SOULD YOU USE ON YOUR KNEE IF NEEDED?


Follow-up: Need to replace plastic cartilage in the replaced knees. Can this be done without total replacement surgery? 6 minutes later
CARDIOLOGY QUESTIONS:
1 I HAVE HEART DISEASE-7 STENTS IN SINCE 2006.
2 PACEMAKER IN 2007
3 PLAVIX IS A MUST--WHAT ABOUT BILATERAL KNEE REVISITATION AT 75.
4 I AM HAVING AN ANGIOGRAM AND POSSIBLE STENTS THIS WEEK
5 WHAT ARE THE BEST KIND OF STENTS AT THIS TIME?
6 WHAT SHOULD MY ACTIVITY LEVES BE FOR HTE DAYS FOLLOWING SURGERY.
7 WHEN CAN I RESUME DOUBLES TENNIS/WEIGHT TRAINING?
 
 
Answered by Dr. K. Naga Ravi Prasad 5 hours later
Brief Answer:
Consult a Cardiologist.

Detailed Answer:
Hi, Since I am an orthopedic surgeon, I am not the right person to give suggestions on your cardiology questions. Sorry to say this.

Consult a cardiologist in your locality and discuss the issues.

Good day
Above answer was peer-reviewed by
 
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