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Joint Commission International.
Joint Commission International.

Revision TKA is a critical surgery

Osteoarthritis of the knee commonest cause of disability in middle aged and elderly people. About 26 million people are suffering from OA knee of which 7.5 million need joint replacement surgery. At the moment about 82-90 knee replacements being done annually. The incidence of revision knee replacements is about 5-10%. The commonest cause in India is infection because some of the surgeries are done in suboptimal conditions. The other causes being loosening, technical errors and other causes.

Total Knee Arthoplasty (TKA) has gained immense acceptance amongst the Indian population. It is a complete solution for patients with knee pain and immobility issues. Not only does the patient gets relieved of the pain but also gets a second chance at a normal life.

The number of TKA surgeries in India have gone up drastically in the past couple of years due to more awareness and accessibility of the required facilities. This has a led to a huge number of existing patients undergone TKA. With the increasing demands placed on TKA in terms of longevity and function, the problem of failure has manifested itself as a substantial reconstructive challenge in the last decade.

The key parameters to judge a successful primary TKA are longevity, stability and mobility. These factors decide the quality of the patient’s life post-surgery. As the patient has come out of a painful period in his life post-surgery results are key to the satisfaction of the patient and the family. But due to a lot of indications such as infection, mechanical loosening, and instability, Revision TKA becomes a necessity. Approximately 5% to 10% of knees undergoing TKA will require revision within 10 to 15 years. Polyethylene wear has emerged as an important cause of TKA failure (aseptic loosening and osteolysis), particularly with some designs.

The principles of revision TKA are similar to those of primary surgery. However, factors such as bone loss and infection places an enormous demand on the technical expertise of the surgeon. Success depends on obtaining a wide exposure, restoration of mechanical alignment in 3 planes, maintenance of the joint line, balance of ligaments and soft tissue, restoration of functioning quadriceps mechanism, achieving stable implant — bone fixation (intramedullary stems), and reconstruction of substantial bone loss with metal wedges or bone graft. Although it is recognized that the results of revision TKA may not be as good as primary TKA, it behooves the surgeon to attain an understanding of the principles and the relevant skills required to provide an optimal, durable outcome.

Revision TKA is a crucial surgery because it is mostly the last opportunity for the surgeon to correct whatever is wrong with the patient. The scope for any error is 0%. The patient’s condition is more fragile and generally requires a substantial level of expertise from the surgeon to perform a perfect surgery.

In the light of the increase in Revision TKA cases, Apollo Hospital has decided to enter into an understanding with Dr. Graichen, where Dr. Graichen would give demonstration on Revision TKA and help surgeons learn the nuances of Revision TKA. Prof.Dr. HeikoGraichen is Head of Department and Medical Director of Asklepios, Orthopaedic Clinic Lindenlohe, Germany. He does around 250 revision surgeries every year and surgeon from across globe goes to his centre to learn revision total knee replacement technique. The undersigning will help …

  1. To train lot of Indian surgeons in his centre on Revision Knee Arthroplasty.

2.Also Prof.HeikoGraichen will visit Apolo Hyderabad twice in a year to operate & teach surgeons on Revision knee arthroplasty.

3.Young surgeons from Indian will undergo one month fellowship in his centre to learn about Primary knee arthroplasty

This is an initiative towards surgical knowledge sharing between surgeons from different parts of the globe dedicated to ensure impeccable surgical results for each and every patient.