Optimal Outcomes for Revision Knee Surgery

Oct
24
2019
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Revision Surgery

The future is often gloomy for patients who’ve had failed knee surgery. Poor range of motion (ROM), pain and stiffness, and differences between the two knees cause functional limitations in daily life. Athletes who’ve had a failed anterior cruciate ligament (ACL) reconstruction are unlikely to return to competitive sport. Even after revision ACL reconstruction or total knee arthroplasty (TKA), most patients are unlikely to have two strong knees and full function.

A Brighter Future 

Patients who have revision knee surgery at Shelbourne Knee Center have a brighter future. “Our goal is to make sure that every patient has a good outcome,” says K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center.

The surgeon’s experience in revision surgery is a key factor in an optimal outcome. Dr. Shelbourne has been taking care of patients’ knees since 1982. He and orthopedic surgeon Rodney Benner, MD, have extensive experience in primary and revision knee surgery. High-volume revision surgery coupled with research-backed rehab protocols result in optimal outcomes for revision ACL reconstruction and TKA patients.

Revision ACL Reconstruction

After revision ACL reconstruction at Shelbourne Knee Center, athletes have a higher return to sport rate and a lower re-injury rate than primary ACL reconstruction patients at most orthopedic practices, according to the literature (1,2).

Return to sports rates after revision ACL reconstruction range from 50-60%, according to the literature (1). The return to sport rate for revision ACL reconstruction in a study of Shelbourne Knee Center patients was:

  • 74% for high school and college athletes (at the pre-injury level)
  •  62% for recreational adults (3).

Read more about this study.

The use of a contralateral patellar tendon graft (PTG) by surgeons at Shelbourne Knee Center is a key factor in these results. A contralateral PTG allows for unrestricted rehabilitation and provides a predictable return to normal strength in both knees. “A contralateral PTG is almost invincible,” says Dr. Shelbourne. “It’s been an overwhelming success at Shelbourne Knee Center.”

Revision TKA

Under-rehabilitation after TKA is often mistaken for failed TKA. “We see a fair number of patients who are dissatisfied with their outcome who don’t have anything wrong with the knee replacement but are under-rehabilitated,” says Dr. Benner. These patients continue to have pain, stiffness and weakness, and limited knee function.

If a thorough workup doesn’t show instability or an infection, Dr. Benner recommends Shelbourne Knee Center’s Knee Rehabilitation Program for Osteoarthritis. Patients often gain the knee function they expected after their TKA. “We’ve even had a few patients who were scheduled for revision surgery who improved enough to cancel surgery,” says Dr. Benner. When revision TKA is necessary, Dr. Benner meticulously plans the procedure and uses specialized tools to preserve as much of the bone as possible.

Read more about revision TKA.

Pre-and Post-op Rehab

Shelbourne Knee Center’s physical therapy protocols, continually refined based on decades of ongoing research, focus on pre-op, post-op and home-based therapy. Eight physical therapists and athletic trainers work on-site. Close collaboration between the physical therapists, athletic trainers and orthopedic surgeons contributes to optimal revision surgery outcomes.

The pre-op rehab program focuses on restoring ROM first and then strength, and for ACL patients, reducing swelling before surgery. To reduce pain and swelling post-op and facilitate rehab, the first seven days are a “bedrest” period. Therapy focuses on restoring normal ROM before strengthening. ACL patients must achieve full ROM and good quadriceps muscle control before they can participate in an aggressive strengthening and functional progression program aimed at return to sport.

For more information about revision knee surgery at Shelbourne Knee Center, call 888-FIX-KNEE.

References

  1. Battaglia MJ, Cordasco FA, Hannafin JA, et al. Results of revision anterior cruciate ligament surgery. Am J Sports Med. 2007; 35:2057-2066.

  2. Wright RW, Gill CS, Chen L, et al. Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am. 2012;94:531-536.

  3. Shelbourne KD, Benner RW, Gray T. Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft. Am J Sports Med. 2014 Jun;42(6):1395-400.