Orthopedic Case by Dr. Lalit Modi

Joint replacement is considered to be the most rewarding surgery in orthopedics, as it is a boon for a patient with joint pain. Like any other surgery it also involves risk of infection although the chances are very low but in case it does occur, the patient should seek attention of joint replacement surgeon to manage it early.

An orthopedic case with infection after knee replacement was recently successfully treated at CK Birla Hospitals RBH. The patient had been operated two years earlier for knee replacement. Initially she felt better but slowly she started feeling knee pain along with lots of discomfort. With investigation, it was diagnosed that she had an infection and loosening of the implant. She was advised surgery, but she continued to walk with the infected knee, which led to huge bone defect and fracture in the bone. Finally, she was just not able to walk and was limited to bed. Then she again consulted us for the revision surgery. But this time it was a big challenge as there was a huge defect in the bone. More than two-thirds of tibial tuberosity was compromised which is essential for function of the knee. Around three centimetres of the bone was destructed by the infection.

At RBH, we did this surgery in two stages. In the first stage, we removed the old implant, debrided the knee joint thoroughly and fixed a hand-made knee implant made with bone cement and antibiotics. The advantage of this implant was that, while managing the bone defect and giving the bone a natural shape, it was also continuously releasing antibiotics for correction of the infection.

The patient was able to walk and bend her knee again. After four months when the infection was completely controlled, we did the second stage surgery, wherein we removed the cemented implant and used special revision knee system to manage all the bone defects. The patient was able to walk the very next day.

Whenever the knee is painful after replacement surgery it is essential to consult and follow the surgeon’s advice. Unnecessary delay can lead to big problems especially if there is any infection.

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