Case Study: Revision Knee Replacement in a 63-year-old male

with a prior Unicompartmental Knee Replacement and ACL repair

A 63-year-old patient presented with complaints of right knee pain. He was involved in a worker’s compensation accident seven years ago. He was employed by the Town Police as a police officer. On the date of the accident, he was doing a training drill with another police officer. Unfortunately, his foot got stuck in between his feet causing his body to twist and his right knee to dislocate.

He had a knee cap dislocation. The patella was relocated on the way to the hospital. He had an Anterior Cruciate Ligament (ACL) repair in two years after by an outside physician. He started experiencing worsening pain and he was advised Partial knee replacement.

He underwent a partial right knee replacement in 3 years after by another physician. He never got a full extension and was never pain-free. He had an exacerbation a year ago while getting up from a chair at work. He heard a pop in her knee and went to a hospital where he was evaluated and x-rays were performed.

He presented to us with the CD of the images. He described the pain as a sharp pain located anteriorly. The pain was especially worse on negotiating stairs. He stated she was only able to negotiate stairs one step at a time and with the help of a banister. The intensity of the pain was described as severe.

He had a previous medical history for gallbladder removal and denied any allergies. He did take a powder called Cholestyramine daily for hyperlipidemia. He was currently not working and used a cane as an assistive device.

On physical examination, there was pain throughout the arc of motion. The range of motion was decreased secondary to pain. The right knee range of motion was 10 degrees to 90 degrees. There was patellofemoral tenderness and medial joint line tenderness. Further, examination revealed mild swelling of the knee joint.

There was no laxity or instability in the sagittal and axial planes. The varus and valgus stress tests were done at 0 degrees, 30 degrees and 60 degrees were negative. The patellar tendon and the quadriceps tendon were intact with no evidence of disruption. The skin overlying the right knee was normal with a well-healed incision. There was no rise in local temperature.

The examination of the left knee, bilateral hips and ankles were normal. There was no distal neurological deficit. The power and tone of both lower extremities were normal. The lower extremity deep tendon reflexes were intact and comparable. The bilateral lower extremity pulses were palpable and comparable.

He was advised a right knee aspiration for gram staining, culture and sensitivity and biochemistry. He was also advised basic blood investigations in the form of Hb, TLC, DLC, ESR, CRP quantitative and qualitative. He agreed for the investigations.

The results of his investigations were within normal limits. There was no evidence of infection of the right knee. Imaging revealed failure of the partial knee replacement. He was advised a revision total knee replacement in view of advanced osteoarthritis. He agreed with the plan.

Preoperative x-ray showing the anteroposterior and lateral views of the right kneePreoperative x-ray showing the anteroposterior and lateral views of the right knee - img 2

Preoperative x-ray showing the anteroposterior and lateral views of the right knee.

PREOPERATIVE DIAGNOSIS(ES): Failed Right knee unicondylar knee replacement.

OPERATION: Revision right total knee arthroplasty.

IMPLANTS USED: PS tibial bearing E1 antioxidant 10 mm polyethylene with Vanguard femur60 mm with tibial component 67 mm.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room after obtaining informed consent and signing the correct surgical site. The risks, benefits, and alternatives were extensively discussed with the patient prior to the procedure. The patient, as well as the family, understands that he is at increased risk of surgical complications because of the nature of the revision.

The patient was definitively positioned and the earlier incision was marked after the patient was anesthetized. The right lower extremity was draped and prepped in the usual sterile manner. The earlier incision was used for the arthrotomy and was extended proximally and distally for dissection purposes and for identifying the anatomical planes.

Skins and subcutaneous tissues were incised. Medial parapatellar arthrotomy was then performed. The femur was then exposed. The patellofemoral replacement was found to be loose and was removed. The screw was well fixed in the bone and using osteotomes and screwdriver, the screw of the patellofemoral replacement was then removed.

The distal cutting guide was then placed into position. The distal cut was then performed. The femur was then sized. Anterior and posterior chamfer cuts were then performed. The screw from the initial surgery was then visualized and it was anticipated that it will interfere with insertion of the final prosthesis and screw was also removed using implant removal instruments.

Attention was then turned towards the tibia. The tibial resection was then performed. The tibial cut was then removed. The overall limb alignment was checked using an alignment guide. The tibia was then prepared. The knee was then kept in extension and in the collapsed state. The patella was reverted and the patellar stability was found to be good.

The tissue around the patella that could help interfere with the range of motion was resected. The patella on the lateral to the patellar prosthesis was resected using a saw to improve the patellar tracking. The patella did not need to be revised.

Attention was then turned towards the femur. The notch cut was then performed. The femur was placed into position. The tibia was placed into position. The poly was placed into position. The knee was reduced. The knee was trialed through a full range of motion and there was a full extension possible, the full flexion was possible intraoperatively. The patellar tracking was excellent

The injection was given into the knee joint for postoperative pain control. The bone was prepared. The femur was cemented into position. Excess cement was removed. The tibia was cemented into position. Excess cement was removed. The poly was then placed into position.

The knee was then reduced and held in full extension with the bump under the ankle. After the cement hardened, the bump was removed and the knee was again trialed through a full range of motion. Medial parapatellar arthrotomy was closed with Vicryl and Stratafix.

Cutaneous tissues were then closed with O Vicryl. Subcutaneous tissues were closed with 2-0 Vicryl. The skin was closed using staples. Sterile dressing was then applied over the wound and the patient was then transferred to the postoperative care unit in a stable condition.

Postoperative x-ray showing the anteroposterior and lateral views of the right kneePostoperative x-ray showing the anteroposterior and lateral views of the right knee - img 2

Postoperative x-ray showing the anteroposterior and lateral views of the right knee.

Post op his recovery was excellent. The pain was managed well with medications and he was ambulatory the same day of the surgery. He was given aspirin for deep vein thrombosis prophylaxis. He was advised physical therapy and home exercise program.

The sutures were removed uneventfully. The patient demonstrated a full range of motion with no pain at three months. The patient was able to walk without support and do her daily activities with ease. She was extremely happy with the outcome of the procedure.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

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Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.