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The art of fixing a failed knee replacement

Dr. Finn and the Finn Knee SystemIn 2009, surgeons in the United States conducted more than 1 million total joint replacements. Of those, 621,029 were total knee replacements, and 60,245 were revision knee replacements, a complex procedure in which the surgeon removes a failed implant and replaces it.

“If you have a joint replacement, there’s a 10 percent chance you will need a revision. If you’re 40 and live to 90, you may need two revisions,” says Dr. Henry Finn, medical director of the Chicago Center for Orthopedics (CCO), chairman of surgery at Weiss and professor of surgery at the University of Chicago. “It’s like a dental procedure. When a dentist fills your tooth, it might last two years or it might last 25 years.”

In 1990, Dr. Finn met a patient named Louis Olguin. “He was one of the good guys who was keeping our country safe,” Dr. Finn says. As a machine gunner in the marines, Olguin had jumped off a building, breaking both legs. Before meeting Dr. Finn, he underwent 15 knee surgeries over 17 years.

In severe pain and unable to walk or carry his newborn son, Olguin agreed to try a prototype for a new type of implant that Dr. Finn had invented—part of the Finn Knee System. Dr. Finn created the implant specifically for people with extensive bone and ligament damage as a result of deformity, trauma, revision, infection or cancer—people who could not be helped with conventional knee replacement. Today, the American Academy of Orthopaedic Surgeons (AAOS) recognizes the Finn Knee as one of the most notable orthopedic inventions of the 1990s.

According to the AAOS, joint replacements last approximately 20 years. Patient factors have a major impact on the life expectancy of an implant. Obesity, inflammatory arthritis and the physical demands the patient puts on the joint daily can all wear a replacement out faster.

“Before a joint is replaced, it is constantly breaking down and repairing itself. Metal and plastic can’t do that,” Dr. Finn explains.

The surgeon’s technique can also impact the implant. “This is a very technically demanding procedure, where a little OCD and perfectionism is a good thing,” says Dr. Finn.

Symptoms of a failed joint replacement include:

  • Pain in the joint, which increases with weight-bearing activities
  • Swelling
  • Instability
  • Loss of range of motion
  • Signs of infection (warmth, fever, chills, night sweats)

So how do you go about choosing a surgeon to complete the complicated revision surgery?

“Word of mouth is probably your greatest source,” Dr. Finn says. “Specifically for a revision, I wouldn’t go to just any place. There are people who dabble in revisions, but you wouldn’t want someone who dabbles in fixing cars to fix your car.”

Patients should seek out centers dedicated to joint replacement excellence. The multidisciplinary CCO team at Weiss includes physicians, nurses, physical therapists and support staff; they meet Mondays 6 a.m. to 9 a.m., discussing every patient from the previous week and planning every upcoming case.

“Do your research and find a place that specializes in knee replacements. Ask your surgeon: How many have you done in the past year?” Dr. Finn says.

Diagnosis involves a medical history, physical examination, X-rays and potentially a joint aspiration, lab tests and further imaging tests.

Many patients have tried other treatments to avoid surgery, including pain management techniques, physical therapy and bracing, but, Dr. Finn says, “In almost all cases, you’re going to need surgery when a joint replacement fails. I wouldn’t ask you to live with a bad tooth.”

With Olguin, there was no question. He needed a knee replacement, but he went into surgery with low expectations. After 15 previous procedures, he was not sure that anyone could save his knees.

Dr. Finn proved to be different. He treated Olguin’s arthritis by replacing his knee and correcting his deformity with the Finn Knee prototype. After surgery, as Olguin noticed improvement daily, he would say to himself, “You know what; I think he really did something.”

Olguin spoke at Weiss earlier this month during a Lunch & Learn event sponsored by the Arthritis Foundation. “Dr. Finn gave me a second life,” he says. “I don’t take pills; I walk. Without him, I wouldn’t have been able to last anywhere doing anything.”

If you have questions about knee replacement or revision surgery, call the Chicago Center for Orthopedics at Weiss at (888) 503-ORTHO, or visit ChicagoOrtho.com.

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