What Is Knee Revision Surgery And How Do I Know If I Need It?

Knee replacement surgeries are highly successful and offer significant relief for patients with arthritis. Sometimes a subsequent surgery, or revision, is needed after a primary replacement has already been completed.

This is known as knee revision surgery, or revision total knee arthroplasty. In this procedure, an orthopedic surgeon will replace a previously implanted artificial knee joint with a new one.

A revision knee replacement may be required for a variety of reasons. Those include:

Infection. One of the most common needs for a revision surgery is infection. An infection in the knee joint can cause severe pain, swelling and limited mobility. Infections are a devastating complication that may require a surgeon to “wash out” the bacteria, remove all or part of the existing implants and insert antibiotic joint spacers or cement.

Implant loosening. Another reason revision surgery may be needed is if the primary implants become loose. Loose components can cause significant pain and joint weakness. Loosening can occur from infection, cement debonding from the bone over time, wear of the polyethylene (plastic), or poor positioning of the components.

Instability. Instability can cause a patient to not trust the knee. It can "give out" or cause refractory bursitis or tendinitis. This condition can sometimes be treated with physical therapy or bracing. But sometimes revision surgery is needed to add more implant constraint or stability.

Fracture. A fracture around the primary implant is another reason knee revision surgery might be needed. This often occurs after a trauma or fall. Depending on the injury, primary implants may not function correctly, can become loose or cause pain. A fracture can also cause inability to place weight on the leg. All of these symptoms typically require urgent surgical correction.

Is knee revision surgery successful?

Like knee replacement surgery, knee revision surgery is highly successful if completed for an appropriate indication. It is critical physicians correctly identify and diagnose the root cause of the failed primary replacement. If done correctly, more than 90% of patients recover well.

Knee revision surgery is done the same way as knee replacement surgery, but it is more complex and may take longer to perform.

During a primary knee replacement procedure, an orthopedic surgeon replaces cartilage with a metal cap on the end of the femur and a metal and plastic piece on top of the tibia. The kneecap is typically resurfaced as well.

In a knee revision procedure, an orthopedic surgeon will remove the old implant and use bone grafts or metal augments if necessary to fill voids where the bone has deteriorated. Then the new implant is placed, sometimes with supportive stems.

Knee revision surgery will provide a patient pain relief, improved stability to allow for better balance and mobility, improved range of motion and a better quality of life. After a successful knee revision surgery, a patient can return to performing daily activities that might have been hindered by an aching knee.

How long does it take to recover from knee revision surgery?

Recovery from knee revision surgery is similar to recovery from an initial knee replacement. However, it may take longer due to the complexity of the procedure.

While most patients need only one night in the hospital following a knee replacement surgery, knee revision patients typically stay for a few days so their doctors can monitor their progress and help manage their pain.

Patients will begin physical therapy to help restore strength, flexibility and mobility to the knee joint.

It is important that patients follow their doctor's instructions carefully to reduce the risk of developing complications, including blood clots and infection, during the first several weeks of recovery.