What Is Knee Replacement Revision Surgery?

A knee revision is the replacement of prosthetic implants in a person who previously had a total knee replacement. In this surgery, known as a "reoperation," an original prosthesis is removed and a new prosthesis put in place.
Some knee revisions may require the replacement of only one implant, while others require a complete exchange of all the prostheses that were implanted during the original knee replacement surgery (known as "revision total knee replacement"). A complete revision of this type is a complex procedure that requires extensive preoperative planning, specialized implants and tools, prolonged operating times, and mastery of difficult surgical techniques.

Reasons for a revision

Infection of the joint may cause stiffness, pain or loosening.

Fracture of the bone around the joint requires the fracture to be fixed.

Instability of the implant that may cause the joint to dislocate.

The breakage of the implant requires replacement.

Wearing out of one or more parts of the implant that requires it to be changed.

Symptoms for a Revision

Symptoms of a failed knee replacement can include :

Pain that can occur during activity or at rest.

Swelling around the joint or recurrent joint effusion.

Noticeable heat in the joint, long after surgery has finished.

Painful clicking or scratching sounds.

Reduced range of motion and function.

Inability to put weight on the leg.

Feeling like your knee wants to "give up" when standing, walking, or going up and down the stairs in the basement.

Why Revision Surgery is More Complicated than Initial Surgery?

A revision procedure is more complex than the original knee replacement surgery because the surgeon must remove the original implant, which would have grown into the existing bone.

In addition, once the surgeon removes the prosthesis, there is less bone remaining. In some instances, a bone graft (Transplanting a piece of bone transplanted from another part of the body or from a donor) might be required to support the new prosthesis. A bone graft adds support and encourages new bone growth. However, the procedure requires additional preoperative planning, specialized tools, and greater surgical skill. The surgery takes longer to perform than a primary initial knee replacement.

Results of Revision Knee Replacement

The results are quite variable, as some problems that require a second surgery are much more straightforward to manage, and others very complex. The problem with trying to compare results of revision knee replacement is that the reasons to perform the surgery, and the extent of the surgical procedure, is so variable that it is hard to draw conclusions on the data. However, most studies of revision knee replacement showed improved function in most patients (80% or more).

Complications of Revision Knee Replacement

Complications that may follow knee revision surgery are similar to those for knee replacement. They include :

Deep vein thrombosis.

Infection in the new implant.

Implant loosening, which you're at higher risk of if you’re overweight.

Dislocation of the new implant.

Additional or more rapid loss of bone tissue.

Bone fractures during the operation.

Difference in leg length resulting from shortening of the leg with the new prosthesis.

Formation of heterotopic bone, which is bone that develops at the lower end of the femur following surgery (Joint infections after surgery increase risk for this).