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Knee Replacement Revision Surgery

What Is Knee Revision Surgery? 

Knee replacement revision surgery is a procedure some people may need if they have a knee replacement joint that is damaged or diseased. With total knee replacement (TKR), or knee arthroplasty, most people have good results and get many years of life from their prosthetic joint. But what happens when a knee replacement wears out? Sometimes, these replacement joints fail. In that case, they need TKR revision surgery, a more complex procedure, to replace them.

Common Reasons for Knee Revision Surgery

You may need to have total knee replacement revision surgery if you had a knee replacement in the past and you have:

  • Knee pain or stiffness
  • Swelling
  • Instability
  • A loose or worn implant
  • Infection in the implant area
  • Fracture (which usually results from a fall)

How It Differs from Knee Replacement Surgery

In total knee replacement surgery, a doctor replaces a diseased or damaged knee joint with a prosthesis. In knee replacement revision surgery, some or all of the components of that prosthesis need to be replaced. There may be damage to your bone and to the surrounding tissue near your original implant. So, doctors usually need to use specialized implants during revision surgery.

How to Prepare for Surgery

A few weeks before your surgery, you’ll have a physical exam to make sure you don’t have any conditions that would affect your success with surgery or recovery. If you have any chronic conditions, such as heart disease, you may also need to see those specialists.

This procedure is usually more complex than your first. For this reason, you may need more recovery time and more help after surgery while recovering. Depending on your condition, you may need to stay at a nursing home or rehabilitation center after surgery. And you will want to make arrangements to have someone help you at home with cooking, shopping, bathing and household tasks during your knee revision replacement recovery time.

Pre-Surgery Tests

Your doctor will likely recommend imaging tests to evaluate the condition of your knee. Those could include X-rays, nuclear medicine bone scans, MRIs and/or CT scans. Blood tests can identify infections in your knee. And if your doctor suspects an infection, they may remove some fluid from your knee joint so it can be analyzed.

Your surgeon will evaluate these tests to determine which components will likely need replacing. However, the final decision on all components replaced is made during surgery.

What the Surgical Procedure Is Like

Knee replacement revision surgery is a more complex procedure than primary knee replacement surgery. It can take several hours, and your orthopedic surgeon will use specialized tools. You’ll have general anesthesia for the procedure.

Your surgeon will make an incision over your knee and move the tendons and kneecap to the side to expose the joint. This incision might be longer than your original incision to give the surgeon room to remove the old knee replacement implant. They will check for signs of infection and for damage to the components, and carefully remove the initial knee replacement and any cement.

Once your prosthesis has been removed, and your knee has been evaluated, your surgeon will add bone grafts or metal pieces or blocks to replace lost bone, if needed. Then, they will insert the new revision knee implant.

Once the new joint’s components are in place and attached, they may also place a drain to collect fluid and blood. Then, they close the incision.

Afterward, you’ll move to the recovery room, where your team will monitor you as you recover from the anesthesia. In the hospital, you’ll take medication to relieve pain and begin to perform physical therapy exercises. Your doctor will recommend therapies to help prevent blood clots and infection. You may continue to take these medications even once you are discharged from the hospital. Most people go home the same day or the next day.

Possible Complications

All major surgical procedures have risks. These risks are typically the same ones you talked about with your surgeon with your first surgery. However, the complexity of the procedure may increase the potential risk. Possible knee revision surgery complications include:

  • Poor healing
  • Infection
  • Stiffness or reduced range of motion
  • Bleeding
  • Fracture
  • Nerve or blood vessel injury
  • Blood clots in the legs or lungs
  • Heart attack, stroke or lung problems

Recovery at Home

Your doctor will give you instructions about caring for your new knee joint. You may need to use a walker or crutches.

Your health care team will let you know how to care for and bandage your wound. Avoid soaking your wound in water until it has healed. Your stitches or staples will probably be removed a few weeks after your surgery.

You will continue physical therapy exercises at home and with your physical therapist, likely for up to three months after surgery. These exercises are essential for building your strength and mobility so you can return to your everyday activities. You may need to limit the amount of weight you place on your knee or your range of motion at first. Eventually, you want to reach the point where you can straighten your knee and bend it to at least 90 degrees.

Recovery time for knee replacement revision can be three to six months for work and most regular daily activities and up to 12 months to fully return to exercise and other strenuous activities.

Long-Term Outcomes

Although some people may still have some pain, stiffness and reduced function even after recovering from surgery, most people have good outcomes after revision knee replacement. They have less pain and more joint stability and can function better.