Revision knee replacement is a surgery done when a previous knee replacement fails due to wear and tear, loosening, infection, instability, or damage to the surrounding bone. In this procedure, the surgeon carefully removes the old implant, cleans out any damaged bone or infected tissue, and prepares the joint for a new, often more complex, prosthesis. Special implants, stems, or augments may be used to restore stability and function. Because bone loss and scar tissue are often present, revision surgery is more challenging and usually takes longer than the initial knee replacement. Recovery may also be slower, but the goal remains the same: to relieve pain, restore mobility, and improve quality of life.
Implant loosening or wear – prosthetic parts wear out or lose attachment to bone.
Infection (periprosthetic joint infection) – bacteria can infect the implant.
Instability or dislocation – knee feels unstable or gives way.
Stiffness and pain – limited movement or severe discomfort.
Bone loss or fracture – bone around the implant weakens or breaks.
Persistent pain – unresolved pain after primary replacement.
MBBS (KEM, Mumbai), MS Ortho, DNB Ortho
FNB Arthroplasty, MRCSEd.(UK) MNAMS
Fellowship in Revision Joint Replacement (Germany)
1. Definition:
Revision knee replacement is a surgical procedure to replace or repair a failed total knee implant, restoring knee stability, function, and comfort.
2. Common reasons for revision:
Implant loosening (mechanical failure or bone resorption).
Infection of the joint (periprosthetic infection).
Wear and tear of implant materials (polyethylene wear).
Instability or recurrent dislocation.
Stiffness or poor range of motion.
Bone loss (osteolysis) or fracture around the implant.
Persistent pain despite primary replacement.
3. Pre-operative assessment:
Detailed medical history and physical examination.
Imaging: X-rays, CT scans, or MRI to evaluate implant position and bone stock.
Laboratory tests to rule out infection (ESR, CRP, joint aspiration).
Cardiac and general health clearance due to increased surgical complexity.
4. Surgical planning:
Choosing appropriate revision implants (constrained, hinged, or custom).
Preparing for possible bone grafting or metal augments.
Availability of specialized instruments and backup implant systems.
5. Surgical procedure steps:
Incision and careful removal of the previous prosthesis.
Removal of cement and debridement of scar tissue.
Management of bone loss using grafts, wedges, or sleeves.
Addressing infection if present (may require staged surgery).
Placement of new revision prosthesis with longer stems for added fixation.
Realignment of soft tissues for stability and improved motion.
6. Complexity of surgery:
More challenging due to scar tissue, distorted anatomy, and bone loss.
Usually requires longer operative time and advanced surgical expertise.
7. Anesthesia and blood management:
General or regional anesthesia.
Higher risk of blood loss; sometimes pre-op blood conservation methods are used.
8. Post-operative care:
Longer hospital stay (typically 4–7 days).
IV antibiotics if infection risk is high.
Pain management with multimodal therapy.
Physical therapy starts early to restore strength and mobility.
9. Rehabilitation and recovery:
Weight-bearing status depends on bone reconstruction and implant stability.
Physical therapy for 3–6 months; full recovery may take 6–12 months.
Regular follow-ups with X-rays to ensure implant stability.
10. Risks and complications:
Higher than in primary knee replacement:
Infection recurrence.
Blood clots (DVT or pulmonary embolism).
Nerve or vessel injury.
Fractures during implant removal or insertion.
Residual stiffness or limited range of motion.
Potential need for further revisions.
11. Longevity of revision implants:
Modern revision implants last 15–20 years, but outcomes depend on patient’s age, bone quality, and adherence to rehab.
12. Expected outcomes:
Most patients experience significant pain relief and improved knee function, but final results may not match primary replacements.
13. Lifestyle modifications:
Avoid high-impact activities.
Maintain healthy body weight to reduce implant stress.
Regular follow-ups are critical for long-term success.