Revision knee replacement: when it's needed, what's involved and the risks

Knee replacement surgery is a common and highly effective procedure for individuals with severe knee pain and limited mobility due to conditions such as osteoarthritis and rheumatoid arthritis. While most knee replacements provide long-lasting relief and improve quality of life, there are instances when revision knee replacement becomes necessary. 

Here, we’ll explore the circumstances that may result in revision knee surgery, what the procedure involves and the associated risks.

When is revision knee surgery needed?

Revision knee surgery is a more complex and less common procedure than initial primary total knee replacement. It is typically considered when the previously implanted artificial knee joint (prosthesis) begins to wear out, becomes unstable or fails to function properly. 

Several reasons may result in the need for revision knee surgery:

Prosthesis wear and tear

Over time, your artificial knee joint may wear down leading to pain, reduced mobility and instability. This is especially common in individuals who are younger and more active.

Loosening

The components of your artificial knee may become loose, causing pain and instability. This can occur due to bone loss around the prosthesis or other factors. 

Infection

Infections can develop in your knee joint, leading to inflammation, pain and potential damage to the prosthesis. In some cases, antibiotic treatment may treat the infection, but surgery may be required to replace the prosthesis. 

Fracture 

A fracture around your prosthesis may occur due to trauma and other factors, resulting in the need for surgery to repair or replace the damaged components.

Instability

Some individuals may experience persistent instability in the knee joint after initial replacement surgery. This instability could result from improper implant alignment with soft tissue issues. Revision surgery may be needed to resolve these problems. 

Allergic reactions

In rare cases, individuals may develop allergic reactions or sensitivities to the materials used in the prosthesis. Consequently, the prosthesis needs to be removed and replaced.

What is involved in revision knee replacement surgery?

Revision surgery is a more intricate procedure than primary knee replacement due to the need to remove the existing prosthesis. The surgical process can be broken down into several key steps:

Assessment before surgery 

You will have a thorough evaluation, which may include imaging tests, such X-ray and MRI scans, to determine the extent of the problem and to plan the revision procedure. 

Anaesthesia 

You will receive a spinal anaesthetic or general anaesthetic, depending on your health, and your surgeon and anaesthetist’s preferences. 

Incision 

A cut (incision) will be made over your knee to access your joint. This often requires a more extensive cut and more dissection of soft tissue than during your primary knee replacement surgery.

Prosthesis removal 

Your existing prosthesis will be carefully removed. This can be challenging as the components may have become integrated with your surrounding bone. 

Bone preparation 

Your surgeon may need to prepare the remaining bone, which may involve removing damaged bone and adding a bone graft to improve stability. 

Implantation of the new prosthesis 

Your new prosthesis will be implanted, which may involve replacing one or more of the components of the previous prosthesis, such as the femoral, tibial or patellar components. 

Closure 

Your surgical cut will be closed and a dressing applied to the site.

Risks associated with revision surgery

Revision knee replacement surgery, like any surgical procedure, carries certain risks and potential complications, including:

Infection

There is a risk of developing a surgical site infection, which may require additional treatment or surgery. 

Blood clots

Blood clots can form in your legs or lungs, potentially causing serious complications. 

Bleeding 

Excessive bleeding during or after surgery may require blood transfusions. 

Nerve and blood vessel damage 

Injury to your surrounding nerves or blood vessels is a rare but possible complication.

Prosthesis complications

The new prosthesis may develop problems over time, similar to those that led to the initial revision surgery. 

Limited mobility, pain and stiffness

You may experience limited knee movement or persistent knee pain despite having revision surgery.

Is revision knee replacement surgery right for you?

While revision surgery offers a chance for improved function and pain relief, it’s important to be aware of the associated risks. You should, therefore, have a comprehensive preoperative evaluation and will also need post-operative rehabilitation. 

When deciding whether or not revision knee replacement surgery is right for you, you should always consult a skilled orthopaedic surgeon who can assess your individual circumstances and recommend the most appropriate course of action for your specific needs.