Revision Knee Replacement

Knee replacement is one of the most successful procedures in all of medicine. TKR procedure allows thousands of adults to return to an active and pain free lifestyle. However, for a variety of reasons, knee replacements can fail. When this occurs a revision surgery (placing a new knee replacement) is necessary to re-establish knee function.

There are many reasons that knee replacements can fail. One of the most common reasons is age-related wear. Knee replacement prostheses can last up to 20 years in ideal situations. At this point the polyethylene (plastic) component of the prosthesis can wear and fail. This can require revision of either the polyethylene insert or the entire knee.

Surgeons are hopeful that current total knee designs will outlast those of previous decades however wear of the components is always a risk. Another cause for knee replacement failure is infection. If infection occurs after a total knee surgery it can become quite problematic. At times it is necessary to remove the entire knee prosthesis and perform revision knee surgery in either one or two stages. Other causes for failure of knee replacement include pain, persistent stiffness, and ligament injury. Furthermore, there are cases where the original components were implanted incorrectly which can result in the need for revision surgery.

Revision knee arthroplasty essentially involves “re-doing” the knee replacement. In most cases the previous components are removed. After this is done the surgeon uses specialized revision components to reconstruct the knee. Compared to the first surgery, revision cases are larger and more complex. The bone can be compromised due to the original knee replacement. The challenge is to obtain stable fixation of the new components on the bone while still maintaining normal function of the knee. Often the surgeon will use additional “stems” on the components to increase stability.

Recovery time for revision surgery is similar to recovery after a primary knee replacement. Patients can expect to work quite hard in physical therapy for the first 6-8 weeks and often are feeling significantly better by this point.

In many cases of total knee failure, the original surgeon will not perform the revision surgery. These cases are technically challenging and are often handled by surgeons with specialty training in joint replacement. Dr. Bhushan Nariani has extensive experience in revision knee replacement. Many patients are referred in from outside surgeons due to failed knee replacements. Dr. Nariani is happy to offer consultation for any patient with a problematic knee replacement regardless of where the original surgery was performed.