Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.

Disease Overview

The knee joints are lined by soft articular cartilage that cushions the joints and aid in the smooth movement of the joint bones. Degeneration of the cartilage due to wear and tear leads to arthritis, which is characterized by severe pain.

Knee Pain-Elderly

What is a total knee replacement?

During total knee replacement, the damaged cartilage and bone are removed from the knee joint and replaced with artificial components. Artificial knee joints are usually made of metal, ceramic, or plastic and consist of the femoral component and the tibial component.

Why may I need a revision? 

Revision knee replacement surgery may be advised to patients if they have one or more of the following conditions:

  • Trauma to the knee joint
  • Chronic progressive joint disease
  • Increased pain in the affected knee
  • Worn out prosthesis
  • Knee instability or a feeling of giving way while walking
  • Loosening of the prosthesis
  • Infection in the prosthetic joint
  • Weakening of bone around the knee replacement, a process known as osteolysis (bone loss)
  • Stiffness in the knee
  • Leg length discrepancy
  • Fracture

Surgical procedure

Revision knee replacement surgery may involve the replacement of one or all the components.

The surgery is performed under general anesthesia. Your surgeon makes an incision over the knee to expose the knee joint. The kneecap along with its ligament may be moved aside so that there is enough room to perform the operation. Then the old femoral component of the knee prosthesis is removed. The femur is prepared to receive the new component. In some cases, the damaged bone is removed and a bone graft or a metal wedge may be used to make up for the lost bone.

Next, the tibial component along with the old plastic liner is removed. The damaged bone is cut and the tibia is prepared to receive the new component. Like the femur, the lost bone is replaced either by a metal wedge or bone graft. Then, a new tibial component is secured to the end of the bone using bone cement. A new plastic liner will be placed on the top of the tibial component. If the patella (kneecap) has been damaged, your surgeon will resurface and attach a plastic component. The tibial and femoral components of the prosthesis are then brought together to form the new knee joint, and the knee muscles and tendons are reattached. Surgical drains are placed for the excess blood to drain out and the incision is closed.

Postoperative care

Following revision knee replacement surgery, a continuous passive motion (CPM) machine may be used to allow the knee joint to slowly move. The machine is attached to the treated leg which slowly moves the joint through a controlled range of motion, while you relax.

You can walk with crutches or a walker. You will be sent for rehabilitation within a couple of days of surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore range of motion to the knee. Your physical therapist will also provide you with a home exercise program to strengthen your thigh and calf muscles.

Knee immobilizers are used when performing physical therapy, walking, and while sleeping to keep the knee stabilized.

Revision knee replacement surgery is performed to replace failed knee prosthesis with a new prosthetic component. The surgery improves mobility and enables you to return to normal activities with a pain-free knee.

AFTER SURGERY

After surgery, you will feel pain. This is completely normal and part of the healing process. Your doctor and nurses will work together to reduce your pain, this will help you recover faster.

Prior to you leaving the hospital your doctor will send a prescription to your pharmacy for some short-term pain relief after surgery. Your doctor may suggest multiple medications to help manage your pain, such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor will discuss which options or combinations would be best for you.

OPIOIDS

At MD West One, your health is always a top priority, which is why we are very passionate about getting you back to full activity in a safe and timely manner. We understand every patient is unique when it comes to pain management. A key component of a successful pain treatment plan includes weighing all risks and benefits to find the pain treatment plan that best fits you.

A high risk of dependence and overdose is associated with the use of opioids. To avoid this from accruing our agreement with you:

  1. You should take all medications as ordered by your provider. If you take the medication in excess of what is prescribed and run out of the medication prior to the refill date, the refill will not be authorized early.
  2. If you are requiring a refill of your prescription please call during regular business hours. Our providers will not refill any pain medications over the weekend, holidays, or after clinic hours.
  3. Make sure to tell your physician or nurse which medications you are taking, including herbal remedies, since narcotic medications can interact with over-the-counter medications and other prescribed medications, especially cough syrups that contain alcohol, codeine, or hydrocodone.
  4. Alteration of any written prescription, sharing, trading, or selling your medication is a federal offense and will be reported.
  5. You are responsible for keeping your pain medication in a safe and secure place, such as a locked cabinet or safe. Stolen medications should be reported to the police and to your physician immediately.
  6. If your medications are lost, misplaced, or stolen, your physician may choose not to replace the medications or to taper and discontinue the medications.

RISK FACTORS

Like all major surgical procedures, there may be certain risks and complications involved with revision knee replacement surgery. The possible complications after revision knee replacement include:

  • Stiffness in the knee
  • Infection
  • Bleeding
  • Formation of blood clots in the leg veins
  • Injury to nerves or blood vessels
  • Prosthesis failure
  • Patella (kneecap) dislocation
  • Ligament injuries

Don't wait any longer to get relief. Make an appointment to see one of our orthopedic specialists. 

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AMERICAN ASSOCIATION OF HIP AND KNEE SURGEONS

This article has been written and peer-reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence-Based Medicine Committee.