Revision Total Knee Replacement

Why Revision Surgery Is Needed for Total Knee Replacements

Failure of right total knee replacement in 78 yo female. Original surgery was 21 years prior. Failure mechanism is complete wear through of the polyethylene insert resulting in metal wear of the femoral and tibial components.

Knee replacement is one of the most successful procedures in all of medicine. Each year in the United States, this 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.

Why Do Knee Replacements Fail?

There are many reasons that knee replacements can fail.

Regular Wear and Tear on the Knee

One of the most common reasons is age-related wear. Knee replacement prostheses can last up to 20-30 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.

Infection Problems in the Knee

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.

Miscellaneous Cause of Knee Replacement Failure

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.

Successful revision surgery for failed right total knee replacement in 78 yo female shown above. The worn components were removed and specialized revision components were utilized to reconstruct the right knee.

How is Revision Knee Replacement Performed

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.

Complications in Revision Knee Arthroplasty

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.

Recovering from a Revision Total Knee Replacement Surgery

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.

Why Dr. Wind’s Experience and Qualifications Matter

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. Wind has extensive experience in revision knee arthroplasty. Revision surgery was one of the focal points during his fellowship training. Many patients are referred in from outside surgeons due to failed knee replacements.

Dr. Wind is happy to offer consultation for any patient with a problematic knee replacement regardless of where the original surgery was performed.