A knee replacement can fail for several reasons. While modern implants are designed to last for many years, they are not immune to problems, especially in very active patients or after a long period of time.

Common reasons for needing a knee revision include:

• Implant Loosening: This is the most common cause. The bond between the implant and the bone can weaken over time, causing pain and instability as the components move.
• Wear and Tear: The plastic spacer between the metal components of the implant can wear down over years of use, similar to a tire tread wearing out.
• Infection: A post-operative infection can develop months or even years after the initial surgery, causing pain, swelling, and loosening of the implant.
• Instability: The ligaments around the knee may become stretched or damaged, making the knee feel wobbly or as if it might give out.
• Fracture: A fall or other trauma can cause the bone around the implant to break (a periprosthetic fracture).
• Stiffness: Excessive scar tissue can build up within the knee, severely limiting its range of motion.

A consultation for knee revision surgery is a detailed and comprehensive evaluation. Your surgeon needs to play detective to figure out exactly why your primary knee replacement is no longer working as it should.

During this appointment, you should expect:

• A Detailed History: Your surgeon will ask about your first surgery, your recovery, when symptoms started, and the nature of your current pain and limitations.
• Physical Examination: The surgeon will assess your knee's stability, range of motion, strength, and alignment.
• Review of Prior Records: It is crucial to bring all medical records from your previous surgery, including the operative report and past X-rays.
• New Imaging: New X-rays will be taken to evaluate the current state of your implant and bones.
• Blood Tests: Your doctor may order blood tests to check for signs of inflammation or a low-grade infection.
• Joint Aspiration: If infection is suspected, the surgeon may use a needle to draw a small amount of fluid from the knee joint for laboratory analysis.

Revision knee surgery is a much more demanding procedure than a primary knee replacement. The surgeon must first carefully remove the old implant without further damaging the bone, which can be challenging if it is well-fixed. There is often significant scar tissue that must be cleared away.

Furthermore, there is typically some degree of bone loss around the old implant. The surgeon must address this deficit, often using metal augments or bone grafts to build a stable foundation for the new revision implant. Revision implants themselves are larger and more complex, with longer stems and options for interlocking components to create the necessary stability that the body’s damaged ligaments can no longer provide. These factors result in a longer, more technically difficult surgery.

Recovery after knee revision surgery is generally longer and more involved than after a primary knee replacement. Your surgeon will give you specific instructions based on the complexity of your procedure.

You can typically expect a hospital stay of one to three days. You will begin working with a physical therapist almost immediately to start moving your new knee. Restrictions on weight-bearing are more common after revision surgery, especially if significant bone grafting was required. You will likely use a walker or crutches for several weeks. A dedicated physical therapy regimen is critical for several months to regain your strength and mobility. Full recovery can take six months to a year, but most patients experience significant pain relief much sooner.

Deciding to undergo a second knee surgery is a major decision. The ideal candidate is someone whose quality of life is significantly impacted by pain, instability, or stiffness from a failed knee replacement. A thorough evaluation must confirm a clear, correctable cause for the implant's failure.

Your overall health plays a key role. Your surgeon will evaluate your fitness for a longer, more complex surgery. It is also vital that you have a realistic understanding of the goals and potential outcomes. The primary goal of knee revision surgery is to provide a stable, pain-free knee for walking and daily activities. While many patients can return to low-impact recreational activities, it is not primarily intended for a return to high-impact sports.

If you are struggling with a painful or unstable knee replacement, you don’t have to accept it as your new normal. An evaluation with a revision specialist is the first step toward finding a solution.

We make it simple to schedule an appointment with one of our expert joint replacement surgeons at Barrington Orthopedic Specialists. You can call one of our office locations or use our convenient online scheduling tool to request an appointment. We look forward to helping you explore your options for getting back to a more comfortable and active life.