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Revision Knee Replacement

On this page, you will learn about:

Addressing pain, instability or implant problems after a previous knee replacement

Revision knee replacement is surgery to replace some or all components of a previous knee replacement. It may be required because of implant loosening or wear, instability, infection, fracture, bone loss or problems with implant position.

Revision surgery is generally more complex than a first knee replacement and may require specialised implants, additional fixation or bone reconstruction. The aim is to reduce pain, improve knee stability and restore mobility and function.

1. Why might a knee replacement need revision?

A knee replacement may require revision when the existing implant or surrounding bone, ligaments and soft tissues are no longer functioning as intended.
Common reasons for revision knee replacement include:
  • Implant loosening or wear – components may loosen or wear over time, causing pain, reduced function or bone loss.
  • Infection – infection around the knee replacement may require removal and replacement of the components, sometimes in more than one operation.
  • Instability – the knee may become loose or unstable because of problems involving the ligaments, implant position or soft-tissue balance.
  • Stiffness – significant stiffness may occasionally require revision surgery when other treatments have not improved movement.
  • Fracture – a fracture around the knee replacement may require specialised revision implants and additional fixation.
  • Implant position or failure – problems with component position or implant function may contribute to pain, instability, stiffness or abnormal loading.
Not every painful knee replacement requires revision surgery. Dr Samson will assess your symptoms, examine your knee and review appropriate imaging and investigations to determine the cause and discuss the available treatment options.

2. How is revision knee replacement assessed and planned?

Careful assessment is important to determine why a knee replacement is painful or no longer functioning as intended. Dr Samson will review your symptoms, previous knee surgery, walking pattern, knee movement and stability, leg alignment and current level of function. Previous operation reports and implant details will also be reviewed where available.

Imaging and investigations

X-rays are usually the first imaging test used to assess the position and condition of the knee replacement and surrounding bone.
  • CT scans – to assess implant position, rotation, bone loss or fracture
  • Blood tests and joint aspiration – where infection needs to be investigated
  • Nuclear medicine or other specialised imaging – in selected cases
The findings from your examination, imaging and investigations help determine the cause of the problem and whether revision surgery may be appropriate.

3. How is revision knee replacement surgery performed?

Depending on the reason for revision and the condition of your existing implants, bone and ligaments, surgery may involve:
  • Replacing worn, loose or damaged components - one or more components may be removed and replaced. Components that remain well fixed and appropriately positioned may sometimes be retained.
  • Reconstructing bone loss - longer implant stems, metal augments, cones, sleeves or bone grafting may be used to provide fixation and reconstruct areas of bone loss.
  • Improving knee stability - where the ligaments no longer provide adequate support, more constrained revision implants may be used to improve stability.
  • Treating infection - an infected knee replacement may require removal of the implants, treatment of the infection and replacement during the same operation or as a staged procedure.
  • Treating fracture around the implant - revision components may be combined with plates, screws, cables or other fixation methods to stabilise the bone.
The reconstruction plan may change during surgery once the existing implants and surrounding bone have been fully assessed. Dr Samson will select the implant and reconstruction method according to the cause of the problem, the available bone and the stability required for your knee.

4. What is the recovery after revision knee replacement?

Recovery after revision knee replacement is generally more gradual than after a primary knee replacement. The length of your hospital stay, and rehabilitation will depend on the complexity of the procedure, the condition of your bone and soft tissues, and whether additional reconstruction or treatment for infection was required. You will usually begin standing and walking with physiotherapy assistance on the day of surgery or shortly afterwards. A walking frame or crutches may be required initially, and temporary weight-bearing restrictions may apply following some types of reconstruction. 

Rehabilitation focuses on managing pain and swelling, restoring knee movement and strength, and improving walking, balance and function.Your return to driving, work, exercise and everyday activities will depend on your recovery and the type of reconstruction performed. Follow-up appointments will monitor your wound, implant position, bone healing and overall progress.

5. What are the risks of revision knee replacement?

Revision knee replacement may carry a higher risk of complications than primary knee replacement.

 

Potential risks include infection, bleeding or blood transfusion, blood clots, wound-healing problems, stiffness, ongoing pain or swelling, instability, nerve or blood vessel injury, fracture, implant loosening or failure, problems with bone healing and the need for further revision surgery. Individual risks depend on the reason for revision, the condition of your bone and soft tissues, the presence of infection, your general health and the complexity of the reconstruction required.

 

Results and recovery vary between patients, and a particular outcome cannot be guaranteed. Dr Samson will discuss the expected benefits, alternatives and individual risks with you before surgery.

Learn more about the risks of knee replacement surgery