Modern knee replacement implants, also known as prostheses or artificial joints, typically last longer and perform better than older models. However, wear-and-tear, injury, and infection may require a knee implant to be repaired or replaced surgically, in a procedure called revision of total knee arthroplasty.
In a revision of total knee replacement (TKR), sometimes called total knee arthroplasty (TKA), a surgeon repairs or replaces an existing knee prosthesis implant.
When your knee no longer functions well due to bone or cartilage deterioration, you may need to replace the damaged portions with a prosthesis. This operation, which restores your knee joint to normal functioning, is called a "total knee replacement" when all the structures of the knee are replaced, and a "partial knee replacement" if only some of the knee is replaced. Your first knee replacement procedure, where the damaged bones are replaced with implants, is also known as “primary” knee replacement surgery.
Unlike the bones in your knee and leg, your body can't naturally repair the artificial prosthesis, so it may gradually wear out. When that happens, you'll need another surgery to repair the prosthesis, replace any damaged components, and ensure the prosthesis is aligned correctly. This repair surgery is called a revision because your surgeon is “revising” or redoing your knee replacement surgery.
Thanks to advances in artificial knee materials and technology, modern implants typically last 15 years or more before they need a revision. However, if the prosthesis sustains damage or becomes infected, you may need TKR sooner.
Just like a primary knee replacement surgery, a knee revision surgery can be partial or total:
In cases where a prosthesis must be repaired because of infection, revision of a total knee arthroplasty can be single-stage or two-stage:
If your artificial knee no longer performs as it should, you may need a revision. Signs that your knee prosthesis is worn out or damaged include:
The primary causes for revision of a total knee replacement are:
In cases where the implant comes loose, the cause isn't always clear. High-impact sports and repetitive activities can increase your risk of mechanical failure. Loosening is also more common among people who get a primary knee replacement relatively young, since they have more time for wear and tear to affect the prosthesis.
Revision knee replacements are more complicated and invasive than primary knee replacement surgeries. Before undergoing a revision, you should speak with your healthcare team about the risks and benefits to determine if a total knee revision would be worthwhile based on your age, activity level, medical history, lifestyle, and other factors.
Like a primary knee replacement, a revision of TKA can relieve pain, restore mobility, make you more independent, and allow you to continue activities you enjoy. In cases of infection, a total knee revision may be necessary to avoid serious complications.
Revision surgery after a total knee replacement carries the usual risks of any surgery:
Some risks are more pronounced in knee revisions:
Revision of a total knee arthroplasty is a complex procedure that requires the same or even more planning and preparation than a primary knee replacement.
Preparation for a knee revision begins several weeks before the operation. You'll meet with an orthopedic surgeon, who will perform a physical exam and discuss with you your symptoms, overall health, and medical history. They'll assess whether you're healthy enough to undergo surgery and determine any other preparations you need, such as temporarily suspending certain medications.
Your doctor will likely take an X-ray or other imaging during your appointment. This allows the surgical team to see the condition of the prosthetic and the bones in your knee, so they can plan the operation and determine what sort of implant to use in your revision prosthesis.
Finally, consider your living arrangements. It can take several months or more to fully recover from a knee revision. Evaluate your home and look for tripping hazards or other issues that may cause problems when you use a walker or crutches in the days after the surgery; clear any clutter. You may want to arrange for a loved one to help you around the house after your surgery. It could also help to rearrange your living and sleeping spaces to avoid the need to go up and down stairs while you recover.
Revisions often take longer to heal than the primary replacement surgery because the incisions are typically larger. Revision implants also tend to be larger and more invasive to install.
It can be. Studies indicate that more than twice as many people have pain after a revision of total knee arthroplasty than people receiving a primary knee replacement.
It may be several weeks before you can walk unassisted following revision knee surgery. However, many patients can walk with a walker or crutches immediately after surgery .
The recovery time for a total knee replacement revision is generally longer than for a primary knee replacement. It's not uncommon for pain, swelling, or mobility issues to persist for a year or more after the operation.
Experts estimate that about 10% of people who have a knee replacement will need a revision at some point.
The most common reason for a revision knee replacement to fail is infection, followed by mechanical loosening of the prosthetic.
Yes. If your artificial knee wears out or becomes damaged or infected, your doctor may recommend a revision of total knee replacement (that is, a second surgery) to repair or replace the prosthesis.
For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.
About BWH
