Revision Total Knee Replacement

Knee Replacements are very hardy devices, often continuing to function without maintenance, under a huge workload, often for more than two decades. 

Knee Replacement Failure

Knee Replacement failure usually means that the patient is experiencing pain after the procedure.  There are only really a few causes for this:  infection, loosening, malpositioning, fracture, instability and stiffness. Knee replacements that are painful without an obvious cause are rarely helped by more surgery. 

Painful TKR Investigation

To investigate the causes of a painful knee replacement often involves bone scans, CT positional scans, CRP- ESR tests and knee fluid removal and testing. Loosening occurs because the bearing surfaces of the knee produce small particles of polyethylene, which eventually damages the bone holding the prothesis in place. After many years the implant loosens from the damaged bone and needs replacing. 

The surgery required can vary from complex two stage revisions for infection, to less complicated arthroscopic procedures for scarring. 
A revision of a whole knee replacement is a larger procedure than the
first replacement, and not something to be entered into lightly. 

WHAT IS A REVISION?  MAJOR OR MINOR?

If your knee replacement needs re-doing, it is termed a “revision”.  A revision of the femoral and tibia components is usually longer and larger than the original surgery with a higher risk of complication and longer recovery. Different implants are needed, usually with longer stems for better fixation to bone. Often patients require special implants for bony defects such as trabecular metal.   Revision for chronic infection is usually a two stage procedure using an initial temporary spacer with later re-implantation 3 to 4 months later. 

Some revisions are smaller, involving only changing the plastic bearing or one component. These usually are less risky with a faster recovery