Revision Total Knee Replacement
When Is Revision Surgery Needed?
1. Implant Loosening and Wear
Over time, the bond between the implant and bone can weaken due to:
High activity levels or excess weight
Wear of the plastic spacer
Bone loss from reaction to wear particles (osteolysis)
Symptoms include increasing pain and reduced knee function. Revision surgery restores stability and relieves pain.
2. Infection
Infected knee replacements can cause pain, stiffness, swelling, and sometimes drainage. Infections may occur early or years after surgery.
Treatment options:
Debridement: Cleaning infection while retaining implants
Two-stage revision: Remove implant, place antibiotic spacer, treat infection, then re-implant new prosthesis
3. Instability
If ligaments are stretched or damaged, the knee may give way. Revision surgery with stabilizing components may be needed if bracing or physiotherapy fails.
4. Stiffness
Scar tissue or poor implant positioning can limit motion. Revision is considered if non-surgical measures like manipulation under anesthesia are ineffective.
5. Fracture Around the Implant
A periprosthetic fracture (bone break near the implant) often results from a fall and may require surgical repair or full revision depending on location, severity, implant stability, and bone quality.
Complex Primary Knee Replacement
Needed when additional issues exist beyond standard arthritis, such as:
Previous fractures with malunion
Existing hardware (plates, screws)
Severe deformity or ligament damage
Major bone loss or instability
Standard implants may not provide enough support. Complex replacements may use:
Longer stemmed implants for deep bone fixation
Metal augments or bone grafts to rebuild missing bone
Thicker liners and constrained (hinged) implants to restore stability
Hinged or Modular Implants
Used in cases with extreme bone loss or severe soft tissue damage. Indications include:
Irreparable ligaments
Loss of anatomical landmarks
Standard implants unable to restore function
Benefits:
Improved alignment
Pain reduction
Ability to stand and walk
Recovery may take longer, and functional outcomes may be limited compared to standard TKR.
Pre-Surgical Planning
Advanced imaging and careful pre-operative planning are critical for complex or revision knee replacements. Sometimes, more constrained implants are selected intraoperatively based on unexpected findings.
Goals of Revision or Complex Knee Replacement
Restore joint stability and alignment
Relieve chronic pain
Improve mobility and independence
Reduce risk of future complications
