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Revision knee replacement surgery

Revision of a total knee replacement is required if the knee replacement has loosened and is painful.  Loosening of the knee replacement can be either due to infection or sometimes the knee can loosen even without infection, which is called aseptic loosening of the knee replacement. Most total knee replacements are expected to last for 10 years or more but can loosen after thisperiod. Occasionally revision of a knee replacement is undertaken due to significant wear of the plastic component of the knee replacement.

Loosening of the knee replacement often presents as pain in the previously operated knee. This is investigated by performing blood tests to rule out infection as well as an X-ray and a type of scan called a bone scan. In all cases of revision knee replacement it is important to rule out infection, as this revision knee surgery needs to be carried out in two stages in the presence of infection. If there is no evidence of infection the changing (revision) of the knee replacement can be done as a single stage procedure.

What happens during revision knee replacement surgery?

During knee replacement surgery the old knee replacement is removed. This can be associated with loss of some bone. If the revision is due to an infection, bone cement mixed with antibiotics is placed in the knee. 6-8 weeks following this procedure if the infection is eradicated, the bone cement is removed and a new knee replacement is inserted. The knee replacement surgery components used for revision knee replacement are different from a primary knee replacement as they often have extensions called stems and are designed to replace lost bone during the removal of the first knee replacement.

What happens after revision knee replacement surgery?

The day after your knee replacement surgery the knee is mobilised with the help of a physiotherapist. In most cases you are able to walk putting full weight through the leg. You can be discharged within a week following knee replacement surgery and you need to continue with the physiotherapy.  It can often take about 6-8 weeks for the knee to settle down following a revision knee replacement.

What can I expect from my revision knee replacement?

The functional outcome of a revision knee replacement is generally not as good as a primary knee replacement but should help in relieving the pain and improving the mobility, which have been restricted as a result of loosening of the previous knee replacement. In the long run a revision knee replacement may last for a shorter period as compared to a primary knee replacement but 80% of revision knee replacement should be working well more than 10 years after the knee replacement surgery.  If the revision knee replacement has been done for infection, by doing the revision in two stages there is about an 80% chance that the infection will be cured.

What are the risks of a revision knee replacement?

The risks of revision knee replacement are similar to a primary knee replacement and include infection, deep vein thrombosis (a blood clot in the leg vein), pulmonary embolus (when the blood clot in the leg veins goes to the lungs), loosening and wear. Less common complications involved with revision knee replacement can include persistence of pain and stiffness.