Do You Need Revision Knee Replacement Surgery?

After healing from a knee replacement, you may feel like you are walking on sunshine. While you are literally not walking on sunshine, knee replacements do make walking and other activities significantly easier and more enjoyable for individuals who previously had severe knee problems. Although knee replacements are one of the most successful procedures, there are some cases where the knee replacement can fail. When this happens, a second surgery known as revision total knee replacement is usually recommended. During this procedure, your surgeon will remove the old prosthesis and replace it with a new prosthesis. While only your surgeon can determine if revision is necessary, here are some possible indications that you may need revision total knee replacement surgery: 


Infections are a risk associated with any type of surgery and occur when bacteria settles around the wound. In the case of knee replacement surgery, infection can also occur when bacteria are inside the prosthesis itself. Most infections occur within the days immediately following surgery, however it is also possible to develop an infection years later. Some key indications of infection are usual swelling, tenderness, or fluid leakage from the incision. Infections at the surgical site can cause the implant to detach from the bone, which results in knee replacement failure. Additionally, excess fluid produced by swelling can exert pressure on the surrounding tissue causing pain and stiffness throughout the joint. 

The Implant is Worn Out

Of course, another key element in maintaining the results of your knee replacement deals with maintaining the structural integrity of the artificial joint itself. During the initial knee replacement procedure, the prosthetic joint is fixed to the bone. As time passes, the implant may start to become loose due to high impact activities, excess body weight, and general wear of the plastic spacer between the two metal pieces. When the plastic spacer becomes worn, it can cause tiny particles of plastic to accumulate around the joint. The body’s immune system will attack these particles and may even start to attack healthy bone around the implant in a condition known as osteolysis. Unfortunately, this will continue to loosen the implant, causing more pain. 


Prosthetic joints are designed to function with the surrounding soft tissues, specifically the ligaments. In some cases, the ligaments may change slightly, which directly affects the functionality of the prosthetic joint. In addition to swelling, this can also cause your knee to be unstable. While non-surgical treatments such as bracing and physical therapy may be able to treat instability, there are certain cases where revision surgery may be recommended. 


If you are still having trouble with stiffness in your knee joint after having a knee replacement, this is likely due to the fact that excessive scar tissue has accumulated around the joint. Before suggesting revision surgery, it is likely that your surgeon will instead recommend a technique known as “manipulation under anesthesia”. While you are under anesthesia, your surgeon will aggressively manipulate your knee joint in order to break up the scar tissue and increase joint flexibility. If that does not help alleviate your stiffness, then revision surgery may be needed. 


Periprosthetic fractures are breaks in the bone that occur around the prosthetic joint, usually as a result of a fall. Unfortunately, these fractures usually require revision knee replacement surgery to repair the fracture and ensure the functionality of the prosthetic joint. When a fracture is involved, the extent of revision surgery will be directly related to the extent and location of the fracture. 

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