Revision knee replacement at Brentwood Hospital

What is revision knee replacement?

Revision knee replacement is a surgical procedure that involves removing a previous knee replacement (either total knee replacement or partial knee replacement) and replacing it with a new artificial joint. Over time, knee replacements can fail due to wear, loosening, infection, fractures, or misalignment, causing pain, stiffness, and instability.

Your consultant will examine the knee and may order X-rays, blood tests, or an MRI scan to assess the condition of the implant(s) and the surrounding bone and soft tissue. If your knee implants have failed, your surgeon may recommend revision knee replacement surgery.

Why might you need a revision knee replacement?

• Aseptic loosening: The bone between the implant and bone can weaken over time, even when there's no infection. Aseptic loosening can also occur with implants fixed with bone cement. The cement breaks down or loses its bond with the bone.
• Wear and tear of the implant: Over time, the implant can wear down, particularly the plastic spacer between the metal components. Tiny particles may be released into the surrounding tissue, causing inflammation, bone loss (osteolysis), or loosening of the implant from the bone.
• Infection: An infection around the implant can damage the bone and soft tissue, making the implant unstable.
• Dislocation: If the implant moves out of its proper position, revision knee replacement may be necessary to restore the alignment and function.
• Fracture: A break of the femur of the thigh bone (femur) and shin bone (tibia) can make the implant unstable and require a revision knee replacement.

Your consultant will conduct a comprehensive examination of the knee and may order X-rays, blood tests, or an MRI scan to assess your current implant(s) thoroughly. If your knee implants have failed, your surgeon may recommend revision surgery.

What happens during a revision knee replacement?

During the surgery

Revision knee replacement usually performed under general anaesthesia. The procedure can take up to 2 hours, depending on the condition of your implants and if there is bone loss.

1. Your surgeon will make an incision (cut) down the centre of your knee.
2. Your old implants will be carefully removed.
3. Your surgeon will examine the bone surfaces to determine if bone grafts or augments (metal pieces) are needed to rebuild the areas with bone loss. 
4. The new knee implant is inserted. Your surgeon will adjust any soft tissue, muscles and ligaments around the joint to ensure the new joint is stable and moves well when the leg is bent and straightened.
5. The cut is closed with stitches or surgical clips, and a padded dressing is applied.

After the surgery

Once your operation is over, you’ll be taken to the recovery room where you will wake from the anaesthetic. Your wound, blood pressure and pulse will be checked carefully. You will have a large dressing covering your wound. You may have a small tube coming out of your wound; this is used to drain any excess fluid from the inside of the wound.

You may also have a drip (infusion) going into your arm. This will keep you hydrated until you can drink, and it can also provide pain relief.

You will need to stay in the hospital for several days. Be sure and let us know if you are in pain. You may need to wear compression stockings to prevent blood clots, also known as deep vein thrombosis (DVT).

A physiotherapist will help you get up and start moving around on your own. They will give you some exercises to help get your knee moving. These are important to help you make a good recovery. The therapist will also show you how to walk up and down stairs and make sure you are confident at doing this before you go home. You won’t be able to drive, so you will need someone to come and take you home from the hospital.

Recovery from revision knee replacement

You will go home using crutches or a walker. Be sure to continue taking any prescribed pain relief medication. Good pain management will help you regain your mobility.

When you get home, it is essential to rest. However, it’s also important to aim to gradually increase your physical activity each day, so you should continue with the exercises the physiotherapist showed you. These will help to reduce stiffness and strengthen your legs. You will need to keep using crutches or a walking stick for a while. To help you manage and increase mobility, it’s recommended that you take any pain relief medication we have prescribed. Continue taking this until you are pain-free.

Everyone heals differently. You will continue to improve over the next 6 to 12 months. Your scar should fade to a thin white line.

Depending on what type of job you do, you should be able to return to work within twelve weeks. You may want to think about a phased return to work.

After your follow-up visit with your surgeon, you should be released to drive, provided you can comfortably operate the pedals and control your car in all situations. This includes an emergency stop. If you are in any doubt about your insurance cover, it’s best to contact your insurance company.

Complications of revision knee replacement

Most people make a good recovery and return to normal activities following revision knee replacement. As with any surgery, there can be complications, such as:

• Pain
• Bleeding
• Infection of the surgical site (incision)
• Scarring
• Blood clots (DVT - deep vein thrombosis)

Specific complications of revision knee replacement surgery are:

• Splitting of the bone can occur when the new implant is inserted, particularly if the bone is weak and brittle. 
• Damage to ligaments and tendons near your knee.
• Nerve damage around your knee, leading to weakness, numbness or pain in your leg.
• Infection in the joint.
• Aseptic loosening - loosening of the joint without infection.
• Dislocation of the knee replacement.
• Stiffness - further minor surgery may be needed to improve this.
• Complex regional pain syndrome: A rare but serious complication involving chronic pain, stiffness and limited use of the knee after surgery.