Revision Total Knee Replacement

This article will explain what revision total knee replacement is, why it might be necessary, and the signs indicating it’s needed. We’ll also discuss how to prepare for the surgery, what happens during the procedure, and the recovery process. 

For personalized care and expert advice, consider scheduling an appointment with Orthopedic Specialists & Sports Medicine, with convenient locations in Granville and Coshocton, Ohio.

What is a Revision Total Knee Replacement?

A revision total knee replacement is a surgical procedure done when a previous knee replacement needs to be corrected or replaced. This can happen if the knee implants used in the initial knee replacement surgery wear out, become loose, or cause pain.

Why Would a Revision Knee Surgery Be Necessary?

A revision total knee replacement is necessary when the knee implants from the initial knee replacement surgery no longer function correctly. There are several reasons why this might happen. 

One common reason is that the knee implants wear out over time, which can cause pain and instability in the knee. Another reason could be that the implants become loose, leading to difficulty in moving the knee and doing everyday activities. Infections around the knee joint can also damage the implants and surrounding tissue, making revision surgery necessary to remove the infected material and replace the implants.

Significant bone loss around the knee joint is another issue that might require a revision total knee joint replacement. This bone loss can happen due to wear and tear, infection, or other complications from the initial surgery. When the bone around the knee is weakened, it can affect the stability of the knee implants, making it hard for them to stay in place and function properly.

Signs that revision total knee surgery might be needed include persistent pain, swelling, or stiffness in the knee. If you have trouble walking or feel that your knee is unstable or giving way, these could also be indications that your knee implants are not working correctly. Additionally, if you notice any signs of infection, such as redness, warmth, or discharge around the knee, it’s important to see your doctor.

A surgeon explaining revision total knee replacement using a model of a knee.

How to Prepare for a Revision Knee Replacement Surgery

Preparing for a revision knee replacement surgery involves several key steps to ensure the best outcome. Here’s a simple guide:

  1. Medical Check-Up: Before the revision procedure, your doctor will perform a thorough medical check-up, including blood tests and imaging scans, to plan the surgery.
  2. Medication Review: Inform your doctor about all medications and supplements you take. You might need to stop certain medications, like blood thinners, before the surgery.
  3. Healthy Habits: Adopt healthy habits such as eating a balanced diet, staying hydrated, and exercising as advised by your doctor. If you smoke, try to quit to promote better healing.
  4. Pre-Surgery Instructions: Follow your surgeon’s instructions, which may include fasting before the surgery and using special antiseptic soap to clean your skin.
  5. Home Preparation: Prepare your home for post-surgery recovery by arranging a comfortable, accessible space and placing essential items within easy reach.
  6. Support System: Arrange for help from family or friends during your recovery for tasks like cooking, cleaning, and transportation to follow-up appointments.
  7. Physical Therapy Plan: Plan for physical therapy after the surgery to strengthen your knee and improve mobility.

What Happens During a Revision Knee Replacement Procedure?

During a revision knee replacement surgery, several important steps are taken to replace the old knee implants and address any issues from the initial surgery. Here’s a simple explanation of what happens during the procedure:

  1. Anesthesia: The surgery begins with the administration of anesthesia to ensure you are comfortable and pain-free during the procedure. This can be either general anesthesia, which puts you to sleep, or regional anesthesia, which numbs the lower part of your body.
  2. Incision and Access: The surgeon makes an incision over the knee to access the knee joint. Scar tissue from the previous surgery is carefully removed, including any excessive scar tissue that may be causing stiffness or pain.
  3. Removal of Old Implants: The next step is to remove the old knee implants. This can be challenging, especially if the implants are loose or damaged, or if there is significant bone loss around the knee joint.
  4. Bone Preparation: After removing the old implants, the surgeon prepares the bone surfaces for the new implants. This may involve cleaning and reshaping the bone to ensure a good fit for the specialized revision knee implants.
  5. Addressing Bone Loss and Scar Tissue: If there is significant bone loss, the surgeon may use bone grafts or special materials to rebuild the bone structure. Excessive scar tissue is also removed to improve the range of motion and reduce pain.
  6. Inserting New Implants: The new specialized revision knee implants are then carefully placed and secured. These implants are designed to accommodate the complexities of a revision procedure and provide better stability and function.
  7. Closure and Recovery: Finally, the surgeon closes the incision with sutures or staples and applies a sterile bandage. The knee is usually placed in a brace or bandage to support healing.

What Happens After Knee Revision Surgery?

After knee revision surgery, the recovery process involves several important steps to ensure a successful outcome. Here’s what to expect:

  1. Hospital Stay: After the surgeon performs the revision joint surgery, you will stay in the hospital for a few days. During this time, medical staff will monitor your condition and manage pain with medications.
  2. Initial Recovery: In the first few days, you’ll begin gentle movements to prevent stiffness and blood clots. Your healthcare team will help you start moving and may use a continuous passive motion (CPM) machine to gently bend and straighten your knee.
  3. Physical Therapy: Physical therapy is a crucial part of the recovery process. A physical therapist will guide you through exercises to strengthen your knee, improve your range of motion, and promote healing. This therapy often starts in the hospital and continues at home or in an outpatient facility.
  4. Home Care: Once you leave the hospital, you’ll need to keep the surgical area clean and dry. Follow your doctor’s instructions for wound care and watch for signs of infection, such as increased redness, swelling, or drainage.
  5. Gradual Improvement: Over the next few weeks and months, your knee will gradually improve. It’s important to continue physical therapy and follow your surgeon’s advice on activity levels to ensure a smooth recovery.
  6. Follow-Up Visits: Regular follow-up visits with your surgeon are necessary to monitor your progress and address any concerns.

By following these steps and actively participating in physical therapy, you can enhance your recovery after knee revision surgery and achieve better knee function and mobility.

What Are Some Alternatives to Revision Surgery?

While revision total knee replacement surgery is sometimes necessary, there are alternatives that might be considered before deciding to perform revision joint surgery. Here are some common alternatives:

  • Medication Management: Pain relievers and anti-inflammatory medications can help manage symptoms and reduce discomfort. Prescription medications might also be used to address specific issues.
  • Physical Therapy: A structured physical therapy program can strengthen the muscles around the knee, improve flexibility, and reduce pain. Therapists can tailor exercises to target problem areas and enhance knee function.
  • Injections: Corticosteroid injections can reduce inflammation and relieve pain in the knee joint. Hyaluronic acid injections may also be used to lubricate the joint and improve movement.
  • Assistive Devices: Using assistive devices like braces, canes, or walkers can help reduce strain on the knee and improve mobility.
  • Lifestyle Modifications: Making lifestyle changes such as losing weight, modifying activities to avoid high-impact exercises, and practicing low-impact exercises like swimming or cycling can help manage symptoms and improve knee health.
  • Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, massage, or chiropractic care.

If these alternatives do not provide sufficient relief, your doctor may then recommend revision joint surgery to address the underlying issues and improve your knee function.

Seek Expert Care for Your Knee Health

If you’re struggling with knee pain or instability, seeking expert advice is crucial. At Orthopedic Specialists & Sports Medicine, our experienced team is dedicated to helping you achieve the best possible outcomes. 

With multiple locations in Ohio, including Granville and Coshocton, we’re conveniently located to serve your needs. Schedule an appointment today to discuss your options and start your journey to better knee health!

Medically reviewed by Alex Tancevski, M.D.