Revision total knee replacement

What is a revision total knee replacement?

A revision total knee replacement is an operation to take out parts of your old knee replacement and put in new ones.

A knee replacement can fail for the following reasons.

• wearing out of the artificial joint
• infection in your knee replacement
• dislocation (coming out of joint)
• fracture (break) of the femur or the tibia around your knee replacement

What are the benefits of surgery?

You should get less pain and be able to walk more easily.

Are there any alternatives to surgery?

If your symptoms are mild, you and your surgeon may decide to watch and wait for a while.

If your knee replacement keeps coming out of joint, you can wear a brace to try to keep your knee in place.

If you have an infection in your knee replacement, using antibiotics over the long term you sometimes prevent your knee replacement from failing.

If you have a fracture near your knee but the replacement is still well fixed to the bone, your surgeon may be able to fix the break with plates and screws without changing your knee replacement. Sometimes the break can be treated using a splint or cast.

What does the operation involve?

Various anaesthetic techniques are possible.

Your surgeon will make a cut on the front of your knee. They will remove your knee replacement and any cement.

Your surgeon will put in a new knee replacement, which is often larger than your old one.

Your knee replacement is fixed into the bone using acrylic cement or special coatings on your knee replacement that bond directly to the bone.

The type of surgery you need can be more complicated if you have an infection, or the bone is thin or broken.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• bleeding
• difficulty passing urine
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• acute kidney injury
• blood clot in your leg
• blood clot in your lung
• chest infection
• heart attack
• stroke

Specific complications of this operation

• split in the bone when your knee replacement is inserted
• damage to ligaments or tendons near your knee
• damage to nerves around your knee
• damage to blood vessels around your knee
• infection in your knee
• loosening
• dislocation of your knee replacement
• continued discomfort in your knee
• severe pain, stiffness and loss of use of your knee

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You can go home when your pain is under control, you can get about safely, and any care you may need has been arranged.

You will need to use walking aids until you can walk well without them. It often takes longer to recover from a revision knee replacement than your first knee replacement. If your knee replacement does not bend well, your surgeon may need to manipulate it (risk: 1 in 40).

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery and most revision total knee replacements work well.

A revision total knee replacement can fail with time, if it wears out, or the original problem comes back.