Revision Knee Replacement Explained

Modern knee replacement is one of the most successful procedures in orthopaedic surgery, helping thousands of Australians every year return to walking, travelling, sport and everyday activities with significantly less pain.  The vast majority of knee replacements provide excellent function and continue to perform well for many years.

Occasionally, however, a knee replacement may develop a problem that requires further surgery.  This is known as a revision knee replacement.  Revision surgery may involve replacing one or more components of the existing knee replacement to restore function, relieve pain and improve stability.

Revision knee replacement is often more complex than primary knee replacement and requires careful planning, specialised implants and an experienced multidisciplinary team.  This guide explains why revision surgery may be necessary, what it involves and what patients can expect during recovery.

At a Glance

This article covers:

• What revision knee replacement is

• Why some knee replacements require revision surgery

• The most common reasons for revision

• Symptoms that should not be ignored

• How revision surgery differs from primary knee replacement

• Recovery after revision surgery

• Frequently asked questions

Revision knee replacement involves removing one or more components of an existing knee replacement and replacing them with new implants.

Depending on the underlying problem, surgery may involve replacing:

• The plastic (polyethylene) insert only

• The femoral component

• The tibial component

• The patellar component (where appropriate)

• Or the entire knee replacement

The operation is tailored to each patient's individual circumstances and may require specialised implants designed to address bone loss or instability.

Modern knee replacements are designed to last for many years.  The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) continues to demonstrate excellent long-term survivorship for contemporary knee replacements.

However, no artificial joint lasts forever, and a small proportion of patients may require revision surgery because of implant-related or patient-related factors.

The reason for revision depends on several factors, including:

• The age of the implant

• Bone quality

• Previous surgery

• Medical conditions

• Activity level

• The underlying cause of the problem

Infection

Although uncommon, infection remains one of the most serious complications following knee replacement.  Symptoms may include:

• Increasing pain

• Swelling

• Redness

• Wound drainage

• Fever

Treatment depends on the timing of the infection and may involve debridement, one-stage revision or two-stage revision surgery.

Implant Loosening

Over time, the bond between the implant and bone may weaken.  Symptoms often include:

• Progressive pain

• Pain when walking

• Swelling

• Reduced confidence

Loosening remains one of the leading reasons for revision surgery many years after the original operation.

Instability

A knee replacement should feel stable during walking and everyday activities.  Instability may occur due to:

• Ligament imbalance

• Component position

• Soft tissue laxity

• Trauma

Patients often describe the knee as "giving way" or feeling unreliable.

Polyethylene Wear

The plastic bearing between the metal components slowly wears over many years.  Excessive wear may lead to:

• Pain

• Bone loss

• Implant loosening

• Reduced function

In selected patients, replacing the polyethylene insert alone may be appropriate.

Stiffness

Some patients develop persistent stiffness following knee replacement.  When physiotherapy and non-operative treatments have not restored movement, revision surgery may occasionally be considered.

Periprosthetic Fracture

A fall can result in a fracture around the knee replacement.  Treatment depends on:

• The location of the fracture

• Whether the implant remains stable

• Bone quality

Some fractures require fixation, while others require revision knee replacement.

Seek specialist review if you experience:

• Increasing pain after a previously successful knee replacement

• Persistent swelling

• Instability or the knee giving way

• Difficulty walking

• Progressive stiffness

• New deformity

• Signs of infection

Early assessment often allows problems to be identified before they become more complex.

Revision surgery is generally more technically demanding than primary knee replacement.

It may involve:

• Removing well-fixed implants

• Managing bone loss

• Reconstructing damaged bone

• Balancing ligaments

• Using stems, augments or cones

• Longer operating times

Careful planning is one of the most important factors in achieving a successful outcome.

Recovery varies depending on:

• The reason for revision

• The complexity of surgery

• Bone quality

• Overall health

Most patients begin walking soon after surgery with the assistance of physiotherapists and possibly a walking aid.  Compared with primary knee replacement, recovery is often:

• Slightly slower

• More individualised

• Dependent on bone healing where reconstruction has been required

Most patients continue improving throughout the first year after surgery.

Is revision knee replacement more difficult than the first operation?

Yes.  Revision surgery is generally more complex because implants may need to be removed, bone defects reconstructed and specialised implants used.

How long do revision knee replacements last?

Modern revision knee replacements have excellent long-term results, although longevity depends on the underlying reason for revision, bone quality and patient factors.

Will recovery take longer?

In many cases, yes.  Recovery is often slower than after a primary knee replacement because revision surgery is usually more extensive.

Can an infection always be treated with one operation?

Not always.  Some infections can be managed with a single-stage procedure, while others require a planned two-stage revision depending on the bacteria involved, the surrounding tissues and patient-specific factors.

Can I return to normal activities afterwards?

Many patients return to walking, travel, golf and other low-impact recreational activities after successful revision surgery.  Your rehabilitation programme will be tailored to your individual needs.

If you have previously had a knee replacement, consider seeking specialist review if:

• Has my knee become progressively more painful?

• Has my walking distance reduced?

• Does my knee feel unstable?

• Is my knee becoming stiffer?

• Has my quality of life declined?

Early assessment often makes treatment simpler and may help preserve bone and improve long-term outcomes.

Disclaimer: This article provides general information only and should not replace personalised advice from your orthopaedic surgeon, GP or physiotherapist.  Every revision knee replacement is different, and treatment recommendations should always be tailored to your individual circumstances.