What Is Revision Knee Replacement?
Procedure, Indications, and Surgical Approach
Revision knee replacement surgery involves removing a previously implanted knee prosthesis and replacing it with a new, more advanced implant. This procedure is typically performed when the original knee replacement fails for various reasons.
Common Reasons for Revision Knee Replacement
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Aseptic loosening of the implant
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Infection around the joint prosthesis
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Joint instability or dislocation
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Fracture involving the implant or surrounding bone
These issues often cause pain, swelling, difficulty walking, or reduced joint function.
Advanced Implant Selection Based on Damage
When a revision is performed, bone loss and ligament stretching are common. To restore stability, a more constrained implant design—such as a semi-constrained or hinged prosthesis—is often used to compensate for weakened structures.
Two-Stage Surgery for Infections
In infected cases, a two-stage revision knee replacement is the gold standard:
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Stage 1: Remove the infected implant, thoroughly clean the joint, and place an antibiotic-loaded cement spacer.
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Wait Period: 6–8 weeks for infection control.
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Stage 2: Reopen the site, remove the spacer, clean again, and implant the new prosthesis.
Single-Stage Revision for Non-Infectious Cases
In non-infectious revisions—such as loosening or instability—the entire procedure can often be done in one stage, offering faster recovery.
Component-Specific Revisions
In early or mild infections, it is sometimes sufficient to debride the area and replace only the polyethylene insert, preserving the other components if they remain stable.
Longer Surgery Requires Patient Optimization
Revision knee surgery is typically more complex and time-consuming than the primary procedure. Patients must be medically optimized in advance to ensure safety during anesthesia, minimize complications, and support better outcomes.
Implant Constraint Affects Longevity
More constrained implant designs, though necessary for stability, may have a shorter lifespan than standard implants due to increased stress on the components.
