Revision Knee Replacement

Total knee revision surgery is the replacement of a failed total knee prosthesis with a new one.

A knee revision may require the replacement of only one implant or the complete exchange of all the prostheses that were implanted during the original knee replacement surgery.

Total knee revision surgery is when all prostheses are replaced. It is a highly skilled procedure. Your surgeon must remove the original implant, which would have grown into your existing bone. There is also less bone remaining and a bone graft may be needed to support the new prosthesis.

Knee revision surgery is a complex procedure. It requires extensive preoperative planning, specialised implants and tools, long operating times, and experience with complex surgical techniques to achieve a good result. Ramsay is pleased to have skilled surgeons who competently perform total knee revision surgery.

You might need a total knee revision if your prosthetic knee implant fails. Often, a knee replacement lasts a lifetime in the elderly. But in younger patients, especially those with an active lifestyle, knee prostheses may eventually need replacing.

The most common reasons people have a total knee revision are:

• Infection – occurs in about 1% of all primary joint replacements. Infection usually presents as pain but you may also have swelling or stiffness. Depending on the degree of infection your surgeon may perform a simple washout of your knee or completely exchange your implants with new ones.
• Instability - is when the soft tissues around your knee cannot provide the stability necessary for adequate function when standing or walking. You may feel pain and/or a sense of the knee "giving away".
• Wear and tear - can include loosening, wearing out, or breaking of prosthesis components, often due to friction over time.
• Stiffness - in some patients. The build-up of excessive scar tissue around the knee prevents the joint from moving fully.
• Fracture - of weak bones around the implant due to age, osteoporosis, or a fall or other trauma. A fracture can disrupt the fixation or the stability of the implant. An operation to stabilise and fix the fracture and replace the artificial joint parts may be required.

The success rate of a revision knee replacement depends on the patient and if it is a first or further revision surgery.

The longer your primary prosthetic knee lasts, the longer your first revision (second prosthetic knee) is likely to last. Males and younger patients are at higher risk of multiple revisions.

If knee replacements are revised, successive revision procedures are progressively less successful¹. This means that patients who undergo a revision have a steadily increasing risk of further revision the more procedures they have. Each subsequent revision lasts for approximately half the time of the previous one².

Research shows that in patients who have a primary total knee replacement, there is approximately a 20% chance that their knee will be revised within 25 years².

Patients who have a revision knee replacement have a 20% chance that this second knee will need replacing within 13 years by a second revision and the implantation of a third prosthetic knee. A second revision has a 20% chance of needing a third revision within 5 years (a fourth prosthetic knee) which in turn has a 20% chance of undergoing a fourth revision (fifth prosthetic knee) within 3 years².

A knee replacement revision can be performed multiple times. With each knee revision surgery, your chance of needing another knee revision increases.

Like all major surgical procedures, there may be certain risks and complications involved with total knee replacement revision surgery.

Possible complications after total knee replacement revision include:

• Stiffness in your knee and continued limited range of motion in your knee
• Infection of your surgical wound or your joint
• Bleeding around your joint - this usually settles but it may need draining by your surgeon
• Injury to your nerves resulting in numbness to the outside of your knee
• Rejection of your prosthesis
• Kneecap dislocation (rare)
• Ligament injuries
• Fracture of the bone during the fitting of your joint implants.

The length of time to recover after knee replacement revision surgery can vary compared to your first knee replacement. Often patients take longer to recover from total knee revision surgery than their original knee replacement surgery.

As with your initial knee replacement, it is important to stand and start walking as quickly as possible afterward. At first, you will require an assistive walking device such as a cane, crutches, or walker.

Your surgeon may recommend blood thinners or special compression stockings to help prevent blood clots.

You can expect to go home in two to five days. Your mobility will be limited so you may need help with household tasks like cooking, shopping, and bathing for several weeks.

Physiotherapy helps to restore your range of motion and strengthen your leg. You should take pain relief as needed so that you can do your rehabilitation. Physiotherapy and specific exercises may be needed for three months or longer. You should follow your physiotherapist’s advice.

If you decide to pay for your treatment, Ramsay offer an all-inclusive Total Care package, where a single one-off payment at a pre-agreed price, delivering direct access to all the treatment you need for complete reassurance. You can also spread the cost of your treatment with finance options available. The knee replacement (knee arthroplasty) cost depends on your local Ramsay facility, to find out more information around knee replacement surgery cost click here.

The procedure may be covered by your medical insurance policy. We advise you to check directly with your insurance provider and get written confirmation before commencing treatment. 

One of the major advantages of seeing a knee surgeon privately is that your appointments and treatment are arranged at times to suit you and without any unnecessary waiting. This is especially important if you are in a lot of pain or if you want to avoid particular dates for surgery.

You will be treated by an experienced orthopaedic surgeon with a special interest in knee surgery who will be able to discuss your individual needs and select the best prosthesis for you.

Additional benefits of being a Ramsay Private patient include:

• choice of consultant, where possible
• rapid access to expert opinion on the best treatment for you
• fast track admission and discharge
• single bedded rooms with en suite bathroom and flat screen TV
• choice from our a la carte menu as an inpatient