Revision knee replacement refers to the procedure to repair or replace a failed first knee replacement. All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition(s). We expect most knees to last more than 15-20 years. However, there is no guarantee that yours will last that long, and 5-10 percent will not last that long. A second replacement or a “revision” of the first joint replacement may be necessary. Although revision knee replacement can be done, it often doesn’t last as long as the first and carries a higher level of risk for a complicating event.
Why might I require revision knee replacement?
The most common reason for knee replacement failure is loosening of the artificial surface from bone. The cause of this loosening is complicated, but this is a known problem with artificial joints and loosening is not usually a failure of the surgeon who put it in your knee. Wearing of the plastic bearing may also result in the need for a new bearing. Newer plastics for the bearing surface have improved the longevity of knee replacements and represent an exciting improvement in these implants. Additionally, instability or misalignment of the components can result in the need for revision knee replacement.
What can go wrong?
Most surgeries go well, without any untoward event, but you should know…
Infection and blood clots are two serious complications that concern us greatly and which we try to prevent. To avoid these complications, we use antibiotics and blood thinners respectively. We also take special precautions in the operating room to reduce risk of infections. It is important that you understand that the risk of getting an infection can never be eliminated and some patients do get infections. In addition, although the chance of a joint replacement infection is very small, it can occur even many years after surgery, which can happen if you develop an infection elsewhere in your body and the infecting agent travels to your joint replacement.
Blood clots forming in the legs after surgery are serious as they can break off and float to your lungs, which can, in rare instances, be fatal. Great effort is made to get you up walking immediately after surgery and to get you on a blood thinner, Coumadin, to try to prevent the formation of a blood clot. Although not foolproof, this combination of precautions is the best-known way to minimize your risks against blood clots forming or ending up in your lungs.
The most common complicating event of revision knee replacement is the development of joint stiffness after surgery. This is why we employ an aggressive physical therapy program immediately after surgery and for many weeks post-op. Occasionally a knee replacement needs manipulation if motion is not regained adequately.
In addition, there is the possibility of persistent limp, permanent nerve and artery injury and significant blood loss. Other issues that will concern your surgeon and of which you should be aware are wound problems, instability, nerve and blood vessel injury, fracture around the implant, implant failures and blood loss, as well as problems that arise with the urinary and gastrointestinal tracks. Although rare, stroke, heart attack and death have occurred with this surgery.
*Although this list of untoward events is thorough, it is by no means complete and you should ask your surgeon about any other concerns that you have.