Revision Knee Replacement

What is revision knee replacement?

A revision knee replacement is the surgical modification or complete replacement of a previous knee implant that has failed or is causing significant symptoms. As with revision hip surgery, revision knee replacement is more complex than primary surgery and is tailored entirely to the specific mode and extent of failure.

Why might revision surgery be needed?

• Aseptic loosening of the implant from the bone
• Polyethylene wear with potential bone loss (osteolysis)
• Instability from collateral or posterior cruciate ligament failure
• Stiffness (arthrofibrosis) from excessive scar tissue
• Periprosthetic joint infection
• Implant fracture or mechanical failure

What is done — depending on the mode of failure

• Polyethylene exchange — replacement of the plastic insert alone where metal components are well-fixed.
• Tibial or femoral component revision — removal and replacement of one metal component when loose or malpositioned.
• Full revision — complete replacement of all components, often with longer revision stems and metal augments or bone graft.
• Soft tissue management and arthrolysis — careful release of scar tissue (arthroscopic or open) for stiff knees.
• Infection management — DAIR, one-stage, or two-stage revision with antibiotic-loaded cement spacers.

Who is this for?

• Patients with a painful, unstable, stiff or infected knee replacement
• Patients with confirmed implant failure on imaging or laboratory investigation

My approach

• Thorough pre-operative assessment: X-rays, CT, CRP and joint aspiration if indicated
• Zimmer Biomet Persona Revision Knee System — scalable from simple insert exchange to full augmented revision
• Antibiotic-loaded cement for infected cases; collaboration with the microbiology team
• Soft tissue assessment with arthrolysis where stiffness is the primary problem
• Non-infected revision: Meriden Nuffield and UHCW
• Infected revision (PJI): UHCW only

Risks

• Higher infection rate than primary surgery
• Greater blood loss — transfusion may be required
• Stiffness — particularly in patients revised for stiffness
• Periprosthetic fracture
• Risk of further revision

Recovery

Recovery from revision knee replacement is longer than from primary surgery, typically 3–5 days in hospital with a graduated rehabilitation programme over 3–12 months depending on the complexity of the reconstruction. Physiotherapy is an essential component of recovery.