Revision Knee Replacement Surgery

You probably know someone who's had their knee replaced - or maybe another joint, like a hip or shoulder. Joint replacement surgery is a very common procedure in the United States. However, sometimes, if the artificial joint gets damaged or worn, people need revision knee replacement surgery to correct the issue.

"Compared to the 800,000 knee replacements done in the U.S. each year, revision surgeries are much less common," explains Lucian C Warth, MD, an orthopedic surgeon at the Center for Hip & Knee Surgery at Franciscan Health Mooresville. Read on to learn what happens when a knee replacement fails and why a revision is sometimes necessary.

Knee Replacements Don't Always Last 20 Years

With today's technology and materials, a typical knee replacement can last 20 to 25 years. But if someone had knee replacement surgery early in life, say in their 40s or 50s, that knee replacement might not last a lifetime, although many still do.

Why A Knee Replacement Might Need Revision Surgery

After years of excellent function people often need revision knee replacement surgery when the cement fixation of the artificial joint to the bone loosens.

"When loosening occurs, the knee can become painful, and the joint has stiffness around the bone a little bit," Dr. Warth said. "This can cause swelling and may hurt as bad as an arthritic knee. We then do a revision." An orthopedic specialist may need to use specialized imaging - such as computerized tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound or bone scans - to determine the issue with the artificial joint.

Infection With Knee Replacement

In the U.S., artificial knees also can fail due to infection, many of which we can prevent. Most who get an infection develop it years after surgery.

"The knee is doing well, and then the person develops another health condition that predisposes them to infections, such as diabetes or peripheral vascular disease," Dr. Warth said.

They can then develop an infection in another part of their body. Bacteria enter the bloodstream, and it can infect the artificial joint.

Preventing Infection With A Joint Replacement

Though rare, people can still take steps to prevent infection in their artificial joint. For example, doctors prescribe antibiotics before visiting the dentist or undergoing a colonoscopy.

Thankfully, many people live normal lives with a condition that raises their infection risk but never get an infection.

Other Causes For Knee Replacement Pain

"There are lot of reasons a joint replacement may hurt, and some don't have to do with the joint," Dr. Warth said.

These issues include soft tissue problems (such as a sprain), nerve problems like a pinched nerve or even back problems. An orthopedic specialist experienced in primary and revision joint replacement can provide an accurate diagnosis and recommend effective treatment for joint pain.

How To Know When You Need Revision Knee Replacement Surgery

Pain in your knee replacement may mean you need knee revision surgery.

"If it's affecting your quality of life and slowing you down, that is one reason for a possible revision," Dr. Warth said.

However, for your health and safety, you'll need to undergo the revision procedure if an infection develops in your knee replacement.

Recovery From Revision Knee Replacement Vs. Primary Knee Replacement

Notable differences between an initial knee replacement and subsequent replacements include:

• Final outcome may be different. "You come in for primary knee replacement, and everything heals - you can walk all day long," Dr. Warth said. "You may not be able to do that for a revision. You may experience more stiffness, for example, and it won't feel as much like a normal knee."
• Higher risk of infection at the time of surgery. Any subsequent surgery on the same area of the body poses a higher risk of infection. This risk happens due to less healthy tissue, scarring and repeated surgery to the site.
• Joint doesn't last as long. In most cases, revision knees only last 12 to 15 years before the person may need more surgery or another replacement. This happens because there is less bony support with more stress on the joint.
• Longer hospital stay. A healthy person with good at-home support may be able to return home the same day as their first knee replacement surgery. Most people undergoing revision knee replacement surgery will need to stay in the hospital for two or three days.
• More extensive surgical procedures. "Because bones weaken as we age, surgeons have to use larger implants and sink them deeper into the bone to get a good stable implant," Dr. Warth said.

Physical Therapy After Revision Knee Replacement Surgery

Physical therapy after knee revision surgery resembles physical therapy after the initial joint replacement. The person begins physical therapy in the hospital after surgery and practices simple exercises they can do at home. Two or three days later, they begin outpatient physical therapy after they leave the hospital.

Successful Recovery From Revision Knee Replacement

To ensure successful recovery after revision knee replacement surgery, Dr. Warth suggests:

• Do physical therapy exercises at home
• Follow the advice of a physical therapist, doctor and nurse
• Keep appointments with doctors and therapists
• Keep the wound clean
• Avoid running, extensive pivoting or jumping

"Most of the time, people fall because they get in a hurry or have an accident," Dr. Warth said. "If they go slow, steady and controlled, they generally do pretty well."

Finding The Right Revision Knee Replacement Surgeon

When facing any type of surgical procedure, you want a surgeon with experience and success. This is true for more complex revision surgeries.

"A lot of orthopedic surgeons are well-trained and quite comfortable doing primary joint replacements but are not as comfortable doing revision surgery," Dr. Warth said. "A large number of patients are referred to us from outside institutions for revision operations."

If you think you may need a revision knee replacement, contact the joint replacement surgeons at Franciscan Health to schedule a consultation - and get started on your journey to less pain.