Revision Knee Replacement

What is a revision knee replacement?

A revision knee replacement is an operation to replace or adjust part or all of a previous knee replacement. It may involve exchanging only the plastic insert, or replacing the metal components on the thigh bone and shin bone and rebuilding bone that has been lost. Revision is a more demanding operation than a first replacement. Dr. Stepanyan completed a fellowship in adult reconstruction at the University of Pennsylvania and treats failed knee replacements regularly.

Why do knee replacements fail?

A German study of revision total knee surgeries found that the most common reasons were infection, loosening, instability, and wear or osteolysis of the implant. Stiffness and pain with no clear cause are also frequent.¹ Early failures, within the first two years, are more often due to infection, instability or stiffness. Later failures are more often wear, loosening, or fracture around the implant.

How do I know if my knee needs revision?

Warning signs include new or persistent pain, pain starting up from a chair, swelling that does not settle, a feeling that the knee gives way, a knee that will not bend or straighten, grinding or clicking, or redness, warmth or drainage near the incision. Some problems, such as early loosening or wear, show up on X-rays before they cause symptoms. That is one reason regular follow-up matters even when the knee feels fine.

How is the problem worked out?

A painful knee replacement needs a diagnosis before an operation. Dr. Stepanyan reviews your surgical records and implant type, examines your alignment, stability and motion, and orders X-rays and sometimes a CT scan. Blood tests, and sometimes a sample of joint fluid, check for infection, which must be ruled in or out because it changes the treatment completely. Problems outside the knee, such as the hip or the spine, can also be the source and are considered.

Is surgery always the answer?

No. A stiff knee may improve with a focused therapy program or a manipulation under anesthesia within the first few months. Pain from a nearby tendon or the back can be treated without touching the implants. Revision is recommended when the implant is the problem and pain, instability or function are suffering enough to justify a larger operation.

What happens in a revision?

The operation is planned around the cause. The surgeon removes the failed components while preserving as much bone as possible, cleans the joint, treats bone loss with specialized implants, wedges, sleeves or bone graft, and sets new components that are stable and well aligned. Some implants add stems that extend into the bone for support. When infection is the cause, a two-stage approach is common, with an antibiotic spacer placed first and a new implant placed later after the infection clears.

Revision takes longer than a first replacement, and most patients stay in the hospital a few nights.

What outcomes can I expect?

Many patients get good pain relief and improved function after revision, particularly when the cause is clear and has been fixed. Results are less predictable than after a first replacement, and there is a higher chance of needing further surgery. Dr. Stepanyan will discuss realistic expectations for your situation before you decide.

Should I get a second opinion?

Yes, if you have had ongoing pain or stiffness since a knee replacement and nobody has found a cause, or if a revision has been recommended and you want to be sure. Request a visit and bring your operative notes, X-rays and any prior lab results.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees knee patients in Glendale, East LA and Santa Fe Springs. He operates at Adventist Health Glendale, Glendale Memorial Hospital, Adventist Health White Memorial and White Memorial Montebello, and Providence Saint Joseph Medical Center.

What does recovery look like?

Revision recovery varies with what was done. These are general stages; your plan will be tailored to your surgery.

1. Weeks 0–2

   Protect and move

   Most patients stay a few nights and start walking with a walker the same or next day. Early motion is encouraged unless a tendon or bone was reconstructed, in which case your plan may add a brace or limits.

2. Weeks 2–6

   Regain motion

   Therapy focuses on bending and straightening the knee, and you progress from walker to cane as your leg allows.

3. Weeks 6–12

   Build strength

   Restrictions ease and strengthening increases. Many patients return to light activity and driving in this window.

4. 3–12 months

   Full recovery

   Strength and endurance continue to improve for up to a year. Periodic X-rays check that the new implant stays stable.

Ask Dr. Stepanyan what limits apply to you and for how long. Call the office promptly for fever, new drainage, increasing pain, or a knee that feels unstable.

Sources

1. Postler A, Lützner C, Beyer F, Tille E, Lützner J. Analysis of total knee arthroplasty revision causes. BMC Musculoskelet Disord. 2018;19(1):55. PubMed