Understanding Total Knee Replacement Failure and Revision Surgery

Total Knee Replacement Failure: Total knee replacement may encounter various reasons for failure, including wear/loosening of the prosthesis, infection, instability, and peri-prosthetic fracture. When a knee replacement fails, patients may experience pain, swelling, stiffness, and instability, hindering their everyday activities.

Primary vs. Revision Knee Replacement: Revision knee replacement differs significantly from primary total knee replacement. It is a longer and more complex procedure, requiring meticulous planning, specialized implants, and tools. During revision surgery, the old or damaged implants are removed, and new constrained implants are used to address the specific issues.

Causes of Implant Loosening: The exact cause of implant loosening may not always be clear. Factors such as high-impact activities, excessive body weight, and wear of the plastic spacer between the metal components of the implant can contribute to loosening. Over time, friction between metal and plastic spacers generates wear particles, leading to bone loss (osteolysis) and component loosening.

Septic Revision for Infection: Infection is a serious complication of joint replacement surgery. In cases of proven joint infection, the implant must be completely removed, and infected tissue is debrided as a first-stage procedure. A temporary cement spacer, leaching antibiotics to fight the infection, is placed in the knee, remaining there for twelve weeks. Intravenous antibiotics are also administered during this period. Once the infection is cleared, a second surgery is performed to remove the antibiotic spacer and insert a new prosthesis.

Other Reasons for Revision: Besides infection and loosening, knee instability is another common reason for revision surgery. If the knee “gives way” or buckles after knee replacement, it could indicate improper balancing or a soft tissue/ligament rupture, requiring potential revision surgery.

Periprosthetic fracture around the knee prosthesis components may also necessitate revision surgery, often resulting from a fall. The extent of the revision depends on factors like the remaining bone quality, fracture type, and location, and the presence of implant loosening.

Complications of Revision Surgery: Revision surgery, like any major procedure, carries potential complications, including poor wound healing, knee stiffness, infection at the wound site or new prosthesis, bleeding, blood clots, bone fracture during surgery, and rare injuries to nerves or blood vessels.

At Dr. Sunil Choudhary’s clinic, we prioritize patient safety and employ advanced techniques to minimize the risk of complications during revision knee replacement. Our skilled and experienced team ensures personalized care and successful outcomes for all patients.