Knee Replacement Revision Surgery

During this surgery, a surgeon removes the old knee implant and replaces it with a new one. In some special cases, the surgeon may only remove a part of the old implant. In many cases, special revision components including stems within the thigh bone and shin bone may be implanted to allow the patient to return to a similar level of support and range of motion. If there has been significant bone loss, the surgeon may address that as well with a combination of bone grafts, wires, metal augments, and metal cones to support and offset the immediate stress to the bone.

• Someone whose original implant has become loose from the bone. Maintaining an active lifestyle over time will result in wearing of the highly engineered plastic insert and may result in the loosening of the implant. Increases in body weight can also play a major role in implant loosening.
• Someone whose implant has reached the end of its useful life (usually 15-30 years) and is ‘worn out’. This is caused over time by friction of the implant parts.
• Someone whose original implant has become infected. Infection is the most common cause for revision within the first two years of surgery. Despite being the leading cause of early failure, a total knee replacement can become infected even years after the surgery.  Infection is a very devastating complication and OrthoNebraska takes extra care during the first surgery to avoid infection in the first place.
• Someone whose joint has become too stiff for them to tolerate due to excessive scar tissue built around the knee joint.

More than 90 percent of patients should expect good to excellent results, meaning significant pain relief, stability and function of the affected knee. The most likely symptom to remain is mild pain. In rarer cases, pain will always be an issue. Fortunately, in most cases, over-the-counter pain medications can usually treat the remaining level of pain.

Revision surgery is more complex, and thus has slightly higher risks of typical surgical complications such as blood clots, infection or anesthesia problems than an original knee replacement.

After your surgery is scheduled at OrthoNebraska Hospital, a nurse navigator will reach out to you to discuss your needs and encourage you to review our online educational videos and guide to help you prepare.

Some examples of things we will encourage you to do:

• Plan on having some help at home for the first few weeks after your procedure. Although you may be functionally independent a bit sooner, you will likely tire easy and want at least some help.
• Plan ahead at home and think about ways to make maneuvering around your house and kitchen easier, clearing obstacles out of the way, and removing large rugs.
• Make sure all handrails are secure and that loose cords are tucked away to prevent falling.

You will need a pre-surgical physical from your primary care doctor and possibly other specialists such as Cardiology and/ or Pulmonology to ensure you are healthy for surgery at OrthoNebraska. After you check in at the hospital on the day of surgery, you will speak with your physician and anesthesiologist before surgery. The anesthesia team will discuss the various levels of sleep you might be appropriate for based on your individual needs, which may include a nerve block, spinal, or general anesthesia. Your surgery will likely take approximately 2-3 hours. Following surgery, you will be in the recovery room for another 1-2 hours before going upstairs to your private room.

Once you are settled in your room, your therapy team and nurse navigators will work with you and your doctor to monitor your progress toward independence with your discharge goals. While this is highly individual, many patients are able to discharge back to home the next day. Whether you are going home with help or alone, you can feel confident that your discharge plan is safe for you.

You will feel mostly back to ‘normal’ after eight to twelve weeks. Full recovery may take about a year, dependent on your general health and dedication to measured progress in therapy.