Revision (redo) knee replacement

When a Second Surgery May Be Needed

Most knee replacements work very well and last many years. However, for a small number of patients, problems can develop over time. When this happens, revision knee replacement may be recommended to improve symptoms, stability and function.

Revision surgery means replacing part or all of an existing knee replacement to address pain, movement problems or mechanical issues. This will normally be conducted in one operation, termed a single-stage revision.

Why might revision knee replacement be necessary?

There are several reasons why a knee replacement may not perform as expected or may stop working properly over time. Common reasons include:

  • Loosening of the implant, where the artificial joint no longer attaches firmly to the bone
  • Infection, which can occur early or even years after surgery
  • Instability, where the knee feels like it may give way
  • Stiffness or reduced movement that limits daily activities
  • Wear or damage to the implant over many years
  • Malalignment of the original implant

Mr Pavlou will carefully investigate the cause of the problem, often using X-rays, CT and MRI scans, isotope scans, blood tests, analysis of joint fluid in the knee and a detailed clinical assessment before recommending revision surgery.

What is revision knee replacement?

Revision knee replacement is more complex than first-time knee replacement. Surgery involves removing the original implant and replacing it with new components designed to restore strength, stability and alignment.

This requires a process of detaching the implant from the bone, which can leave defects in the bone and soft tissues. These then need to be addressed during reconstruction using special techniques and revision-type implants to provide extra support.

Techniques used in revision knee replacement

To create a stable and long-lasting result, surgeons may use additional supportive components.

Stems

Stems are extensions attached to the knee implant that fit deeper into the thigh or shin bone. They help:

  • Improve stability
  • Spread weight more evenly
  • Anchor the implant securely

You can think of stems like reinforcing posts that provide extra strength.

Cones

Cones are metal supports used when there has been bone loss around the knee joint. They:

  • Fill gaps where bone is missing
  • Provide a solid foundation for the new implant
  • Help the implant bond securely to the bone

Cones are especially useful in more complex revision cases.

Metaphyseal sleeves

Metaphyseal sleeves are specially shaped metal components that fit tightly into the upper part of the bone near the knee. They:

  • Encourage bone to grow onto the implant
  • Provide strong, long-term fixation
  • Help restore stability when bone quality is reduced

Mr Pavlou will choose the most appropriate combination of these tools based on your individual needs.

Benefits of revision knee replacement

For many patients, revision surgery can offer:

  • Reduced pain
  • Improved stability and confidence when walking
  • Better knee function
  • Improved quality of life
  • Correction of problems from the original knee replacement

While recovery may take longer than a first knee replacement, many patients experience meaningful improvement. It is important to remember that revision surgery is less predictable than first-time knee replacement. It is often conducted to prevent an impending catastrophic failure or to stop a problem from getting worse and is normally only recommended if completely necessary. One must balance the benefit of surgery against the risks.

Risks and considerations

Revision knee replacement is a major procedure and carries some risks, including:

  • Infection
  • Blood clots
  • Stiffness or ongoing discomfort, which is more common after revision due to scar tissue build-up
  • Nerve or blood vessel injury (rare)
  • Longer recovery time compared to first-time surgery
  • Possibility that symptoms may improve but not fully resolve
  • Ongoing soft tissue discomfort due to multiple surgical insults to the knee, which can leave ongoing pain despite a new implant being successfully implanted

Mr Pavlou will take extensive steps to reduce these risks and will discuss them with you in detail.

Recovery after revision surgery

Recovery varies depending on the complexity of the surgery. Most patients will:

  • Begin gentle movement soon after surgery
  • Work closely with physical therapists
  • Require a longer rehabilitation period than after initial knee replacement
  • Experience more variable recovery, as revision surgery is more unpredictable

Improvement often continues for several years.

A personalised decision

Not everyone with knee replacement problems needs revision surgery. The decision is made carefully, based on your symptoms, test results, overall health and personal goals.

The aim of revision knee replacement is not just to fix an implant, but to prevent worsening problems if there is a mechanical issue. It may restore comfort, stability and confidence so you can return to everyday life with less pain.

If surgery is not advised, there are other less invasive medical treatments which may be appropriate. Mr Pavlou will redirect you to the appropriate doctor should these be an option.

Two-stage revision knee replacement: what it means

In some cases, most commonly when a knee replacement becomes infected, a single-stage operation is not the safest or most effective solution. In these situations, your surgeon may recommend a two-stage revision knee replacement.

Why is a two-stage revision needed?

A two-stage revision is usually performed when:

  • There is a deep infection around the knee replacement
  • The infection cannot be reliably cleared with one operation
  • Long-term success depends on fully removing the infection before placing a new implant

Treating the infection thoroughly is essential to achieving a stable,