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When Revision Knee Replacement Surgery May Be Required

If I have knee joint replacement surgery, will I have to have it redone sometime in the future?

Total knee joint replacement surgery is one of the most successful procedures being done today. According to the Agency for Healthcare Research and Quality, well over 600,000 of these procedures are performed each year in the U.S alone, resulting in reduced pain and restored mobility for patients. Recovery time is shorter and far less uncomfortable than in the not too distant past, due to the use of minimally invasive arthroplasty and nanotechnology. 

Plus, on top of innovative methods and a vastly improved recovery process, the quality of the materials used to replace the original bones in the joint has improved so greatly that over 90% are still in place and functioning 15 years or more after the surgery. While there is every reason to believe that many of these will continue for years to come, there are those that will require revision knee replacement surgery

Reason for Revision Knee Replacement Surgery

As great a track record as they have, knee replacements sometimes need to be redone, which is what revision surgery is. In this second surgery, some or all of the artificial parts used in the original surgery will be removed and replaced. This may sound just like the initial surgery, but revision surgery is actually more difficult and requires more time, a special set of tools and materials, as well as intensive planning. In addition, the procedure should only be performed by an Orthopaedic Surgeon who has experience in revision surgery or even better who is a trained revision surgery specialist.

There are several reasons that knee joint revision surgery may be required. Some of the more common ones include:

  • Implant wear and loosening – over time, the implanted prosthesis will be subject to wear, just like the original joint parts, and there may also be some loosening of the bond that was created between the implant and the bone. 
  • Infection – few things can cause more problems with surgical procedures of all kinds than the introduction of infection. Modern surgical environments are designed to prevent infection, and it is rare in joint replacements. That said, it can occur while the patient is still in the hospital or during the recovery period at home or even at a later time. Once the infection takes hold within the joint, it may cause the bond to weaken. There will also be pain and inflammation, necessitating a second surgery.
  • Periprosthetic fractures – fractures of the bones around the implants are referred to as periprosthetic. These fractures usually happen because of a fall and can damage or destabilize the joint. It will depend on the amount of damage to determine if the fracture is severe enough to warrant revision surgery.  
  • Instability – the knee replacement relies on the body’s ligaments for support and they, too, are subject to wear and tear. If they lose their flexibility or strength, the individual may feel as if the joint is “giving way” and there may be reduced functioning. This can result in the need for surgery.  
  • Other factors – all situations are unique and there are other factors that can contribute to joint replacement failure. Age at the time of surgery is, of course, a big consideration. The younger the patient, the more likely the need for a second surgery. Activity level and carrying excessive body weight can also contribute to the longevity of the implant. 

Patrick A. Meere, M.D., C.M., a board certified, fellowship trained orthopedic surgeon with 25 years of clinical experience in the New York City area is a Clinical Professor of Orthopedic Surgery, NYU School of Medicine, the Director of the Laboratory for Advanced Arthroplasty Research in Robotics and Sensors (LAARS) and the Co-Director of the Robotics Center in the Department of Orthopedic Surgery at NYU Langone Health. He was the president of the 2019 CAOS (International Society for Computer Assisted Surgery) conference held in New York City from 6/19 – 6/22/2019. If you have questions about knee or hip replacement surgery, please use our convenient online contact form by clicking here.

Posted in: Knee Replacement

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