Orthopedics Hip & Knee Knee Replacement Surgery Revision Knee Replacement Surgery By Jonathan Cluett, MD twitter linkedin Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Jonathan Cluett, MD Medically reviewed by Medically reviewed by Stuart Hershman, MD on September 21, 2020 linkedin Stuart Hershman, MD, is board-certified in orthopaedic surgery. He is the director of adult spinal deformity & complex spinal reconstruction at Massachusetts General Hospital and is on the faculty at Harvard Medical School. Learn about our Medical Review Board Stuart Hershman, MD Updated on September 30, 2020 Print A revision knee replacement surgery is a procedure that is performed to replace a knee implant that is no longer functioning properly. Knee replacement implants are designed to last a long time, but they do not last forever, and there are a number of problems that can occur necessitating a repeat surgery to replace the implant. JodiJacobson / Getty Images Revision knee replacement is a major surgery because performing a replacement surgery can be much more complicated the second (or third, or fourth) time in the joint. Over time, scar tissue, bone loss, and instability can all contribute to making a repeat surgery a much more difficult treatment. How Long Replacements Last Most knee replacements last several decades, some longer. However, there are also times when a knee replacement needs to be redone after years or even just months. Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement. The average knee replacement lasts more than two decades, but there are reports of implants lasting longer, and new materials and surgical techniques are hoped to provide even longer-lasting knee replacements. That said, there are times when knee replacements may last a very short time, even in otherwise healthy patients. A small percentage of patients (around 1% to 2%) end up needing their knee replacement revised within a few years of their initial surgery. Reasons Why a Revision Replacement Is Necessary Revision replacements are performed for a number of reasons. Some of the more common include: Loosening of the implant Infection of the joint Instability of the knee Malalignment of the parts Many people ultimately have a revision knee replacement because the problem is causing significant pain. While pain can be a problem in itself, a revision knee replacement surgery should not be performed without understanding why the pain is occurring. Performing this type of surgery for pain without an identified cause is unlikely to yield good results. Instead, the cause of the problem with the knee replacement needs to be precisely understood, and there needs to be a plan to address that problem with the implant. An operation without a clear plan to address the problem is unlikely to be helpful. How Implants Wear Out Most knee replacements are made with metal caps that cover the end of the thigh bone and the top of the shin bone. Between these metal caps is a piece of plastic that provides a smooth surface for bending of the implant. The plastic can wear out over time, either as a slow, gradual wearing away, or a sudden catastrophic failure. There are some situations where the wearing out can be accelerated. These situations include when the alignment of the implants was not ideal, when the knee is unstable (too loose), or if the patient performs activities that put too much stress on the implant. Knowing which activities can cause damage to knee replacement implants can help ensure the parts last as long as possible. Why Revisions Are More Complex Revision replacement is difficult for several reasons. First, when someone has surgery, scar tissue develops, and soft tissues become less identifiable. Performing the second surgery is always more difficult. Second, when performing a knee replacement, bone is removed. When performing a revision knee, often more bone has to be removed, and some may be lost as a result of the problem with the implant. Maintaining adequate bone to support the new implant can be a challenge. Finally, obtaining a knee that is flexible enough to allow for motion, yet stable enough to keep you steady, is also more difficult in revision situations. Results of Revision Knee Replacement The results of revision knee replacement are less favorable than with a first replacement surgery. That said, the results are quite variable, as some problems that require a second surgery are much more straightforward to manage, and others very complex. The problem with trying to compare results of revision knee replacement is that the reasons to perform the surgery, and the extent of the surgical procedure, is so variable that it is hard to draw conclusions on the data. However, most studies of revision knee replacement showed improved function in most patients (80% or more). Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Postler A, Lützner C, Beyer F, Tille E, Lützner J. Analysis of Total Knee Arthroplasty revision causes. BMC Musculoskelet Disord. 2018;19(1):55. Published 2018 Feb 14. doi:10.1186/s12891-018-1977-y Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet. 2019;393(10172):655-663. doi:10.1016/s0140-6736(18)32531-5 Lee DH, Lee SH, Song EK, Seon JK, Lim HA, Yang HY. Causes and Clinical Outcomes of Revision Total Knee Arthroplasty. Knee Surg Relat Res. 2017;29(2):104–109. doi:10.5792/ksrr.16.035 Haider H. 7.10 Wear: Knee Joint Arthroplasty. Comprehensive Biomaterials II. December 2017:152-174. doi:10.1016/b978-0-12-803581-8.09359-0 Graichen H. TKA revision - reasons, challenges and solutions. J Orthop. 2014;11(1):1–4. Published 2014 Mar 26. doi:10.1016/j.jor.2014.01.005 Additional Reading Dennis DA, et al. "Revision Total Knee Arthroplasty" J Am Acad Orthop Surg August 2008 vol. 16 no. 8 442-454.