Revision Knee Replacement

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Dr Kau Chung Yuan (许医生)


MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)


What is Revision Knee Replacement?

Revision knee replacement is a surgical procedure performed to replace a failing or failed knee prosthesis. This surgery becomes necessary when the initial knee replacement—whether total or partial—no longer functions correctly.

Causes for revision can include wear and tear of the prosthetic components, loosening, infection, instability, or mechanical failure, leading to pain, reduced mobility, and impaired function of the knee joint.

What makes it different from Total or Partial Knee Replacement?

Revision knee replacement distinguishes itself from total and partial knee replacements through several critical aspects:

Complexity and Duration

Revision surgeries are inherently more complex and generally take longer to perform than primary knee replacements. This is due to the need to remove the previous implant, address any bone loss, and prepare the bone for the new implant.

Prosthesis Type

The prostheses used in revision surgeries are often different from those used in primary surgeries. They may include additional components to compensate for bone loss or to enhance stability.

Surgical Challenges

Revision knee replacement faces unique challenges, such as dealing with scar tissue from the previous surgery, bone quality issues, and the presence of complex deformities or instability.

Indications for Revision Knee Replacement

Revision knee replacement is typically considered under specific circumstances where the initial knee replacement has failed or is no longer providing the intended benefits. The primary indications for this surgery include:

  • Prosthesis Wear and Tear
    Over time, the materials of the knee implant can wear down, leading to loosening and instability.
  • Loosening of the Implant
    Loosening can occur due to osteolysis (bone loss around the implant) or mechanical failure, causing pain and reduced function.
  • Infection
    Infections around the knee prosthesis can lead to significant complications, necessitating the removal and replacement of the implant.
  • Instability and Malalignment
    If the knee joint is unstable or improperly aligned due to the initial surgery, revision may be required to correct these issues.
  • Fractures
    Periprosthetic fractures (fractures around the implant site) can compromise the stability of the implant and require revision surgery for optimal treatment.
  • Stiffness and Reduced Mobility
    In some cases, excessive scar tissue formation or improper implant positioning can lead to stiffness and limited range of motion, prompting consideration for revision.

The Procedure for Revision Knee Replacement

Preoperative Assessment and Planning

This phase involves a comprehensive evaluation of the patient’s medical history, physical examination, and imaging studies such as X-rays, MRI, or CT scans to assess the condition of the existing implant, bone quality, and the extent of any bone loss or deformity. Blood tests may also be conducted to rule out infection.

The surgical team uses this information to plan the surgical approach, select the appropriate revision prosthesis, and anticipate the need for any special techniques or tools to address bone defects or other challenges.

Surgical Steps

The entire procedure can take several hours, depending on the complexity of the case and the extent of the preparation required to accommodate the new implant.

  1. Anaesthesia and Incision: Revision knee replacement is performed under general or spinal anaesthesia. The surgeon makes an incision over the knee to access the joint.
  2. Removal of the Old Implant: Specialized tools are used to carefully remove the old prosthesis while minimizing damage to the surrounding bone and tissues.
  3. Preparation of the Bone: Once the old implant is removed, the surgeon assesses and prepares the bone surfaces for the new implant. This may involve removing any damaged or infected tissue, treating bone defects with bone grafts or metal augments, and shaping the bone to fit the new prosthesis.
  4. Implantation of the New Prosthesis: The selected revision implant, which may include additional components such as stems for enhanced fixation, is carefully positioned and secured in place.
  5. Closure: The incision is closed with sutures or staples, and a dressing is applied to the wound.

Challenges with Revision Knee Replacement

Revision knee replacement surgery is performed to address the complexities encountered when a primary knee replacement fails, presenting a set of specific challenges that include:

  • Management of Bone Loss
    Significant bone loss, which can occur due to the removal of the old implant, infection, or osteolysis, requires careful planning and may involve the use of bone grafts or metal augments to rebuild the bone structure.
  • Scar Tissue and Adhesions
    Previous surgeries can leave behind scar tissue, making access to the knee joint more difficult and increasing the risk of complications.
  • Correcting Malalignment
    Achieving proper alignment of the knee components is crucial but can be challenging in revision surgery due to altered anatomy or bone defects.
  • Selection of Implant
    The choice of revision implants, which often include components designed for enhanced fixation and stability, is critical to accommodate the specific challenges of each case.
  • Infection Risk
    Patients undergoing revision surgery face a higher risk of infection, which necessitates careful preoperative planning and postoperative care to minimize this risk.

Recovery and Rehabilitation

Recovery following revision knee replacement surgery encompasses a meticulously structured rehabilitation process. This process is tailored to ensure optimal healing, enhance knee function, and facilitate a return to daily activities.

Initial Recovery Phase
  • Hospital Stay: Patients typically spend a few days in the hospital post-surgery, during which pain management, prevention of infection, and early mobilization are prioritized.
  • Pain Management: Effective pain relief strategies are employed to manage postoperative pain, facilitating earlier participation in rehabilitation.
  • Early Mobilization: Under the guidance of physical therapists, patients begin gentle knee movements and exercises soon after surgery to promote circulation, prevent stiffness, and strengthen the knee.
Rehabilitation Process
  • Physical Therapy: A tailored physical therapy program is essential, focusing on gradually increasing knee strength, flexibility, and range of motion. The program evolves over weeks to months, adapting to the patient’s progress.
  • Home Exercises: In addition to supervised therapy sessions, patients are given exercises to perform at home to enhance their recovery.
  • Follow-up Assessments: Regular follow-up with the surgical team allows for monitoring of the knee’s healing and adjustment of the rehabilitation plan as necessary.

Outcomes and What to Expect

Most patients experience significant pain relief and improvements in knee function, which facilitates daily activities and potentially allows for engagement in low-impact sports. The longevity of the revision implant is influenced by factors such as the patient’s activity level, weight, and overall health.

It’s important for patients to have realistic expectations and to commit to the rehabilitation process to achieve the best possible outcomes. Regular follow-up appointments are crucial to monitor the implant’s performance and to address any issues promptly.

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Patient Feedback

Ethan Chan
Dr. Kau is an exemplary doctor who is experienced in his field and is very patient with his patients. He walked me through the details of my knee condition and addressed all my concerns. Thanks to Dr. Kau, I had a better understanding of my ACL and MCL injury and the various treatment options available. His advice and treatment have been very valuable to me.
Ming Lee Chua
Dr Kau was very careful and explained clearly the surgery procedures. After surgery, the care while I was in hospital was closely monitored and he even came during weekends! The hip so far has recovered and healed. His ‘predictions’ of when what can happen are so accurate. Trust him.
Teo Pek Suan Diana
I had a very successful total hip replacement done by Dr Kau 4 years ago. 4 months after the operation I was back walking, cycling and swimming. The beautiful job gave me much confidence Dr Kau is most professional and has such great doctor patient communication.

Dr. Kau Chung Yuan

MBBS (S’pore)

MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)

Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.

He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.

  • Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
  • Master of Medicine (Orthopaedics), Singapore (MMed) 2013
  • Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
  • Bachelor of Medicine and Surgery (MBBS, Singapore) 2004

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    Frequently Asked Questions (FAQs)

    Can younger patients undergo revision knee replacement?

    Yes, younger patients can undergo revision knee replacement if necessary. The decision is based on the patient’s level of pain, disability, and the failure of their current knee implant, rather than age alone. A thorough evaluation is essential to ensure that revision surgery is the most appropriate option.

    How can patients best prepare for revision knee replacement surgery?

    Patients can prepare for revision knee replacement surgery by maintaining a healthy lifestyle, including balanced nutrition and quitting smoking, to enhance surgical outcomes and recovery. Engaging in preoperative exercises to strengthen the muscles around the knee may also be recommended.

    Are there alternatives to revision knee replacement?

    Alternatives to revision knee replacement may include non-surgical management options such as pain medication, physical therapy, and knee injections to manage symptoms. However, these alternatives are typically considered when surgery is not feasible or the patient prefers not to undergo another operation.

    How often do revision knee replacements fail and require further surgery?

    The rate of failure for revision knee replacements is higher than that for primary knee replacements, but it varies widely depending on individual circumstances. Continuous advancements in surgical techniques and implant technology aim to reduce these rates. Close follow-up care can help in monitoring the implant’s integrity and addressing any issues early.