Revision knee replacement

If a total or partial knee replacement stops functioning as intended then it may need to be revised (redone) and this is normally a more demanding operation for the patient and the surgeon. Depending on the reason for revising the knee the operation will be performed as a single or two stage procedure. Mr Gallacher does not routinely undertake revision TKR and will normally refer you on to one of his colleagues that has a special interest in this type of complex surgery.

Single stage revision involves removing the old knee replacement and inserting a new one. It is carried out for knee replacements that have become worn out over time, are not stable (wobbly) or for progression of arthritis in partial knee replacements. You will be mobile with elbow crutches and would normally be in hospital for 4-7 days. The recovery is then very similar to a first time knee replacement. The first 2-4 weeks are hard work as your knee is painful and swollen but you are working hard with physiotherapy to regain movement. Most patients can walk with only one crutch or a stick by 6 weeks and many can drive by 6 weeks. You will be seen for follow up at 12 weeks in the outpatients clinic.

An antibiotic spacer for two stage revision

A rotating hinge revision knee replacement

Two stage revision is more difficult for the patient. This is only undertaken for infected knee replacements when the infection must be treated before putting in a new knee. The operation is done in two stages, often separated by 12 weeks. Initially the infected knee replacement and tissue is removed and the gap is filled with a spacer made of cement and antibiotics. You are treated with intravenous antibiotics initially and then with tablet antibiotics.

You can mobilise with crutches but the knee does not move like a replacement and your mobility will be compromised. You will normally be in hospital for 10-14 days depending on the duration of intravenous antibiotics.

Your response to antibiotics will be monitored with blood tests and when the infection has been treated you will come back into hospital for the second stage to put in a new replacement knee. The recovery from the second operation is similar to that of a single stage revision and you can expect to be mobile without crutches by around 6-8 weeks.