Knee Revision Surgery

When a knee implant fails for any reason, a subsequent operation called a knee replacement revision is normally required to prevent damage to the joint, reduce pain, and restore function.  Knee revision is more difficult and complicated than an initial knee replacement surgery and entails a greater risk of complications and lengthier recovery period.

Knee replacement problems can occur for a number of reasons, including normal wear and tear, overuse or strain on the knee, product defects, surgical error, or complications from the initial surgery.

Potential complications with knee replacement surgery can include the following:

• infection
• unexpected bleeding into the knee joint
• damage to local ligaments or arteries
• nerve damage around the joint, resulting in numbness or weakness
• blood clots, deep vein thrombosis, pulmonary embolism
• fracture during or after surgery
• excess bone growth after surgery
• scarring
• kneecap dislocation
• numbness around the wound scar
• allergic reaction
• instability 

While some of these knee replacement complications will resolve without further surgical intervention, others will require knee revision surgery.

Conditions requiring knee revision surgery

In some instances, severe complications can ensue after a primary knee replacement surgery, requiring the patient to undergo a knee replacement revision.

• Osteolysis: a condition in which the body attacks the bone around the implant in an attempt to rid the tissue of plastic particles produced by wear on the polyethylene insert cushioning the artificial joint.  This can cause destruction of the bond holding the prosthesis to the bone, as well as bone loss, weakening, and fractures.  This process is accelerated in patients with uneven gait or poorly-aligned implants.
• Instability: instability can have many underlying causes, but is usually marked by generalized pain and a feeling of weakness in the knee.  One cause of instability is when the metal implanted into the bone pushes its way into the tissue, causing looseness and the potential for fractures or detachment.  Instability can also result from inadequate range of motion in the artificial joint or from improper positioning or alignment of the implants.
• Fractures: these can occur as a result of osteolysis or other weakening, but are also sometimes caused by the surgery itself.
• Infection: infection within the joint is a serious problem because antibiotics will not be able to reach the site of infection.  Usually some form of corrective procedure is required to resolve the infection.
• Dislocation: improperly aligned or secured implants, surgical error, or injury to the knee can result in joint dislocation, which requires knee revision surgery.

Recalled knee replacements associated with high revision rates

Voluntary product recalls are not uncommon and do not necessarily indicate defective product design.  However, the following knee replacements and components have been subject to FDA knee replacement recalls due to flawed components and/or their association with serious complications:

• Zimmer NexGen LPS, CR, and MIS
• Zimmer Persona – Tibial implant
• Zimmer Natural Knee System
• DePuy Limb Preservation System LPS Diaphyseal Sleeve (Class I Recall)
• DePuy PFC E knee system
• Stryker Scorpio CR and PS components
• Stryker Duracon Total Knee
• Stryker ShapeMatch Cutting Guides
• Smith & Nephew Oxinium Genesis II and Profix II
• Smith & Nephew Journey Uni Tibial Baseplate
• Biomet Vanguard 

The most common problems associated with these products are loosening or adherence failure.  However, DePuy’s LPS sleeve product was the subject of a Class I recall – the FDA’s most stringent.  The LPS diaphyseal sleeve was designed to reconstruct severe tissue defects and help surgeons to fit LPS knee replacement systems to their patients better.  However, the implant has the capacity to fracture during normal usage, even while walking, in addition to a tendency to come loose.  The FDA has warned that the knee replacement could cause loss of function, loss of limb, infection, compromised soft tissue, and even death.

Due to the complications associated with these prosthetic knee devices, recipients may experience a higher failure rate and require knee revision surgery much sooner than they would with other knee replacements. Thousands of injured patients have opted to pursue compensation by filing a knee replacement lawsuit against the manufacturers.

Risks and complications of knee revision surgery

Knee replacement revision is more complex than a primary knee replacement.  Surgeons often have to cut away bone in order to remove the implant and complications from the initial surgery or from extensive tissue damage is difficult to repair.

This type of procedure takes somewhat longer than a primary knee replacement, and may last two to three hours.  Surgeons may have to use metal wedges, bone grafts, donated bone, surgical wire and wire mesh, and special surgical techniques in order to repair or replace damaged bone and secure the new implant into place.

Potential complications of knee revision surgery include:

• deep vein thrombosis, or DVT  (painful blood clots in the legs)
• pulmonary embolism (a blood clot that blocks blood flow to the lungs)
• infection in the new prosthesis
• bleeding
• damage to nerves or blood vessels
• loosening of the new prosthesis
• excess bone growth
• an increased risk of bone fracture during the operation
• dislocation of the new prosthesis, which is twice as likely in knee revision surgery than in the original surgery
• shortening of the leg due to bone loss, resulting in difference in patient leg length
• additional or more rapid bone loss