Revision knee replacement is the removal and replacement of a knee prosthesis that is no longer functioning properly. It is a more demanding operation than a first-time knee replacement, requiring specialized training, careful preoperative planning, and implants designed for the challenges of reconstruction after a failed primary procedure.
Dr. Leo Zalikha trained in revision knee replacement during his adult reconstruction fellowship at Stanford Medicine. Revision arthroplasty was a major focus of his training, including cases with extensive bone loss, ligament deficiency, infection, and periprosthetic fracture. He manages revision knee cases regularly in his practice.
Registry data show that about 93% of total knee replacements are still functioning at 15 years, 90% at 20 years, and 82% at 25 years (Evans et al., The Lancet, 2019), but failure can occur for several reasons:
The bond between the implant and bone can weaken over time, particularly if microscopic wear particles trigger an inflammatory response that erodes the surrounding bone (osteolysis). A loose implant causes pain, instability, and progressive bone loss.
A knee replacement depends on balanced soft tissues and properly sized components for stability. If the ligaments are insufficient or the components are not well-balanced, the knee may feel loose or "give way." Chronic instability limits function and confidence.
Some knees develop excessive scar tissue (arthrofibrosis) after replacement, resulting in a stiff joint with limited range of motion. When physical therapy and manipulation under anesthesia are not effective, surgical revision may be needed.
Prosthetic joint infection is a serious complication that often requires surgical intervention. Bacteria adhere to the implant surface and form biofilm, making antibiotic treatment alone insufficient in most cases.
The polyethylene (plastic) bearing surface between the metal components wears over time. Modern plastics are highly durable, but older implants or those under heavy use may wear through, causing pain and instability.
A fracture around the knee implant can occur after a fall or from weakened bone. Depending on the fracture pattern and implant stability, revision of one or both components may be required.
A knee replacement placed in poor alignment can cause abnormal wear, pain, and accelerated failure. Robotic-assisted technology in primary surgery aims to reduce this problem, but revision may be needed when malalignment is the cause of a failed replacement.
Revision knee replacement is more challenging than primary knee replacement:
Before recommending revision surgery, Dr. Zalikha performs a thorough workup:
Operative reports, implant identification, and the history of the original surgery
Standing X-rays, and often a CT scan with metal artifact reduction to assess bone stock and component position
Blood tests (ESR, CRP) and joint aspiration with cultures when infection is suspected. Ruling out or confirming infection is essential because the surgical strategy differs completely
Knee pain after replacement is not always caused by the implant. Dr. Zalikha evaluates for hip pathology, spine issues, vascular causes, and complex regional pain syndrome before attributing the problem to the knee replacement
Revision knee surgery requires technical skill and patience. Removing well-cemented or well-fixed components without damaging surrounding bone, reconstructing deficient areas, and achieving stable fixation of revision implants are demanding tasks. Dr. Zalikha's fellowship training at Stanford provided extensive exposure to these techniques. He also offers complex primary arthroplasty for challenging first-time replacements.
If you have a knee replacement and experience
These symptoms warrant evaluation by a fellowship-trained revision specialist. Learn more about the signs of a failed knee replacement. A virtual second opinion is available for patients who want Dr. Zalikha’s input before traveling.
If your knee replacement is not performing as expected, Schedule a consultation with Dr. Zalikha or call (562) 362-5024. A Virtual Second Opinion is available.
