Revision Surgery After Total Knee Replacement

Reviewed by Greg Jaroszynski MD, FRCSC | Last updated May 2026

Revision knee surgery means correcting or replacing part or all of a previous knee replacement when it has failed or is causing significant problems.

Key Points

Used for a failed, painful, loose, infected, unstable, stiff, or broken prosthesis.
More complex than primary knee replacement.
May require special implants and bone reconstruction.
Higher complication and re-revision risk than first-time knee replacement.
Recovery is less predictable.

What Revision Surgery Means

Revision total knee replacement means removing, changing, or adding one or more parts of a previous knee replacement.

It may be needed when a knee replacement becomes loose, infected, unstable, stiff, worn, malaligned, painful, or damaged by fracture. Sometimes more than one problem is present at the same time.

Common Reasons for Revision

Large registry data show that the most common reasons for revision knee replacement include aseptic loosening or bone loss around the implant, infection, instability, pain, implant wear, malalignment, periprosthetic fracture, dislocation or subluxation, and stiffness.

Infection is especially important because it is associated with a higher chance of further surgery after the revision.

Investigations Before Surgery

Before deciding on revision surgery, further tests may be needed to understand why the knee replacement is painful or failing.

Updated x-rays
Long-leg alignment films
CT scan when component position or bone loss needs more detail
Blood tests for inflammation
Knee aspiration to check for infection when appropriate

Why Revision Surgery Is More Complex

Revision surgery is more complex than a first-time total knee replacement. Scar tissue, bone loss, stretched or damaged ligaments, poor bone quality, retained cement, infection, and difficult-to-remove implants can all make the operation more demanding.

Implants and Reconstruction

The implant used for revision surgery is chosen for the problem being treated.

Some revisions require stems that extend into the bone, metal augments, cones or sleeves to rebuild bone loss, bone graft, thicker plastic liners, or more constrained implants when the ligaments cannot support the knee reliably.

When Infection Is Present

If infection is present, treatment may require staged surgery, a temporary spacer, and a course of antibiotics before the final reconstruction.

The treatment plan depends on the type of infection, the condition of the implants, bone loss, soft-tissue quality, the patient's general health, and microbiology results.

Expected Outcome and Risks

Many patients improve after revision knee replacement, especially when there is a clear mechanical problem that can be corrected.

However, outcomes are generally less predictable than after primary knee replacement. Revision surgery has higher risks of infection, stiffness, blood clots, fracture, wound healing problems, medical complications, and later re-revision.

The goal is a safer, more stable, less painful knee with better function, but the knee may not feel as good as a successful first-time knee replacement.