Revision knee replacement continues to be one of the more challenging operations in the repertoire of joint replacement surgeons. There are several factors leading to failure of a knee replacement, both short and long term.
Short term they include mechanical problems and instability as well as infection. Long term, wear of the polyethylene, loosening of the implants, and infection can be the leading causes of failure of a knee replacement. At the time of revision surgery there is often soft tissue scarring which complicates the operation; loss of bone and soft tissue resulting from implant removal, and the need to obtain fixation beyond the joint line by use of stems in the thigh bone and shin bone. Reconstruction of the bony defects, realignment of the leg, and proper soft tissue tension are all important aspects of revision surgery.
Most revision operations are done by higher volume joint replacement surgeons due to the increased complexity. There are several steps in the evaluation of a painful total knee which will be discussed with you by your surgeon.
— William P. Barrett, MD