Total knee replacement is one of the most commonly performed procedures for managing advanced knee arthritis and joint damage. As the population ages and stays active longer, the demand for durable joint care continues to grow. While most patients experience long-term relief, some may need a second surgery, known as a knee revision. This advanced procedure is designed to correct problems with an original knee implant and restore comfort, stability, and function.
At Indiana Orthopedic, Dr. Timothy J. Williams offers specialized care in complex hip and knee revision surgeries. As a board-certified, Harvard-trained orthopedic surgeon with over 20 years of experience, Dr. Williams serves patients in Noblesville, Terre Haute, and the greater Indianapolis area. Whether you're dealing with ongoing pain or implant complications, we provide personalized care using the latest joint replacement technology.
Let's explore the most common reasons people undergo knee revision surgery and how to recognize the warning signs early.
1. Implant Wear or Loosening
Knee implants are built to last, but they're not indestructible. Over years of daily activity, the materials can gradually wear down, especially in active individuals. As this wear progresses, tiny debris particles may trigger inflammation in surrounding tissues, leading to loosening of the implant. Patients often notice increasing pain, swelling, or reduced stability. Left untreated, this loosening can lead to bone loss around the implant site, making future surgeries more technically challenging and reducing long-term outcomes. Regular follow-ups and imaging can help catch these issues early.
2. Infection Around the Implant
Infection is a serious and potentially limb-threatening complication that can occur after total knee replacement. It may develop within days of surgery (acute infection) or emerge months to years later (chronic infection). Warning signs include persistent joint warmth, redness, unusual drainage, swelling, increasing pain, or fever. A confirmed infection usually requires the removal of the implant, a process known as explantation, followed by a deep joint debridement and temporary placement of a spacer with antibiotics. Once the infection is controlled, a second-stage revision procedure is performed to insert a new prosthesis. People with diabetes, weakened immune systems, or poor skin integrity are at higher risk, making early detection and preventive care critical.
3. Instability and Joint Laxity
If your knee frequently feels unstable, such as buckling, giving out, or feeling unsupported, you may be experiencing joint instability. This can occur if the ligaments were not properly balanced during your initial surgery or if they have weakened over time. Instability can make daily activities like walking, climbing stairs, or engaging in physical therapy difficult and unsafe. In such cases, knee revision surgery may be necessary to restore proper alignment, reinforce ligament support, and improve joint function for better mobility and stability.
4. Misalignment of the Implant
Accurate positioning of knee implant components is essential for long-term success. When an implant is not properly aligned, it can lead to abnormal joint movement, increased wear on the prosthesis, and discomfort during walking or daily activities. Misalignment may also affect posture and balance, contributing to muscle fatigue and back or hip pain. To address this, revision surgery is performed to adjust the alignment, restore normal biomechanics, and improve comfort and mobility.
5. Stiffness or Loss of Motion
It's normal to feel some stiffness after knee replacement surgery, especially in the first few months. However, if your knee remains stiff or your range of motion is still limited after six months, it may be a sign of a more serious problem. Common causes include excessive scar tissue (arthrofibrosis), an implant that's too large or incorrectly positioned, or poor joint alignment. These issues can make it difficult to bend or straighten your leg, limiting your daily activities. An orthopedic knee revision specialist can evaluate your condition and determine if corrective surgery is needed to restore movement and improve function.
6. Fractures Around the Implant
Periprosthetic fractures are breaks in the bone near or around a knee implant. These fractures often result from falls, direct trauma, or weakened bone caused by conditions like osteoporosis. When these fractures occur, especially if the implant becomes loose or the break is complicated, revision surgery is typically needed. The procedure may involve stabilizing the fracture, replacing or repositioning the implant, and reinforcing the surrounding bone to restore function and promote healing.
7. Persistent or New-Onset Pain
Ongoing or recurring knee pain, months or even years after a total knee replacement, may signal a complication that needs medical attention. This discomfort could stem from implant loosening, joint instability, soft tissue irritation, or a hidden infection. Rather than waiting for symptoms to worsen, schedule an evaluation with an experienced orthopedic knee revision specialist. Through imaging and a detailed clinical exam, they can identify the underlying issue and recommend a targeted treatment plan to restore comfort and stability.
8. Metal Allergy or Reaction
In some cases, patients may develop a sensitivity or allergic reaction to certain metals in their knee implants—most commonly nickel, cobalt, or chromium. These reactions can lead to symptoms such as joint inflammation, localized pain, persistent swelling, warmth around the joint, and sometimes skin rashes or itching near the surgical site. While rare, these immune responses can interfere with the success of the implant. When conservative treatments fail to relieve symptoms, revision surgery may be required to replace the existing components with hypoallergenic or titanium-based alternatives, which are less likely to cause allergic reactions.
9. Implant Breakage or Mechanical Failure
Mechanical failure of a knee implant, although uncommon, can happen due to long-term wear, poor material integrity, or traumatic injury such as a fall. Signs of failure may include grinding or clicking noises, a sudden sense of looseness, or a noticeable decline in joint function. Prompt assessment by an orthopedic knee revision specialist is essential. Delaying care may lead to further bone damage or joint complications that make future revision surgery more complex.
10. Progression of Arthritis in Surrounding Joints
Even if your knee replacement surgery was initially successful, arthritis can still develop or progress in the surrounding parts of the joint or nearby areas like the hip, ankle, or spine. This added wear and tear can put uneven pressure on the implant, which may result in discomfort, joint imbalance, or altered walking mechanics. In such cases, knee revision surgery can help realign the joint system, restore function, and protect the durability of your implant.
When to Consult a Knee Revision Specialist
If you’re still experiencing pain, swelling, or trouble moving your knee after joint replacement, it may be a sign your implant isn’t working as it should. These issues often indicate deeper concerns, like loosening, instability, or infection, that shouldn’t be ignored. The sooner you’re evaluated, the better your chances of avoiding further complications.
At Indiana Orthopedic, we provide expert assessments, on-site imaging, and revision surgery options tailored to your needs, so you can get back to moving comfortably again.
Restoring Comfort, One Step at a Time
Knee revision surgery is a highly specialized solution for patients facing persistent pain, implant failure, or mechanical issues. If you're concerned about your current knee replacement, don't wait to get help. Dr. Timothy J. Williams at Indiana Orthopedic is committed to helping patients restore their mobility and confidence through expert care and cutting-edge technology.
To schedule a consultation, call our Noblesville office at (317) 620-0232 or our Terre Haute location at (812) 900-7544. You can also request an appointment online. We're here to help you walk with confidence and live without limits.
Frequently Asked Questions
WHAT IS KNEE REVISION SURGERY?
It's a procedure that replaces a failed or worn-out knee implant with a new one to restore function.
HOW DO I KNOW IF I NEED A REVISION?
If you experience pain, instability, swelling, or stiffness after your first knee replacement, see a specialist.
IS REVISION SURGERY MORE COMPLEX THAN THE FIRST SURGERY?
Yes. It often requires specialized implants and advanced techniques due to bone loss or scar tissue.
HOW LONG DOES RECOVERY TAKE?
Recovery varies but usually takes longer than a primary knee replacement—often 8–12 weeks with physical therapy.
WHO SHOULD PERFORM MY REVISION SURGERY?
Choose a board-certified orthopedic knee specialist with experience in revision procedures.
