Revision Knee Surgery

Repeat (also called “revision”) surgery is different than first time (also called “primary”) total knee replacement. The technical aspects of the surgery are more complex than the original total knee replacement, and recovery may be slower than the original surgery. However, the preparation for surgery and the hospital experience tend to be very similar to the primary knee replacement. There may be different weight bearing restrictions after surgery, as well as different rehabilitation protocols.

Revision total knee replacements are sometimes required if the original knee replacement has worn out or is causing pain or instability.  This can restore function and allow patients to ambulate and perform their activities of daily living. Thus, the benefits may outweigh the risks.

Patients should undergo revision surgery if they have symptoms and/or imaging findings that warrant repeat surgery. The purpose of surgery is to fix a complication or to improve a patient’s function.

The technical aspects of the surgery are more complex than the original total knee replacement, however, the preparation for surgery and hospital experience tend to be very similar to the original total knee replacement. The choices for revision depend on the patient’s needs. Each surgery is individualized, and there are many different reasons for performing a revision knee surgery. Some revisions are simpler, so there may be less associated pain. Some revisions are very complex, and may require longer rehabilitation times. Please talk to your surgeon about whether or not you should make the decision to have revision knee surgery, and about the specifics of your revision knee surgery.

What does my hospital stay look like?

You will arrive the morning of your surgery and get prepared for surgery. You will be taken to the preoperative holding area where your surgeon or member of the team will mark the correct operative location. You will meet the anesthesia team and nurses who will be involved in your operation. 

After surgery, you will recover in the post-anesthesia care unit (PACU) as your anesthesia wears off. You will then be transferred to your room.  Once your anesthesia wears off, physical therapy will assist in getting you out of bed and you will begin to walk. Once you can walk, eat normal food and have your pain controlled, you can leave the hospital. 

How long will I be in the hospital?

On average, patients stay for 0-3 nights after total knee revision surgery. Your discharge may be as early as the day of surgery, or may be prolonged, depending on the complexity of your revision.

How painful is knee revision surgery?

No surgery is painless, and revision knee replacement surgery is no exception. However, pain after revision knee surgery should be manageable. Generally, the most difficult time is in the first 4 weeks after surgery.

How will my pain be managed?

Most patients getting knee replacement surgery undergo spinal anesthesia with sedation, so they are not awake during the surgery. This type of anesthesia has many benefits, not the least of which is the continuation of pain relief for several hours after surgery. Additionally, spinal anesthesia has been demonstrated in studies to have other benefits, such as decreased blood loss and a decreased risk of developing blood clots when compared with general anesthesia. The muscle relaxation provided by spinal anesthesia also makes performing the surgery easier and therefore may be less traumatic for the patient.  Some patients may also receive a nerve block just after surgery to help control pain.

After surgery, patients are typically treated with oral pain medication. This spares the patient from the side effects of stronger IV medicine. If needed, IV medications may be used as well. Patients are often discharged with a prescription for the pain pills that worked for them during their hospital stay.

Patients can also help relieve their pain with means other than pain medicine. For example, applying ice and elevation to the operated leg after therapy can go a long way toward controlling the swelling that often causes discomfort after such activity.  Maintaining activity can also help prevent stiffness and swelling, which can also lead to pain. 

Is it OK to take pain medicine?

Many patients express concerns about taking pain medicine after surgery, particularly with respect to narcotic addiction.  While it is possible to become addicted to narcotic pain medication, this is rare when the medicine is taken appropriately after surgery.  Postoperatively, patients have a good reason to have pain and it is okay to take pain medicine as directed by your surgeon at this time. It often takes less narcotic medication to control a person’s pain when the medicine is taken appropriately – that is, when the patient begins to experience some discomfort. In the early postoperative period, patients should not try to “hold off” on taking pain medicine because they think the pain will calm down in time. These patients who “hold off” until their pain becomes too severe often need more narcotic medications to control their pain than they otherwise would have needed if they had taken their pain medicine earlier. This increases the chance that they may experience a side effect of the pain medications.

What are the side effects of pain medicine?

Side effects of pain medicine and anesthesia include nausea, constipation, and sometimes a tired feeling. Having these side effects does not mean that a patient is allergic to the medication. If a patient has a problem with these side effects, often the medication can be adjusted or a different medication tried in order to minimize these effects.  Please call your surgeon’s office if you are having any issues with your medications.

When is my first post-operative office visit?

The 1st office visit after surgery is typically 2-6 weeks from the date of surgery. If you have staples or visible sutures, the 1st office visit after surgery is often 2 weeks from the date of surgery.

When will my staples or sutures be removed?

Approximately 2 weeks after your surgical date, the staples or sutures will be removed. Some patients will have no visible staples or sutures and therefore will not need to have anything removed.

When will my dressing be removed?

If you have a specialized dressing that looks like a large band-aid, you may shower with the dressing in place. The dressing should be removed 5-7 days from the day of surgery. If you have dressing that is wrapped around your leg, it will most likely be removed before you are discharged from the hospital. If not, it can be removed 2 days after surgery and the area should be kept clean and dry.

How long will I remain on anticoagulation (blood thinners)?

These blood thinners are prescribed for up to 2-6 weeks post-operatively. If you are prescribed aspirin, you will take it twice a day for 4 weeks. If you are on warfarin (Coumadin), you will need your blood to be drawn twice a week to ensure that you are taking an adequate level of the medication. Your medical doctor who cleared you for surgery will arrange for monitoring your warfarin by blood labs and will communicate with you the dose you should take. Sometimes, other medications are used to reduce the risk of blood clots and you should follow your physician’s directions when taking these medications.

Is swelling of my knee, leg, foot, and ankle normal?

Yes, for three to six months. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day).

Is it normal to feel numbness around the knee?

Yes, it is normal to feel numbness around the incision and/or on the outside part of your knee.

Why is my leg bruised?

It is common to have bruising on the skin. It is from the normal accumulation of blood after your surgery.

What exercise should I perform at home?

Please do exercises as instructed by your surgeon. Remember that if you are using your knee to do things (e.g. walking around), you are actually doing physical therapy for your knee. You may have been given a link for an on-line physical therapy program “Force Therapeutics” that will help guide you on which exercises are appropriate after your total knee replacement.

How long will I need to use a walker, cane, or crutches?

This varies with each patient. Patients often use a walker or crutches initially after surgery. Some patients may have restricted weight-bearing after revision surgery while others will not.  Your surgeon will tell you about your weight-bearing status after your surgery.

May I go outdoors prior to my first postoperative visit?

Yes, we encourage you to do so.

May I drive or ride in a car before my first postoperative visit?

Yes, you may ride in a car, however, you must be off all pain medications prior to driving. It is a patient's responsibility to determine their own safety. Patients must be able to operate their car safely.

May I ride in an airplane before my first postoperative visit?

Yes, you may ride in an airplane. Be sure to get up and move around at frequent intervals to prevent blood clot formation. You may find it more comfortable to sit in an aisle seat.

Please note:

All questions will be answered at your follow-up exam. For non-emergency questions, please call the allied health professional for your physician. This number is provided to you in your discharge instructions.

For all emergencies or questions after 4:30PM or on weekends, please call 267-339-3500. If you do not speak with someone immediately and your issue is an emergency then please go to your nearest emergency room .

Message left on voicemails during business hours will be answered. Messages left on voicemails AFTER business hours will NOT be answered until the next business day. Messages left on Force Therapeutics will be answered during the next business day. Clinical questions/comments should NOT be left on Force Therapeutics and should be directly addressed to the allied health professional by a phone call.

What is the maximum range an artificial knee can achieve?

This depends on your preoperative range-of-motion. Your final range-of-motion will be close to the range-of-motion that you had before the surgery.

Revision total knee replacements have higher risks compared to primary total knee replacements. There are higher risks of nerve and blood vessel injuries, increased risks of clots to the legs and lungs, and there is a higher risk of infection since another surgical procedure is being performed. Revision total knee replacement patients may undergo subsequent revision surgery. While inflammation of the leg veins (phlebitis) is not rare, the occurrence of symptomatic blood clots has been greatly reduced with the use of compression devices in the hospital and blood thinning medications such as aspirin. Early mobilization (walking and moving one’s foot up and down) are extremely important for helping to reduce the development of blood clots. Other complications include infection, wear, stiffness or loosening of the parts. In the instances where one of these complications occurs, they may need to be corrected with another revision surgery.

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