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Painful or Failed Total Knee Replacement

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What is a Painful or Failed Total Knee Replacement?

Total knee replacement is a surgery employed to resurface knee joints damaged by arthritis, degeneration, or injury and replacing the damaged joints with a prosthesis (an artificial knee joint).

The failure of total knee replacement surgery to provide pain relief and improved function despite replacing the damaged joint with a new prosthesis is known as painful or failed total knee replacement.

Knee Anatomy

The knee is made up of the femur (thighbone), the tibia (shinbone), and patella (kneecap). The lower end of the thighbone meets the upper end of the shinbone at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in smooth movement of the bones over one another. The meniscus, a soft crescent-shaped cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

Causes of a Painful or Failed Total Knee Replacement

Knee replacement surgeries have been generally highly successful in terms of physical function, postoperative pain, and patient satisfaction. However, there have been cases of painful or failed total knee replacement, which can be attributed to:

  • Infection: The metal and plastic implants can be susceptible to bacterial infection causing painful joints.
  • Wear and Loosening: The friction caused by rubbing of joint surfaces against each other wears away the surface of the implant leading to bone loss and loosening of the implants.
  • Instability: Improperly placed implants may cause instability leading to a sensation of the knee “giving way” wherein soft tissue encircling the knee is found to be too weak to aid in standing or walking.
  • Fracture: Injury or fractures around the knee implant may disturb knee stability requiring revision surgery.
  • Stiffness: Knee stiffness as a result of mispositioning of the implant, excess scar tissue formation, poor motion before surgery, and other surgical complications.
  • Patient-Related Factors: Age, surgical history, activity level, and obesity contribute to implant failure.

Signs and Symptoms of a Painful or Failed Total Knee Replacement

Signs and symptoms of a painful or failed total knee replacement may include:

  • Severe pain
  • Stiffness
  • Mobility issues
  • Instability due to joint loosening
  • Dislocation
  • Swelling and inflammation
  • Warmth and redness
  • Effusion
  • Diminished range of motion
  • Mechanical failure

How is a Painful or Failed Total Knee Replacement Treated?

Painful or failed total knee replacement can be successfully addressed by revision total knee replacement surgery. Knee revision surgery is a re-operation of a total knee replacement. This procedure involves a complete or partial exchange of prostheses implanted during the original total knee replacement with new prostheses.

Benefits of Correcting a Painful or Failed Total Knee Replacement

More than 90 percent of individuals who have undergone revision total knee replacement have noticed a significant improvement in their well-being, including:

  • Increased mobility
  • Reduced pain
  • Improved joint function
  • Improved quality of life
  • High satisfaction and success rate

Risks and Complications of Correcting a Painful or Failed Total Knee Replacement

As with any surgery, some of the potential complications involved with corrective surgery for failed total knee replacement include:

  • Bleeding
  • Infection
  • Intraoperative fractures
  • Damage to blood vessels and nerves
  • Blood clots or deep venous thrombosis
  • Pulmonary embolism
  • Stiffness or instability of the joint
  • Anesthetic complications

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