From the Guidelines
When knee replacements don't work out, patients typically experience persistent pain, instability, stiffness, or infection, with loosening, infection, and instability being the most common failure mechanisms, as reported by Sharkey et al in 2023 1. The causes of knee replacement failure can be multifaceted, including loosening, infection, instability, periprosthetic fracture, and arthrofibrosis, with infection being the most common reason for early revision and aseptic loosening being the most common reason for late revision 1. Key considerations for managing failed knee replacements include:
- Identifying the cause of the failure through physical examination, imaging studies, and possibly blood tests
- Treatment options depending on the specific problem, such as physical therapy, medication management with NSAIDs, corticosteroid injections, or antibiotics for infection
- Revision surgery as a potential necessity to replace or repair components of the artificial joint, which is more complex than the initial surgery and may require specialized implants, bone grafts, or extended rehabilitation 1. It is essential to approach each case individually, considering the patient's unique circumstances and the potential risks and benefits of each treatment option, as the success rate for revision surgeries is generally lower than primary replacements, with approximately 80-85% of patients experiencing good outcomes 1.
From the Research
Failure of Knee Replacement
When knee replacement doesn't work out, it can be due to various reasons. Some of the common causes include:
- Periprosthetic infection, which is one of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery 2
- Technical factors in performing surgery, which may influence both the short- and long-term success rate 3
- Poor alignment of the prosthesis, which appears to be critical for the success of the surgery 3
Treatment Options
Treatment options for failed knee replacement include:
- Debridement, antibiotics, and implant retention (DAIR), which has a high success rate for the treatment of acute periprosthetic joint infection (PJI) 4
- Irrigation, débridement, and polyethylene exchange (IDPE) with retention of stable implant, which can be considered in patients with acute infection and stable components 5
- Revision total knee arthroplasty, which may be necessary in cases where the infection is chronic or the implant is loose 3
Outcomes
The outcomes of these treatment options can vary, but some studies have reported: