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Orthopedics & Joint Replacement

Revision Knee Replacement Surgery

Replaces a knee implant that has loosened, worn out, become infected or feels unstable, after tests to find out exactly why it failed.

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Revision Knee Replacement Surgery at Prakash Hospital, Orthopedics & Joint Replacement
Surgery duration
2 to 4 hours
Anaesthesia
Spinal or general, with a nerve block
Hospital stay
4 to 7 days
Recovery
6 to 12 months for full benefit
On this page

Overview

Most knee replacements work for 15 to 20 years or more, so a replaced knee that starts to ache, swell or give way is worrying, and so is one that never settled after surgery. The first question is always why. Pain can come from the implant loosening, a hidden infection, a worn plastic insert or ligaments that no longer hold the knee steady. It can also come from the hip, the spine or a nerve, which a second knee operation won't fix.

Revision knee replacement takes out some or all of the old implant and puts in parts designed for this job. Removing the old parts usually costs some bone and the ligaments may be weaker, so revision implants often have longer stems that anchor deeper in the thigh and shin bones. Metal blocks (augments) or bone graft fill gaps where bone is missing, and a more linked, constrained design can stand in for ligaments that no longer work.

It's a bigger operation than your first knee replacement, and recovery is slower. Most people get good pain relief and a stable knee, though movement is often a little less than after the first surgery. Results are much better when tests find a definite cause the operation can correct.

Your surgeon starts with the detective work: X-rays, blood tests for infection, fluid drawn from the knee where needed, and CT scans at our diagnostic department to map bone loss. Our blood bank cross-matches blood in advance for major surgery, and physiotherapy starts early.

Why it's done

Revision is recommended when tests point to a specific problem with the implant or the tissues around it.

  • Aseptic loosening, where the bond between implant and bone breaks down over the years without infection, one of the most common reasons
  • Infection around the implant, soon after surgery or years later, sometimes spread from elsewhere in the body
  • Instability, where stretched or weak ligaments let the knee wobble or give way
  • Wear of the plastic insert, which can lead to bone loss around the implant
  • A fracture of the bone around the implant, usually after a fall
  • Severe stiffness that hasn't responded to physiotherapy, or a badly positioned implant causing kneecap problems

Is it right for you?

Usually a good fit

  • Tests have found a clear cause, such as loosening, infection, instability or wear
  • Pain, swelling or giving way limit your walking
  • You're fit for a longer operation and can commit to a longer rehab than last time

May not be suitable

  • Pain with no cause found on tests. Revision rarely helps, and the hip, spine and nerves need checking
  • A urine, chest, skin or tooth infection, until it's treated
  • Poor skin or soft tissue over the knee, until a plan is made to cover the wound
  • Very high blood sugar, severe anaemia or a recent heart attack, until stabilised

Types and techniques

Partial or full revision

If only one part has failed, such as a worn plastic insert with well-fixed metal parts, just that part may be changed. More often, loosening or infection means replacing all the components.

Filling bone loss

Metal augments, cones or sleeves and bone graft rebuild missing bone, and stems running down inside the bone share the load so the new parts hold firmly.

More support for weak ligaments

When the side ligaments are stretched or damaged, a more constrained implant with a central post, or in severe cases a hinged knee, gives the stability the ligaments can't.

Treating an infected knee

An infection caught within a few weeks can sometimes be cleared with a thorough washout and a new plastic insert, keeping the metal parts. Long-standing infections are usually treated in two stages: the implant comes out and an antibiotic-loaded cement spacer goes in, you have about 6 weeks of antibiotics, and the new knee is fitted once tests show the infection has cleared.

Preparing for surgery

  • Bring your previous operation notes and implant details, which help plan the parts needed
  • Blood tests including ESR and CRP (infection markers), HbA1c and haemoglobin, mostly done in our pathology lab
  • If infection is suspected, fluid is drawn from the knee with a needle and tested. Antibiotics can hide the germs, so avoid them for about 2 weeks beforehand unless your doctor says otherwise
  • Anaemia is treated before surgery, with iron or other treatment, to lower the chance you'll need a transfusion
  • Blood thinners and diabetes medicines are adjusted on your doctor's advice, never on your own
  • Set up your home as for your first knee: a firm chair with arms, a raised toilet seat and no loose rugs
  • Revision usually needs fresh pre-authorisation from your insurer, so start early. Our insurance and TPA panels page lists who we work with

The procedure, step by step

  1. 01

    Anaesthesia

    The anaesthetic is spinal or general, with a nerve block for pain. Antibiotics go in at the start, unless samples need to be taken first.

  2. 02

    Opening through the old scar

    The surgeon usually uses your previous scar, lengthening it if needed, and releases thick scar tissue so the kneecap can move aside safely.

  3. 03

    Samples and removing the old parts

    Several tissue samples go for culture. The old components and cement are removed carefully, saving as much bone as possible.

  4. 04

    Rebuilding bone

    Bone defects are measured and filled with augments, cones, sleeves or graft.

  5. 05

    Fitting the revision implant

    Trial parts are placed and the knee's stability and movement are checked before the final stemmed components are fixed.

  6. 06

    Closing

    The wound is closed in layers, sometimes over a drain. The operation usually takes 2 to 4 hours.

Benefits and risks

Benefits

  • Relief from pain caused by a loose, worn or infected implant
  • A stable knee that no longer gives way
  • Clearing an infection that antibiotics alone can't cure
  • Walking further, with more independence
  • A new implant that usually lasts many years

Possible risks

  • Infection, more likely than after a first replacement, at roughly 3 to 5 in 100 after revision for loosening or wear, and higher when the reason was infection
  • Needing a blood transfusion, more likely than with a first knee replacement
  • Stiffness, with movement often a little less than after the first operation
  • Blood clots in the legs or lungs
  • A fracture, damage to the tendon that straightens the knee, or nerve injury
  • Loosening or wear of the revision implant, which may need another operation years later

Recovery timeline

Expect a slower recovery than last time. How much bone was rebuilt decides how soon you can put full weight on the leg.

  1. 01

    Days 0 to 2

    You're up with the physiotherapist within a day or two, using a walker. Pain relief is stronger than after a first replacement for the first few days.

  2. 02

    Days 3 to 7, in hospital

    Walking practice, bending exercises and safe transfers. If bone graft was used, you may be told to put only partial weight on the leg for several weeks.

  3. 03

    Weeks 2 to 12

    Stitches come out at 2 to 3 weeks and you move from walker to stick. Exercises focus on straightening and bending the knee, as scar tissue forms quickly after revision.

  4. 04

    3 to 12 months

    Strength and walking distance keep improving, and it can take 6 to 12 months to feel the full benefit. Follow-up X-rays check that the new parts are fixed well.

When to call your doctor

  • Fever, chills, or redness, swelling or discharge at the wound
  • Knee pain, heat and swelling that increase instead of settling
  • Calf pain or swelling, or sudden breathlessness or chest pain
  • Being unable to straighten the knee yourself or lift the leg
  • Signs of infection elsewhere, such as burning urine or a dental abscess, which need prompt treatment
  • A fall onto the operated knee

Call us on +91-8826000033 or come straight to our 24/7 emergency department.

Alternatives to surgery

Treating other causes of pain

If tests don't point to the implant, your surgeon will look for other causes, such as hip arthritis, a trapped nerve in the back or a nerve pain condition around the knee, and treat those instead.

Long-term antibiotics

For people too unwell for major surgery, antibiotic tablets taken long term can sometimes keep an infection in check. This controls it rather than curing it.

Watching a mild problem

Slight wear or looseness that isn't getting worse on X-ray may be watched with regular check-ups, as long as the knee is usable and bone isn't being lost.

Talk to our Orthopedics & Joint Replacement team

Ask about your options, the cost and your insurance before you decide. See the insurance and TPA panels we work with.

Book an Appointment+91-8826000033

This page explains Revision Knee Replacement Surgery in general terms. Your own plan depends on your health, your test results and your doctor's advice. Please read our medical disclaimer.

Your care team

Revision Knee Replacement Surgery is led by our Orthopedics & Joint Replacement team, with other departments stepping in at each stage of your care.

Orthopedics and Traumatology Department
Leads your treatment

Orthopedics and Traumatology Department

At Prakash Hospital, our Orthopedics and Traumatology Department offers expert diagnosis, surgical and non-surgical treatments, and rehabilitation for bone, joint, and musculoskeletal injuries.

What the department treats

Total Knee Replacement

Total Hip Replacement

Arthroscopic Surgery

Spine Surgery

Trauma and Fracture Care

Sports Medicine

Visit the Orthopedics & Joint Replacement department

Other departments involved

General Medicine

Controls diabetes, anaemia and heart conditions before surgery and helps manage antibiotics if the knee was infected.

Visit department

Blood Bank

Cross-matches blood before surgery, since revisions more often need a transfusion.

Visit department

Physiotherapy

Starts walking and knee-bending exercises early and fits the programme to your weight-bearing limits.

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Meet the specialists

Related procedures

Procedures often considered alongside Revision Knee Replacement Surgery, or that treat related conditions.

Total Knee Replacement

Replaces a knee worn out by arthritis with a metal and plastic joint to relieve pain and get you walking again.

Partial Knee Replacement

Replaces only the worn part of an arthritic knee, keeping the healthy cartilage and ligaments.

Joint Reconstruction

Realigns and rebuilds a joint damaged by injury, deformity or earlier surgery, keeping your own joint.

Fracture Fixation Surgery

Realigns broken bones and holds them with plates, screws, rods or frames so they heal in the right position.

More in Orthopedics & Joint Replacement

Other procedures our Orthopedics & Joint Replacement team performs.

View the department

Total Hip Replacement

Replaces a worn or collapsed hip ball and socket with an artificial joint to end groin pain and restore walking.

Shoulder Replacement

Replaces a damaged shoulder ball and socket to relieve arthritis pain and help you use your arm again.

Arthroscopy (Knee/Shoulder)

Keyhole surgery using a thin camera to diagnose and repair problems inside the knee or shoulder.

ACL Reconstruction

Rebuilds a torn ACL with a tendon graft through keyhole surgery to stop the knee giving way.

Ligament Repair Surgery

Reattaches or rebuilds torn ligaments in the knee, ankle, elbow or thumb to steady an unstable joint.

Spine Surgery (Discectomy)

Frees a trapped spinal nerve by removing slipped disc or bone, easing sciatica and leg pain.

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हड्डियों में सूजन (Bone Inflammation) क्यों होती है?

हड्डियों में सूजन (Bone Inflammation) क्यों होती है?

हड्डियों में सूजन के कारण, लक्षण और इलाज जानें। ऑस्टियोमाइलाइटिस, आर्थराइटिस और हड्डी के दर्द को नजरअंदाज न करें। Prakash Hospital में पाएं एडवांस ऑर्थोपेडिक उपचार।

9 Jun 2026

by Prakash Hospital

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Frequently Asked Questions

Answers to common questions about Revision Knee Replacement Surgery at Prakash Hospital, Noida.

Is revision surgery more painful than the first knee replacement?

Usually a little, for the first week or two, because the operation is longer and more tissue is disturbed. Pain relief is planned for this, usually a nerve block plus regular tablets, so you can still get up and walk. If the old knee was loose or infected, many find the pain afterwards is less than what they lived with before.

Can an infected knee replacement be fixed in one operation?

Sometimes. An infection caught within about 4 weeks of surgery, or of symptoms starting, can often be treated with a washout and a new plastic insert, keeping the implant. Long-standing infections usually need two operations at least 6 weeks apart, though selected cases are done in a single stage.

How long will a revision knee last?

Most revision knees are still working well 10 years later, though as a group they don't last quite as long as first-time replacements.

Can a knee be revised more than once?

Yes, although each revision is harder because there's less bone to work with. That's why the cause of failure needs to be found and fixed properly the first time.

I'm 78. Am I too old for revision surgery?

Age alone doesn't rule it out. What matters is your heart, lungs, kidneys and how active you are. If the knee is infected or badly loose, doing nothing carries risks too, so your surgeon and physician will weigh both sides with you and your family.

Will I be able to squat or use an Indian toilet?

No. A revised knee usually bends a little less than a first replacement, often to around 90 to 110 degrees. Plan on a Western toilet or raised seat for good, and use a chair rather than the floor.

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