What Is the Difference Between Primary Knee Surgery and Revision Knee Surgery?

Knee replacement is one of the most common and successful surgical procedures. When performed by an experienced board-certified orthopedic surgeon using the most advanced implant designs and latest surgical techniques and technology, 90% of knee replacement patients can expect their new implant to last about 20 years. However, there are situations where revision knee surgery is required, either due to a poor surgical outcome or because a knee implant wore out over time.

There are approximately 22,000 revision knee surgery procedures performed in the United States every year, and over 50% of these revision procedures occur within two years of the initial surgery. Revision knee surgery is more complicated than the original procedure, often referred to as primary knee replacement. If you’re considering revision knee surgery, it’s important to understand the differences between these procedures.

What Is Primary Knee Surgery?

Primary knee surgery refers to the initial knee replacement procedure performed to surgically remove damaged bone and cartilage from your knee joint and replace it with an artificial knee implant. The procedure is performed to eliminate chronic knee pain and restore proper function and mobility of the knee joint.

There are two different types of primary knee replacement procedures:

• Total Knee Replacement – The entire knee joint is removed during the procedure
• Partial Knee Replacement – This is a less invasive procedure that only replaces the damaged portion of the knee joint, while preserving the healthy parts

What Is Revision Knee Surgery?

Revision knee surgery is a follow-up knee replacement procedure performed to replace a failed artificial knee implant with a new prosthetic implant. Revision knee replacement is a more complex procedure that requires more extensive planning prior to surgery. It is also typically associated with a longer and more challenging recovery process.

There are several reasons why revision knee surgery is more complicated than primary knee replacement:

• Specialized implants and tools are used
• More difficult surgical techniques are required
• There is a longer surgical time
• There is additional trauma and scar tissue in the knee that wasn’t present during the initial surgery
• There’s less bone remaining in your knee

In addition, there is a greater risk of complications associated with revision knee replacement.

Common Reasons for Revision Knee Surgery

As with all medical devices, knee implants aren’t designed to last forever. Eventually, they may wear out and need to be replaced. That means that even if your primary knee replacement surgery was extremely successful, you may need to undergo a revision procedure down the road if your implant wears out. Since over 90% of knee implants last about 20 years, it will be a long time before you need a revision procedure. It also means that younger knee replacement patients are more likely to need revision knee surgery than patients who undergo primary knee replacement in their 60s or older.

However, there are other potential reasons why you may need revision knee replacement before the lifespan of your implant wears out. Some of the most common reasons include:

• Infection – An infection can develop if bacteria settle around the wound or the implant device, and they can often lead to severe complications. Infections will usually occur within a few days or weeks after knee replacement surgery, but in some instances they may not develop until years later. Common signs of infection include swelling, tenderness and fluid leakage.
• Implant Loosening – Knee implants are securely fixed to the bone and should remain stable for many years. However, there are some instances where they may become loose due to infection, trauma to the knee, excessive body weight or wear and tear. If the implant becomes loose, you may experience pain, instability or a change in alignment of your knee.
• Instability – Instability may occur due to loose soft tissue in the knee, improper positioning of the implant, damage to the ligaments surrounding the knee or changes in the knee’s anatomy over time. This can cause pain and a feeling that your knee is “giving away.”
• Stiffness – Excessive scar tissue formation or improper implant positioning can result in stiffness or limited range of motion. Nonsurgical treatments will typically be the first course of action to correct this issue but if those treatments aren’t successful, revision knee surgery may be necessary.
• Leg Fractures – Fractures occurring around the knee can potentially damage the knee implant or impact the stability of your knee.
• Improper Implant Positioning – Improper positioning of the implant during the initial surgery can lead to mechanical issues that require a revision procedure.

Key Differences Between These Procedures

Primary and revision knee surgery differ in several key ways:

• Purpose – Primary knee replacement is performed to replace your damaged knee joint with an artificial implant. Revision knee replacement is performed to address complications from the initial procedure or to replace an implant that fails over time.
• Complexity – Revision knee surgery is a more complex procedure and as a result, you should always work with a skilled knee surgeon with extensive experience performing revision procedures.
• Surgical Time – Revision knee surgery typically takes longer to perform due to the presence of additional scar tissue and the need to remove the existing implant before inserting the new one.
• Implant Design – Revision knee replacement often uses specialized implants with longer, thicker stems for extra support since there is less natural bone to work with.
• Recovery Time – Recovery after revision knee surgery is generally longer and more challenging than after primary knee surgery due to the complexity of the procedure and any potential issues such as infection or instability that developed from complications after the initial procedure.
• Implant Lifespan – Primary knee replacement surgery typically has a longer implant lifespan. These initial implants can last for 20 years, whereas implants placed in revision knee surgery typically only last around 10 years.
• Cost – Due to the added complexity and the need for specialized components, revision knee surgery is considerably more expensive than primary knee surgery.

Raising the Bar for Knee Replacement on the Western Slope

Whether you’re undergoing primary knee surgery or revision knee surgery, working with a highly experienced surgeon will play a major role in the outcome of your procedure. At Colorado Advanced Orthopedics, we’ve been raising the bar for knee replacement on the Western Slope since our clinic opened in 2020. Our team includes some of the finest board-certified, fellowship trained orthopedic surgeons in the region, allowing us to provide a level of care that is typically only found in major metropolitan areas.

Dr. Kevin Borchard performs all our knee replacement procedures. He’s performed over 1,000 knee replacement surgeries and has extensive experience in both primary and revision knee surgery. In addition, Dr. Borchard uses the latest techniques and most advanced technology, including the Mako Robotic-Arm Assisted Surgery System. Dr. Borchard’s experience and our clinic’s commitment to using the best technology have resulted in surgical outcomes that exceed industry standards in many key metrics. This is one of the primary reasons why Colorado Advanced Orthopedics was recently recognized by Healthgrades as one of the Top 100 Joint Replacement Hospitals in the country.

Contact us today to schedule an appointment. We serve patients in Meeker, the White River Valley, Grand Junction and throughout the Western Slope.