Dr. Öğr. Üyesi Görkem Kıyak
OrthopedicsVerified
- 21+years exp.
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Joint Replacement
Revision knee replacement
Why a knee replacement may need revising (loosening, instability, infection, stiffness, wear, fracture), how surgeons find the cause, what insert exchange and full revision involve, what stems, cones and hinged implants are for, what the evidence says, approximate costs in Turkey against the UK, US and Germany, recovery, risks and how to choose a team.
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Revision knee replacement: what it is and what it replaces
Revision knee replacement is surgery to correct or replace a failed knee implant. A standard knee replacement has three main parts: a metal cap on the end of the thigh bone (femur), a metal tray on the top of the shin bone (tibia) with a plastic insert between them, and often a plastic button on the kneecap. Revision may change just the plastic insert, replace one metal component, or take out everything and rebuild the joint with larger implants, longer stems and filler pieces for bone that has been lost. It is considerably more complex than the first operation.
This guide explains why knee replacements fail, how the cause is pinned down, what the surgeon does, what the evidence says about results, what revision costs in Turkey compared with the UK, US and Germany, and the limits of travelling for it. The primary operation is covered in total knee replacement, and the specialty overall in our orthopedics treatments in Turkey.
Why do knee replacements need to be revised?
- Loosening: the implant loses its bond with the bone, causing pain on weight-bearing, often with start-up pain after rest.
- Instability: the knee feels as though it gives way or wobbles, because ligaments are slack, the implant is misaligned or the wrong balance was set at the first operation.
- Infection: constant pain, swelling, warmth or a wound that does not heal; it can occur years after surgery.
- Stiffness (arthrofibrosis): scar tissue limits bending or straightening and does not respond to physiotherapy.
- Wear of the plastic insert: particles can cause swelling and bone loss around the implant.
- Kneecap problems and fracture: the patella tracks badly or the bone around the implant breaks.
A swollen, painful knee after replacement is not always a failed implant, and some causes, such as hip or back pain, are outside the knee. Assessment decides which, and revision is only worth doing for a clear reason.
How is the cause of a painful knee replacement found?
The surgeon needs your original operation note and implant label, then examines range of movement, stability, swelling, kneecap tracking and nearby joints. Standing X-rays show alignment and any change in position compared with older films; a CT scan or bone scan can show loosening or bone loss. Blood tests (CRP, ESR) screen for infection, and a sample of joint fluid is taken for culture and cell count when infection is possible. Persistent pain without a visible cause is a reason to hold back; revision for unexplained pain has a lower success rate than revision for a clear mechanical problem.
The assessment produces a diagnosis and a plan: an insert exchange, a revision of one or both metal components, a procedure to free a stiff knee, or a staged treatment for infection. A hospital that gives a fixed price without this information cannot tell you what you will need.
What does revision knee replacement involve, step by step?
The operation is done under spinal or general anaesthesia, usually with a thigh tourniquet, and takes two to four hours. Through the old scar the surgeon takes samples for infection testing, removes the old components with fine tools and cuts to preserve as much bone as possible, then assesses the defects. Missing bone is filled with metal cones or sleeves, cement, or bone graft, and the new femoral and tibial parts are fitted, often with stems that extend into the bone shaft for extra fixation. Ligament stability decides the level of constraint: posterior-stabilised and varus-valgus constrained implants give more control, and a hinged implant is used when the ligaments cannot be relied upon. The surgeon balances the knee and checks kneecap movement before closing over drains.
Related operations include a plastic insert exchange when the metal is well fixed, and, for infection, a one- or two-stage approach with an antibiotic spacer between operations. Less invasive options such as knee arthroscopy are occasionally used to remove scar tissue but cannot fix a loose or misaligned implant.
Does revision knee replacement work? What the evidence shows
For a clear mechanical cause, revision often gives real improvement in pain and stability. The expectations need to be realistic, though. Joint registries, including the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, show that revision knees are more likely than first knees to need another operation, and that functional scores after revision are on average lower than after a good first replacement. The less certain results are found in revision for stiffness and for pain without a clear cause. For infection, success depends on clearing the organism as well as rebuilding the joint. A revision does not give a younger knee; it gives a more stable and less painful one. Beware of any clinic offering assurances about the final range of motion before examining you.
Revision knee replacement cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the operation and hospital stay, not quotes. The spread is wide because a simple insert exchange is far cheaper than a hinged, stemmed reconstruction. Each hospital confirms its own price in writing after reviewing your images and history.
| Country | Approximate cost range |
|---|---|
| Turkey | €9,000 – €26,000 |
| United Kingdom | €15,000 – €35,000 |
| United States | €35,000 – €90,000 |
| Germany | €15,000 – €35,000 |
What changes the price: the extent of revision, the implant type (stems, metal cones, rotating hinge), bone graft, the length of stay and any intensive care, investigations for infection, and whether a second operation is planned. A package should list the implant, the hospital stay, physiotherapy, medication and transfers, and state what happens in the event of a complication.
Insert exchange, partial or full revision: how do the options compare?
| Approach | Suited to | Typical limits |
|---|---|---|
| Plastic insert exchange | Worn or unstable knee with well-fixed, well-aligned metal parts | Cannot fix a loose component or major misalignment |
| One-component revision | Loosening or malposition of the femur or tibia alone | The remaining original part may wear or fail later |
| Full revision with stems, cones or hinge | Bone loss, instability, multiple failed parts | Longer operation, longer rehabilitation, higher complication rate |
If your problem is a hip implant instead, see our companion guide to revision hip replacement. If you have not had a first replacement and are weighing options such as robotic partial resurfacing, read about knee MAKOplasty.
Who is a good candidate for revision, and who should not travel?
Good candidates have a diagnosed problem (loosening, instability, infection, wear or fracture) that limits daily life, an adequate general health profile, and a surgeon who has confirmed the cause. Heart or lung disease, diabetes, obesity, smoking, anaemia and a skin problem over the knee all raise risk and need planning. Revision for unexplained pain, or while an infection is untreated, is generally discouraged.
Travel is difficult for patients with active deep infection who need a two-stage operation, those with complex medical problems, and anyone who has no named surgeon at home to take over follow-up. Long flights soon after knee surgery raise the risk of clots. A remote review of your scans and operation notes is the right first step, and it should happen before you book flights.
Recovery after revision knee replacement: week by week
- Days 1 to 7: physiotherapy starts the day after surgery with standing and gentle bending; the hospital stay is typically four to seven days.
- Weeks 1 to 6: walking with a frame or crutches, daily exercises to reach full straightening and increasing bend, ice, elevation and blood-thinning medication.
- Weeks 6 to 12: a stick, then unaided walking; weight-bearing may be limited if bone graft or a fracture repair was used.
- Months 3 to 12: swelling and stiffness improve gradually; the final result is judged at about a year.
Plan to stay in Turkey for about 10 to 14 days so the wound and early bending targets are checked before flying; regular walking, calf exercises and clot prevention are advised on the journey. Ongoing physiotherapy matters more after revision than after a first knee, so organise it before you leave.
Risks and complications of revision knee surgery
Risks are higher than for a first replacement. They include infection, stiffness, blood clots in the leg or lung, bleeding, wound-healing problems (the skin over the knee is thin), fracture, nerve or blood vessel injury, instability, persistent pain and the need for further surgery. The risk is greater with long operations, extensive bone loss and other illnesses. The NHS and the British Orthopaedic Association publish patient information about knee replacement and its complications, and registry reports provide the general benchmark for discussing numbers with your surgeon.
How to choose a revision team and spot red flags
Choose a hospital where revision knees are routine: a specialist arthroplasty surgeon, a wide range of revision implants including stems, cones and hinges, bone graft options, a microbiology laboratory, intensive care and physiotherapists used to complex cases. Red flags are a quote without scans, no discussion of cause, no plan to test for infection, a promise of a specific bend or pain-free knee, and no follow-up at home. Read how our process works and request a review through the free quote page.
Questions to ask the hospital
- What is the cause of my knee's failure, and what tests confirmed it?
- Which operation and implants do you plan, and why?
- How many revision knees does the surgeon perform in a year?
- What happens if the problem is bigger than expected at surgery?
- What will physiotherapy involve, and who supervises my care at home?
Hospitals with Orthopedics in Turkey
Frequently asked questions
It is surgery to replace or correct a failed knee implant, ranging from changing the plastic insert to replacing all components with stemmed implants and bone-filling pieces. It is more complex than the first replacement.
Common reasons are loosening, instability, infection, stiffness, wear of the plastic insert, kneecap problems and fracture. Assessment with X-rays, blood tests and sometimes joint fluid sampling confirms the cause.
For a clear mechanical cause it often improves pain and stability, but outcomes are less predictable than a first knee replacement and re-revision is more common. Revision for stiffness or unexplained pain has less certain results.
Approximate ranges are €9,000 to €26,000 in Turkey and about €15,000 to €35,000 in the UK. The price depends on how much is revised, the implants and the stay, and it is confirmed in writing after image review.
Expect four to seven days in hospital, walking aids for about six to twelve weeks and gradual gains for up to a year. Bone grafting or a fracture repair can lengthen the timeline.
Pain is managed with spinal or general anaesthesia and medication. Many people find early recovery as hard or harder than the first time, especially after longer operations, and physiotherapy can be uncomfortable.
Sometimes. Early stiffness can respond to manipulation under anaesthetic or scar release. Later stiffness may need revision, but the outcome is less certain, so surgeons look for a mechanical cause first.
Plan on about 10 to 14 days, covering tests, four to seven hospital days and early rehabilitation. Complex or infected cases may need longer, and your surgeon will set the length.
Flying soon after knee surgery raises the risk of blood clots. Surgeons usually wait until the wound is healing and you are walking safely, and advise blood thinners, regular movement and hydration.
Bring your operation note and implant details, recent X-rays or scans, blood test results and a list of medicines and allergies. These let the surgeon plan implants and judge infection risk before travel.
Patient stories