{"id":3982,"date":"2023-04-27T13:42:51","date_gmt":"2023-04-27T11:42:51","guid":{"rendered":"https:\/\/marcheggianimuccioli.it\/knee\/total-knee-arthroplasty-revision\/"},"modified":"2025-06-19T07:36:04","modified_gmt":"2025-06-19T05:36:04","slug":"total-knee-arthroplasty-revision","status":"publish","type":"page","link":"https:\/\/marcheggianimuccioli.it\/en\/knee\/total-knee-arthroplasty-revision\/","title":{"rendered":"Total knee arthroplasty revision"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"3982\" class=\"elementor elementor-3982 elementor-2829\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d61a566 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d61a566\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d2efd45\" data-id=\"d2efd45\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9cc4053 elementor-widget elementor-widget-heading\" data-id=\"9cc4053\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-large\">Knee Replacement Surgery<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4130081 elementor-widget elementor-widget-text-editor\" data-id=\"4130081\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>Let\u2019s explore this topic in the following sections:<\/p><ul><li><a href=\"#principali-cause-che-portano-alla-revisione-delle-protesi-di-ginocchio\"><span style=\"font-weight: 400;\">Main causes leading to knee prosthesis revision<\/span><\/a><\/li><li><a href=\"#infezione-periprotesica\">Periprosthetic infection or knee prosthesis infection<\/a><\/li><li><a href=\"#protesi-ginocchio-usurata\">Worn-out knee prosthesis<\/a><\/li><\/ul>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb82a8c elementor-widget elementor-widget-text-editor\" data-id=\"bb82a8c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Knee prosthesis revision is a major surgical procedure required when a previously implanted knee prosthesis begins to show problems or functions suboptimally<\/strong>. This procedure is essential for various reasons and can significantly improve patients\u2019 quality of life by reducing pain and restoring joint function.<\/p><p><strong>The average lifespan of a knee prosthesis ranges between 10 and 25 years<\/strong>, and thanks to increasingly refined techniques, this duration continues to grow year after year. However, there are several reasons why a prosthesis might fail or require revision. These include prosthetic component wear or loosening from the bone, infections, fractures, new-onset instability, or patient-related factors\u2014such as prior surgeries on the knee, body weight, or activity level. [1\u20132]\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-ac7554a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ac7554a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-b563f34\" data-id=\"b563f34\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a1628b7 elementor-widget elementor-widget-image\" data-id=\"a1628b7\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"298\" src=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-768x298.jpg\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-768x298.jpg 768w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-300x116.jpg 300w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-1024x398.jpg 1024w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-1536x596.jpg 1536w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-2048x795.jpg 2048w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig1-2-scaled.jpg 2000w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Fig. 1 Aseptic revision of a unicompartmental prosthesis. Left: preoperative image showing clear aseptic loosening. Right: semi-constrained revision prosthesis.<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6cd480f\" data-id=\"6cd480f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-236c7fd elementor-widget elementor-widget-text-editor\" data-id=\"236c7fd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><span style=\"font-weight: 400;\">Regardless of the cause, implant failure generally presents the same cluster of symptoms: pain, reduced knee function, swelling, and sometimes increased local temperature. <\/span><\/p><p><span style=\"font-weight: 400;\">When experiencing any of these symptoms, it is essential to undergo a specialist consultation to assess whether surgical revision is needed.<\/span><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-e31c895 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e31c895\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-074aa58\" data-id=\"074aa58\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2f81979 elementor-widget elementor-widget-image\" data-id=\"2f81979\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"284\" src=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-768x284.jpg\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-768x284.jpg 768w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-300x111.jpg 300w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-1024x379.jpg 1024w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-1536x569.jpg 1536w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-2048x759.jpg 2048w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig2-2-scaled.jpg 2000w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Fig. 2 Complex revision of a total knee prosthesis with bone loss. Left: preoperative image with visible tibial plateau fracture and prosthetic subsidence. Right: rotating hinge revision prosthesis with personalized tibial plateau reconstruction.<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-af45f30\" data-id=\"af45f30\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ffc532f elementor-widget elementor-widget-image\" data-id=\"ffc532f\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"241\" height=\"300\" src=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig3-1-241x300.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig3-1-241x300.jpg 241w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig3-1-822x1024.jpg 822w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig3-1-768x956.jpg 768w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig3-1.jpg 1020w\" sizes=\"auto, (max-width: 241px) 100vw, 241px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Fig. 3 Complex revision of total knee prosthesis with bone loss (see also Fig. 2). Note the alignment correction of the lower limb axis after revision.<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-c08f6f2 elementor-widget elementor-widget-text-editor\" data-id=\"c08f6f2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><span style=\"font-weight: 400;\">During this procedure, the surgeon removes some or all of the previously implanted prosthesis components, replacing them with new ones. <\/span><\/p><p><span style=\"font-weight: 400;\">While the goal remains the same as the primary replacement\u2014pain relief and improved function\u2014revision surgery is longer and more complex, requiring careful planning and specific implants to ensure a successful outcome. In the primary procedure, femur, tibia, and patella surfaces are replaced with metal components.<\/span><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cbc4ade elementor-widget elementor-widget-menu-anchor\" data-id=\"cbc4ade\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"principali-cause-che-portano-alla-revisione-delle-protesi-di-ginocchio\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e9b6c6 elementor-widget elementor-widget-heading\" data-id=\"3e9b6c6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-large\">Main Causes of Knee Prosthesis Revision<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b1a79a8 elementor-widget elementor-widget-text-editor\" data-id=\"b1a79a8\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>The main reasons for knee prosthesis revision include aseptic loosening, periprosthetic infections, osteoarthritis progression in unicompartmental prostheses, and prosthesis wear.<\/p><p>Approximately 15\u201320% of patients are dissatisfied with their knee prosthesis outcomes\u2014sometimes without a clearly identifiable cause, other times due to issues revealed by lab tests or imaging. Infection is a potential complication of any surgery\u2014including total knee replacement\u2014and can occur during hospitalization or even years after the procedure.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccdb9c8 elementor-widget elementor-widget-heading\" data-id=\"ccdb9c8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">Main Risk Factors for Knee Arthroplasty Infection<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a851a7a elementor-widget elementor-widget-text-editor\" data-id=\"a851a7a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Knee arthroplasty infection is a serious complication that can severely impair implant function, leading to stiffness and pain.<\/strong> The implant may loosen or remain fixed while symptoms progress, making revision surgery necessary.<\/p><p>Major risk factors include:<\/p><ul><li>Previous knee surgeries;<\/li><li>Obesity;<\/li><li>Diabetes mellitus;<\/li><li>Renal failure;<\/li><li>Respiratory failure;<\/li><li>Immune system disorders;<\/li><li>Treatment with biological drugs;<\/li><li>Infections in other parts of the body (e.g., urinary, intestinal, pulmonary, dental).<\/li><\/ul>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-90a81fe elementor-widget elementor-widget-menu-anchor\" data-id=\"90a81fe\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"infezione-periprotesica\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-562a68d elementor-widget elementor-widget-heading\" data-id=\"562a68d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-large\">Periprosthetic Infection or Knee Prosthesis Infection<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-614a9b4 elementor-widget elementor-widget-text-editor\" data-id=\"614a9b4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Infections involving knee prostheses are among the most serious postoperative complications.<\/strong> They may require urgent surgery to remove the implant, debride the area, and start specific antibiotic therapy.<\/p><p>Prompt diagnosis and early treatment are essential for optimal outcomes and to prevent complications. In many cases, it\u2019s not possible to reimplant a new prosthesis immediately.<\/p><p>These situations require a two-stage revision procedure (Fig. 4). [2]\u00a0<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-284f363 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"284f363\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6000005\" data-id=\"6000005\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c89f110 elementor-widget elementor-widget-image\" data-id=\"c89f110\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"223\" src=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-768x223.jpg\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-768x223.jpg 768w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-300x87.jpg 300w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-1024x297.jpg 1024w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-1536x445.jpg 1536w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-2048x594.jpg 2048w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2020\/12\/Fig4-1-scaled.jpg 2000w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Fig. 4 Two-stage revision of infected knee prosthesis. Left: infected and loosened prosthesis. Center: antibiotic-loaded spacer. Right: X-ray after reimplantation with rotating hinge prosthesis.<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-96ed267\" data-id=\"96ed267\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-376904d elementor-widget elementor-widget-heading\" data-id=\"376904d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">Aseptic Loosening of the Knee Prosthesis<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0a89b55 elementor-widget elementor-widget-text-editor\" data-id=\"0a89b55\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Aseptic loosening affects about 1\u20132% of knee prosthesis patients<\/strong>. It occurs due to loss of implant adhesion to bone, often from insufficient cement fixation. Treatment is typically surgical and involves single-stage revision to restore stability and function (see Fig. 1).<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca96dfe elementor-widget elementor-widget-heading\" data-id=\"ca96dfe\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">Knee Prosthesis Revision for Fracture<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-116607a elementor-widget elementor-widget-text-editor\" data-id=\"116607a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Fractures near the prosthesis may require revision, especially if they compromise implant stability.<\/strong> This situation requires careful assessment and often a tailored intervention.<\/p><p><strong>A \u201cperiprosthetic fracture\u201d refers to a bone injury adjacent to the prosthetic components.<\/strong> These are often caused by falls and usually require revision surgery.<\/p><p>In planning the revision, the surgeon considers the fracture location, component stability, bone quality, and the patient&#8217;s general condition. In elderly patients with poor bone quality, large revision implants may be used to replace the fractured bone (Figs. 2 and 3).<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5eda4f elementor-widget elementor-widget-heading\" data-id=\"a5eda4f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">Joint Stiffness or Instability<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1e179d5 elementor-widget elementor-widget-text-editor\" data-id=\"1e179d5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Stiffness and instability can greatly affect joint function and patient wellbeing.<\/strong> Sometimes, revision surgery is necessary to restore mobility and stability.<\/p><p>After total knee replacement, mobility may remain insufficient due to excessive scar tissue around the joint. In such cases, the orthopedic surgeon may perform a &#8220;manipulation under anesthesia&#8221; to break adhesions and improve motion.<\/p><p>Another common procedure is arthroscopic arthrolysis (removal of adhesions via arthroscopy). If the knee remains stiff or imaging shows malpositioned components, revision surgery may be required.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a47fb63 elementor-widget elementor-widget-menu-anchor\" data-id=\"a47fb63\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"protesi-ginocchio-usurata\" class=\"elementor-menu-anchor\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0500ab7 elementor-widget elementor-widget-heading\" data-id=\"0500ab7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-large\">Worn-Out Knee Prosthesis<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bc29283 elementor-widget elementor-widget-text-editor\" data-id=\"bc29283\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>As previously mentioned, knee prostheses generally last 15\u201320 years, depending on use, patient weight, and activity level. Wear\u2014especially of the polyethylene insert\u2014may require revision.<\/p><p>Over time, friction and mechanical load cause component wear, leading to deterioration, pain, and limited motion. The decision to proceed with revision depends on the extent of wear, patient symptoms, and impact on quality of life.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-507cfdd elementor-widget elementor-widget-heading\" data-id=\"507cfdd\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">How Is Knee Prosthesis Revision Surgery Performed?<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f7410e3 elementor-widget elementor-widget-text-editor\" data-id=\"f7410e3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p>Revision surgery involves removing the old implant, preparing the bone, and inserting a new prosthesis. The procedure is tailored to each patient and may vary significantly in complexity.<\/p><p>This delicate but crucial operation aims to restore joint function and improve quality of life. Accurate diagnosis of implant failure is essential to developing an effective surgical plan. Surgical steps typically include:<\/p><ul><li><strong>Incision<\/strong>: along the previous scar, extended as needed;<\/li><li><strong> Evaluation<\/strong>: careful assessment of local conditions;<\/li><li><strong> Debridement<\/strong>: removal of debris or fibrotic tissue;<\/li><li><strong> Explantation<\/strong>: removal of the old prosthesis;<\/li><li><strong> Implantation<\/strong>: insertion of the new prosthesis;<\/li><li><strong>Reconstruction<\/strong>: filling any bone defects.<\/li><\/ul><p>Patients typically begin partial weight-bearing 24 hours after surgery and start physiotherapy, which continues for 2\u20133 months. In some cases, full weight-bearing is delayed by 1\u20132 months depending on the extent of bone reconstruction.<\/p><p>If the prosthesis fails without infection, a single revision surgery\u2014known as aseptic revision\u2014is usually sufficient. [2]<p>Long-term outcomes are excellent. Many patients achieve satisfying results within a few months and return to daily activities. However, complete recovery of joint mobility or pain elimination may not always be possible, especially in cases involving infection or major bone loss.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-71189fa elementor-widget elementor-widget-heading\" data-id=\"71189fa\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-medium\">Knee Prosthesis Revision: Prof. Marcheggiani Muccioli\u2019s Background<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-543575e elementor-widget elementor-widget-text-editor\" data-id=\"543575e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<p><strong>Prof. Giulio Maria Marcheggiani Muccioli has distinguished himself in orthopedics, graduating with honors in Medicine and Surgery at the University of Bologna in 2006<\/strong>, specializing with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute, and earning a PhD in Surgical Sciences.<\/p><p>He is an <strong>Associate Professor of Orthopedics at the University of Bologna\u2019s Faculty of Medicine and Surgery<\/strong>, with a focus on biomechanics and lower\/upper limb pathology.<\/p><p>He expanded his expertise through international fellowships in the UK, Japan, and the USA, establishing himself as an orthopedic surgeon with extensive experience, performing over 250 surgeries annually.<\/p><p>He plays a key role in training new generations of doctors through academic teaching in various medical and surgical disciplines.<\/p><p><strong>He is one of only ten Italian surgeons selected in the last 20 years by the American Knee Society for the prestigious John Insall Knee Surgery Fellowship<\/strong>. His contributions include over 250 scientific publications and constant academic and conference involvement, demonstrating his commitment to advancing minimally invasive techniques, sports medicine, and innovations in knee and shoulder treatment.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c6e2cd8 elementor-aspect-ratio-169 elementor-widget elementor-widget-video\" data-id=\"c6e2cd8\" data-element_type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/youtu.be\\\/wms2ZL7gJz8&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;,&quot;aspect_ratio&quot;:&quot;169&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-wrapper elementor-fit-aspect-ratio elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de72c2d elementor-widget elementor-widget-heading\" data-id=\"de72c2d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Bibliography<\/h5>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1484b02 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1484b02\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-340a2bb\" data-id=\"340a2bb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d9a1dff elementor-widget elementor-widget-text-editor\" data-id=\"d9a1dff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t<ol><li><span style=\"font-weight: 400;\"> High rate of implant loosening for uncemented resurfacing-type medial unicompartmental knee arthroplasty. Bruni D, Zaffagnini S, Iacono F, Bragonzoni L, Lo Presti M, Neri MP, Marcheggiani Muccioli GM, Nitri M, Raspugli G, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3175-3182.<\/span><\/li><li><span style=\"font-weight: 400;\"> Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today&#8211;has anything changed after 10 years? J Arthroplasty. 2014 Sep;29(9):1774-8. doi: 10.1016\/j.arth.2013.07.024. Epub 2014 Jul 5. PMID: 25007726.<\/span><\/li><li><span style=\"font-weight: 400;\"> Lombardi AV Jr, Kolich MT, Berend KR, Morris MJ, Crawford DA, Adams JB. Revision of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty: Is It as Good as a Primary Result? J Arthroplasty. 2018 Jul;33(7S):S105-S108.<\/span><\/li><li><span style=\"font-weight: 400;\"> The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre. Iacono F, Raspugli GF, Bruni D, Filardo G, Zaffagnini S, Luetzow WF, Lo Presti M, Akkawi I, Marcheggiani Muccioli GM, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2014 Dec;22(12):3034-8.<\/span><\/li><li><span style=\"font-weight: 400;\"> Lei PF, Hu RY, Hu YH. Bone Defects in Revision Total Knee Arthroplasty and Management. Orthop Surg. 2019 Feb;11(1):15-24.<\/span><\/li><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb033a4 elementor-widget elementor-widget-spacer\" data-id=\"cb033a4\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c432e38 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c432e38\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6766d66\" data-id=\"6766d66\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-097fc1d elementor-widget elementor-widget-heading\" data-id=\"097fc1d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\"><h4 data-elementor-setting-key=\"title\" data-pen-placeholder=\"Type Here...\" style=\"font-style: normal;\">Book online<\/h4><\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-54d0c9a elementor-widget elementor-widget-image\" data-id=\"54d0c9a\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.miodottore.it\/giulio-maria-marcheggiani-muccioli\/ortopedico-medico-dello-sport\/roma\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"71\" src=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2019\/07\/MioDottore-708946-300x71.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2019\/07\/MioDottore-708946-300x71.jpg 300w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2019\/07\/MioDottore-708946-440x106.jpg 440w, https:\/\/marcheggianimuccioli.it\/wp-content\/uploads\/2019\/07\/MioDottore-708946.jpg 450w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-461d58e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"461d58e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1511b8c\" data-id=\"1511b8c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7523f04 elementor-widget elementor-widget-spacer\" data-id=\"7523f04\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Knee Replacement Surgery Let\u2019s explore this topic in the following sections: Main causes leading to knee prosthesis revision Periprosthetic infection or knee prosthesis infection Worn-out knee prosthesis Knee prosthesis revision is a major surgical procedure required when a previously implanted knee prosthesis begins to show problems or functions suboptimally. This procedure is essential for various [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3939,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3982","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v18.5.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Knee Prosthesis: Improved Review | Marcheggiani Muccioli<\/title>\n<meta name=\"description\" content=\"A knee replacement may require revision: get all the information you need to face the procedure.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/marcheggianimuccioli.it\/en\/knee\/total-knee-arthroplasty-revision\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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