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Revision Total Knee Replacement

The National Institutes of Health states that knee replacement surgery has shown to be a safe and cost-effective treatment for alleviating pain and restoring function for patients who have not responded to non-surgical therapies.1 It is also one of the most common commonly performed orthopedic procedures in the U.S.2

While total knee replacement (TKR) complication rate is low, the overall revision rate for knee replacement in the United States has been reported at 12-13% annually.3-6 Over one third of these reported revisions occur within the first two years, which translates to approximately 4% of all knee replacements resulting in early revision.3-6 The need for revision TKR may occur for various reasons. Sometimes, improper soft tissue balance of a patient’s original TKR procedure – resulting in persistent pain, instability and stiffness – may be the cause.3,5-8 In these cases, where radiographs and physical exams may seem normal but the patient’s knee still simply does not feel good (known as the “looks good, feels bad” knee), your surgeon may use VERASENSE to correct this imbalance and potentially replace fewer metal components than planned.9

How Sensor-Guided “Looks Good, Feels Bad” Revision Total Knee Replacement Works

A more complex procedure than primary TKR, revision surgery takes a longer time to complete:10

  1. Following the same incision from your primary TKR (oftentimes resulting in a longer incision to make room for the removal of old components), your surgeon will begin the procedure by moving your knee cap and tendons to the side to access your joint.
  2. Your surgeon will examine your soft tissues and then assess all the components of your prosthesis to see which parts are loose, worn and/or out of position.
  3. Using VERASENSE sensor-assisted technology, your surgeon will determine whether or not a soft tissue imbalance is the cause of your symptoms. If so, he/she will make the necessary soft tissue adjustments to better balance your knee based on real-time data sent wirelessly from the sensor technology to a monitor in the operating room.
  4. Whether all or only partial components need to be removed and replaced, the surgeon does so carefully while preserving as much bone as possible. Any cement used in the primary TKR is also removed. Once the old components are removed, the surgeon prepares the bone surfaces, inserts the revision implant(s) and repairs any damaged ligaments before closing the surgery site.

A clinical study of 58 revision cases involving seven surgeons at seven facilities resulted in 88% of the planned total revision cases changing into partial revisions where fewer metal components were replaced. Compared to total revisions, partial revisions result in lower implant costs. The use of VERASENSE in revision TKRs may avoid unnecessary soft tissue or bony corrections and may prevent unnecessary total revision surgery.9

Ask Dr. Jacob about the use of VERASENSE sensor-assisted technology in revision total knee replacement:

  1. National Institutes of Health Consensus Development Conference Statement: Total Knee Replacement 12/10/03.
  2. Cram P, Lu X, Kates SL, et al. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308:1227.
  3. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res.2010; 468(1):45–51.
  4. Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms ager knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Join Surg. 2015; 97(9): 715-720.
  5. Lombardi AV Jr1, Berend KR1, Adams JB1. Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Joint J. 2014 Nov;96-B(11 Supple A):101-4.
  6. Schroer WC, Berend KR, Lombardi AV, et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013;28(8 Suppl):116–119.
  7. Rodriguez-Merchan, EC. Instability Following Total Knee Arthroplasty. HSS J. Oct 2011;7(3): 273–278.
  8. Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am 2008; 90: 184–94.
  9. Leone W, et al. Using Sensors to Evaluate Revision TKA: Treating the “Looks Good; Feels Bad” Knee. EC Orthopaedics 3.5 (2016): 381-385.
  10. AAOS Website,, Accessed September 2017.