Failed Total Knee Arthroplasty

A total knee replacement replaces the worn surfaces of the knee joint with artificial components.

The procedure typically involves:

• A metal component attached to the femur (thigh bone)
• A metal component attached to the tibia (shin bone)
• A highly durable plastic spacer between the components
• Sometimes a resurfaced kneecap (patella)

Together, these components create a new joint designed to reduce pain and improve function.

When everything is working properly, patients often stop thinking about their knee altogether.

In fact, one of Dr. Tauchen’s favorite follow-up visits occurs when a patient walks into the office and says:

“Honestly, I forgot I even had a knee replacement.”

That is the goal.

While knee replacements are incredibly durable, they are still mechanical devices subjected to millions of cycles of loading every year.

Walking, climbing stairs, golfing, biking, exercising, and simply living life place stress on the implant and surrounding tissues.

Most modern knee replacements function extremely well for many years, but problems can occasionally develop.

There are many potential causes of a painful knee replacement.

Some occur shortly after surgery. Others may not develop until years later.

Common causes include:

Implant Loosening

Over time, the bond between the implant and the surrounding bone may weaken.

A loose implant can cause pain, instability, and loss of function.

Infection

Although uncommon, infection remains one of the most important causes of knee replacement failure.

Infections may develop shortly after surgery or even years later.

Knee Stiffness

Some patients develop significant scar tissue and loss of motion after surgery.

A stiff knee can be frustrating even when the implant itself is functioning properly.

Instability

When the soft tissues surrounding the knee are unable to adequately support the joint, patients may feel as though the knee shifts, buckles, or cannot be trusted.

Component Wear

Although modern materials are highly durable, wear can occur over time.

Implant Malposition

In some cases, component alignment or positioning may contribute to pain, stiffness, instability, or abnormal mechanics.

Patellofemoral Problems

Issues involving the kneecap can lead to persistent pain, particularly when climbing stairs, getting out of a chair, or kneeling.

Unexplained Pain

Perhaps surprisingly, some patients experience pain despite seemingly normal X-rays and testing.

These situations often require a particularly thoughtful and comprehensive evaluation.

One thing Dr. Tauchen emphasizes is that revision surgery should never be based solely on the fact that a knee hurts.

The most important question is why it hurts.

Symptoms vary depending on the underlying cause.

Common symptoms include:

Persistent Pain

Pain that never improves after surgery or returns after a period of success should be evaluated.

Swelling

Ongoing swelling can indicate inflammation, mechanical problems, or infection.

Stiffness

Some patients feel as though their knee simply will not bend or straighten the way it should.

Instability

Patients often describe the sensation that the knee may give out or shift unexpectedly.

Pain with Stairs

Difficulty navigating stairs is one of the most common complaints after a problematic knee replacement.

Difficulty Walking

Walking longer distances may become increasingly uncomfortable.

Clicking or Mechanical Symptoms

Some patients experience unusual sensations, popping, or movement within the joint.

Loss of Confidence

This may be one of the most important symptoms of all.

Patients often tell Dr. Tauchen:

“I don’t trust my knee.”

That lack of confidence can affect nearly every aspect of daily life.

People stop exercising. They avoid travel. They skip activities they enjoy.

The problem often becomes much bigger than the knee itself.

Evaluating a painful knee replacement requires a systematic approach.

The first step is listening carefully to the patient’s story.

Dr. Tauchen wants to understand:

• When symptoms began
• Whether the knee ever felt normal
• What activities trigger pain
• Whether swelling is present
• Whether instability occurs
• What treatments have already been attempted

A detailed physical examination follows.

Knee motion, stability, strength, alignment, gait mechanics, and areas of tenderness all provide important clues.

X-rays are typically the most important initial imaging study.

They help evaluate:

• Implant position
• Alignment
• Loosening
• Bone quality
• Component wear

Additional testing may include:

Blood Tests

Blood work can help identify infection or inflammation.

Joint Aspiration

Fluid may be removed from the knee and analyzed to evaluate for infection.

CT Scans

CT imaging can provide additional information regarding component positioning and bone anatomy.

Advanced Testing

Specialized studies may occasionally be necessary when the diagnosis remains unclear.

One of the most important parts of the process is avoiding assumptions.

A painful knee replacement is not automatically loose.

It is not automatically infected.

And it does not automatically require revision surgery.

The diagnosis should guide the treatment—not the other way around.

Many patients arrive expecting that revision surgery is the only possible answer.

Sometimes it is.

Often it is not.

The appropriate treatment depends entirely on the underlying cause of symptoms.

Some patients benefit from physical therapy, strengthening, medications, injections, or other non-operative treatments.

Others require revision knee replacement surgery to address loosening, instability, infection, stiffness, or component-related problems.

The encouraging news is that many patients improve significantly once the true source of the problem is identified.

Dr. Tauchen believes that the most important part of treating a failed knee replacement is establishing the correct diagnosis before discussing treatment options.

Because the goal is never simply to revise a knee replacement.

The goal is to help patients get back to living their lives.

Whether that means walking comfortably, traveling without limitations, playing golf, riding a bike, exercising, or simply going through the day without constantly thinking about their knee, the focus remains the same: reducing pain, restoring function, and helping patients regain confidence in their joint.