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Understanding Risks with Knee Replacement Surgery
Important factors to consider when contemplating knee replacement surgery, helping you to make an informed decision about this life-changing procedure.
Let's talk about what you can expect from knee replacement surgery. The good news is that this procedure typically leads to positive outcomes.1 With today's improving technology and surgical techniques, your knee replacement has about an 85% to 90% chance of functioning well for 15 to 20 years.2
But like any surgery, knee replacement does come with some risks. Being aware of these can help you make informed decisions and know what to be aware of and to expect.
One concern, though rare, is infection after surgery. This happens in less than 2% of patients and can cause symptoms like swelling, pain, and fever.3 If this occurs, your doctor will likely recommend a combination of antibiotics and possibly additional surgery. 4 The good news is that antibiotic spacers have demonstrated impressive results, with studies showing infection eradication rates consistently ranging from 80-95%.5
A lesser known complication of knee replacement surgery is metal hypersensitivity, or put more simply, an allergic reaction to the knee replacement implant.10 Metal hypersensitivity reactions to knee implant components can be an overlooked contributor to post-surgical problems. Research suggests that these immune responses may trigger a cascade of complications that mimic other issues, including persistent joint pain, inflammation, reduced mobility, and in some cases, contribute to implant loosening and mechanical failures over time. Evidence indicates that the chronic inflammatory response can affect surrounding tissues, potentially compromising bone integrity and exacerbating joint stiffness and instability that patients might otherwise attribute solely to mechanical factors.10
The good news is that medical science has made significant advances in this area.
Here in Australia, advanced surface technologies are now available that can shield your body from metal ion release, helping to prevent these reactions altogether. These protective options are part of standard care and come at no additional cost to you.
Learn moreOver time, your implant may loosen or wear out, causing pain and instability. 6 If this happens, you might need revision surgery to replace the worn components. Your surgeon will recommend the best approach for your situation.
About 20-30% of people experience ongoing pain after knee replacement.7 This can be caused by inflammation, infection, nerve damage, or implant issues. There are many treatment options available, from medications to physical therapy. Don't hesitate to talk with your medical team if you're experiencing persistent pain.
Around 4-16% of patients experience stiffness after surgery, especially if full motion isn't regained early on. This may result from scar tissue, previous surgeries, or implant positioning.8 Treatments range from physical therapy to special procedures that help break up scar tissue.
Fractures near the implant are rare (0.3-2.5% of patients) but can occur, especially after falls. Risk factors include age, weak bones, and infection.9 Your surgeon will discuss treatment options based on your specific fracture.
Every patient deserves the best possible outcome from their surgery, which is why it's important to discuss all available implant options with your surgeon to find what's most compatible with your specific needs.
1. Chaudhary C, Kothari U, Shah S, Pancholi D. Functional and Clinical Outcomes of Total Knee Arthroplasty: A Prospective Study. Cureus. 2024 Jan 16;16(1):e52415. doi: 10.7759/cureus.52415. PMID: 38371004; PMCID: PMC10869992. https://pubmed.ncbi.nlm.nih.gov/38371004/
2. Evans JT, Walker R, Evans W et al. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up The Lancet, Volume 393, Issue 10172, 655 – 663. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32531-5/fulltext
3. Davis JS, Dewar D, Manning L. Prosthetic joint infection diagnosis in an age of changing clinical patterns of infection and new technologies. The Medical Journal of Australia. 4 March 2024. Med J Aust || doi: 10.5694/mja2.52228 https://www.mja.com.au/journal/2024/220/5/prosthetic-joint-infection-diagnosis-age-changing-clinical-patterns-infection
4. Vasso M, Capasso L, Corona K, Pola E, Toro G, Panni AS. Periprosthetic knee infection: treatment options. Orthopedic Reviews. Vol 14 Issue 4, November 2, 2022 ED. https://doi.org/10.52965/001c.37537
5. Karachalios, T., & Komnos, G. A. (2021). Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes. EFORT Open Reviews, 6(9), 727-734. Retrieved Mar 21, 2025, from https://doi.org/10.1302/2058-5241.6.210008:
6. Chang MJ, Lim H, Lee NR, Moon YW. Diagnosis causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res. 2014 Jun;26(2):61-7. doi: 10.5792/ksrr.2014.26.2.61. Epub 2014 May 30. PMID: 24944970; PMCID: PMC4061408. https://pmc.ncbi.nlm.nih.gov/articles/PMC4061408/
7. Aoyagi K, Law LF, Carlesso L, Nevitt M, Lewis CE, Wang N, Neogi T. Post-surgical contributors to persistent knee pain following knee replacement: The Multicenter Osteoarthritis Study (MOST). Osteoarthr Cartil Open. 2023 Jan 18;5(1):100335. doi: 10.1016/j.ocarto.2023.100335. PMID: 36798734; PMCID: PMC9926203. https://pmc.ncbi.nlm.nih.gov/articles/PMC9926203/
8. Archunan M, Swamy G, Ramasamy A. Stiffness After Total Knee Arthroplasty: Prevalence and Treatment Outcome. Cureus. 2021 Sep 25;13(9):e18271. doi: 10.7759/cureus.18271. PMID: 34722049; PMCID: PMC8544175. https://pubmed.ncbi.nlm.nih.gov/34722049/
9. McGraw P, Kumar A. Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol. 2010 Sep;11(3):135-41. doi: 10.1007/s10195-010-0099-6. Epub 2010 Jul 27. PMID: 20661762; PMCID: PMC2948125. https://pubmed.ncbi.nlm.nih.gov/20661762/
10. Lachiewicz PF, Watters TS, Jacobs JJ. Metal Hypersensitivity and Total Knee Arthroplasty. J Am Acad Orthop Surg. 2016 Feb;24(2):106-12. doi: 10.5435/JAAOS-D-14-00290. PMID: 26752739; PMCID: PMC4726476. https://pmc.ncbi.nlm.nih.gov/articles/PMC4726476/
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