Revision Knee Replacement
About this PSP
The Revision Knee Replacement PSP was initiated by the British Association for Surgery of the Knee (BASK) with support from the British Orthopaedic Association (BOA). The PSP explored unanswered research questions about the assessment, management and rehabilitation of ‘problematic knee replacements’.
The PSP built on the work done by the Hip and Knee Replacement for Osteoarthritis PSP, but had a scope that focused on the pathway at a later stage - when a patient has further problems following initial knee replacement.
In the initial survey, 769 uncertainties were submitted by 267 people, made up of 137 patients, 18 carers/spouses and 112 healthcare professionals. 201 respondents ranked the uncertainties included in the interim survey and the Top 10 was agreed by 12 patients/carers and 12 healthcare professionals in a workshop.
The Revision Knee Replacement Top 10 was announced in January 2020.
Key documents
Revision Knee Replacement PSP Question Verification Form
Top 10 Priorities
- What are the causes of persistent pain following a knee replacement? How can the pain be prevented or minimised?
- What is the best way to diagnose and treat infection of a knee replacement?
- What are the most effective ways to organise health care and avoid delay to improve the results and patients’ experience of revision knee surgery?
- What factors determine (predict) whether revision knee surgery is likely to work?
- What can be done after and/or before revision knee surgery (including physiotherapy and exercise) to optimise the result?
- What is the psychological impact of a problematic knee replacement and what support do people need before, during and after revision knee surgery?
- How should we measure the outcomes following revision knee surgery in a way that is meaningful to patients, and is surgery cost effective?
- Is there a way to manage some types of problematic knee replacement to avoid revision knee surgery ( through physiotherapy, lifestyle change and / or self-management)?
- What causes knee stiffness following knee replacement? How can it be avoided and how is it best treated?
- What are the best forms of surgery to use for revision knee surgery (including choice of implant and technique)?
The following questions were also discussed and put in order of priority at the workshop:
- What are the best ways to investigate the causes of pain following a knee replacement?
- What are the best treatments for pain in replacement knees, particularly if revision knee surgery is not recommended?
- What is the best way to treat a break or fracture around a knee replacement?
- How long does a revision knee replacement last and what can be done to extend its life?
- What are the best ways to manage patients’ unmet expectations and dissatisfaction with problem knee replacements and/or revision surgery?
- What factors increase the risks of infection and how can these risks be reduced?
- What are the long-term outcomes when a knee replacement has been infected?
- What are the best non-surgical treatments around the time of revision knee surgery to improve outcomes (e.g. reducing bleeding, improving wound care)?
- What are the most effective forms of pain relief during revision knee surgery and in the recovery period?
- What are the long-term outcomes of revision knee surgery?
- What are the best ways to investigate implant-related failure in a knee replacement?
- If necessary following infection in a knee replacement, should revision surgery be done in one or two operations?
- What is the best way to restore lost bone during revision knee surgery?
Document downloads
For full details of all of the questions identified by this PSP, please see the document below.