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Revision knee - the operation the first surgeon avoids.

Redo knee replacement for loosening, infection, instability or wear - done by a consultant revision arthroplasty surgeon with dedicated revision instruments, augments, cones and hinge inventories on the shelf. Two-stage revision for infection, MDT-led, no shortcuts.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private revision knee replacement costs in the UK.

Indicative ranges across our revision arthroplasty network. Revision is longer, more implant-heavy and always more expensive than a primary.

In short

£20,000–£30,000, home 3–5 nights.

Procedure Indicative range
Aseptic revision total knee (single component) £20,000–£30,000
Aseptic revision total knee (both components) £25,000–£38,000
Two-stage revision - stage 1 (spacer) £18,000–£28,000
Two-stage revision - stage 2 (reimplantation) £22,000–£34,000
Hinged/constrained revision knee (bone loss) £28,000–£42,000
Knee joint aspiration + alpha-defensin £650–£1,200
Revision arthroplasty consultation only £320–£550

Prices vary by the implants used (stems, sleeves, cones, hinge), by whether one or two stages are needed for infection, and by hospital. A two-stage revision costs the sum of both stages plus 6–12 weeks of IV antibiotics.

The problem

The right diagnosis, the right revision, the right team.

Revision knee replacement is where primary arthroplasty lists quietly under-deliver - infection missed, one-stage revisions done in contaminated fields, and revisions done by primary surgeons without cone or augment inventory.

  • Rule out infection first

    Every failed knee replacement is infected until proven otherwise. Aspirate, alpha-defensin, ESR/CRP - before, not after, the revision decision.

  • The right revision surgeon and the right shelf

    Revision needs cones, sleeves, augments and hinge inventory on the day. Not every knee arthroplasty hospital stocks them.

  • Two-stage for infection, no exceptions on autopilot

    One-stage revision has a role for selected chronic infections in the right centre - everywhere else, two-stage remains the gold standard.

When it helps

When revising a knee replacement is the right step.

The failure modes we see most, plus the presentation that needs same-day aspiration and IV antibiotics.

  • Aseptic loosening

    Progressive pain on weight bearing, radiolucent lines around the implant on X-ray - the commonest reason for revision at 10–20 years.

  • Prosthetic joint infection (PJI)

    Pain, warmth, sinus, effusion or systemic sepsis. Every persistently painful knee replacement is infected until proven otherwise.

  • Instability

    Giving way, feeling of insecurity, sub-luxation - often ligament or component-position related.

  • Malalignment

    Varus or valgus collapse, patellar maltracking - usually revision with alignment correction and, sometimes, a constrained or hinged implant.

  • Polyethylene wear and osteolysis

    Focal bone loss around the implant from polyethylene particles - revision with liner exchange or full revision.

  • Periprosthetic fracture

    Fracture around a knee replacement - fix or revise depending on implant fixation and bone stock.

  • Extensor mechanism failure

    Patella tendon or quadriceps disruption - one of the harder revisions, sometimes needing allograft or synthetic augmentation.

  • Red flag: hot, swollen, systemically unwell

    Acute swelling with fever, redness and systemic upset is likely acute PJI - same-day team review, blood cultures and aspiration, not a routine appointment.

Procedure options

The revision fits the failure mode.

What each option involves - from a simple liner exchange to a rotating hinge with cones - and when each earns its place.

  • Single-component revision

    Femoral or tibial component alone (with liner exchange) - for isolated loosening with the other component well fixed and well aligned.

  • Full revision total knee replacement

    Both femoral and tibial components replaced, usually with stems and augments to bypass bone loss. The workhorse revision.

  • Two-stage revision for infection

    Stage 1 - remove implants, debride, insert antibiotic cement spacer, IV antibiotics 6–12 weeks. Stage 2 - reimplantation once infection is cleared. Cure rates 85–95 percent.

  • One-stage revision for infection

    A single-sitting revision with radical debridement and immediate reimplantation - for selected chronic PJI with an identified organism, in specialist centres.

  • DAIR (debridement, antibiotics, implant retention)

    For acute PJI within 3–4 weeks of primary - irrigation, debridement, polyethylene exchange and prolonged antibiotics. Success 40–70 percent depending on organism.

  • Constrained condylar knee

    Higher constraint for ligament insufficiency - adds stability at the cost of some implant longevity.

  • Rotating hinge revision

    For severe bone loss, gross instability or extensor mechanism issues. The last-resort implant, but essential to have available.

  • Cones, sleeves and augments

    Metal cones (trabecular metal), tantalum sleeves and metal augments fill bone defects. Available inventory determines what is possible on the day.

Safety and recovery

What to expect afterwards - honestly.

Revision knee replacement is more complex, longer and less predictable than a primary. The single biggest determinant of a good outcome is the surgeon and the hospital, not the implant.

  • GA or spinal anaesthetic, longer than a primary

    Every revision takes longer than the primary. Cell salvage and standard DVT prophylaxis reduce blood loss and clot risk.

  • Infection risk is higher than primary

    PJI rate after aseptic revision 3–5 percent; after two-stage revision for infection, 5–15 percent risk of reinfection. Both higher than the 1–2 percent for primary.

  • Function is generally less than primary

    Revision knees are usually stiffer, with a smaller range of motion and less predictable pain relief than a well-functioning primary - an honest number worth knowing.

  • Bone loss and extensor issues drive constraint

    Where ligaments or bone stock are poor, constrained or hinged implants are used - trading longevity for stability.

  • DVT and PE

    Standard prophylaxis reduces symptomatic clot risk. Any calf swelling, chest pain or breathlessness after surgery needs urgent review.

  • Wound problems and skin healing

    Previous scars, longer incisions and diabetes raise the risk of wound complications. Plastic surgery input where the soft tissue envelope is poor.

  • Peroneal nerve palsy

    A small risk in valgus knee correction - usually recovers over weeks to months.

  • Revision durability

    Aseptic revisions typically last 10–15 years; hinged and constrained implants sometimes shorter. Long-term surveillance is part of the deal.

  • Red flags after surgery

    Fever, worsening pain, spreading redness, wound discharge, calf swelling or breathlessness need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether it was a single-component swap or a hinged revision with cones, the note the revision surgeon sends you keeps to the same shape.

A UK consultant revision arthroplasty surgeon reviewing knee X-rays

A quiet reminder

Clinical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the notes and any results before your review, just ask.

  1. 01 Header

    Failure mode and revision type

    Why the primary failed - aseptic loosening, PJI, instability, wear, fracture - and whether the revision was one or two-stage.

  2. 02 Technique

    Implants used and bone loss addressed

    Which implant system, stems, cones, sleeves, augments or hinge, and how bone defects were managed.

  3. 03 Findings

    Intra-op cultures, tissue samples, stability

    Intraoperative frozen sections and cultures, ligament balance, joint stability after reimplantation.

  4. 04 Impression

    Rehab plan and expected function

    Read this first: weight-bearing status, physio plan, antibiotic regimen if infection was treated, and expected range of motion and pain relief.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Revision knee replacement is usually covered when medically indicated. Two-stage infected revisions and long antibiotic courses are usually covered too, subject to pre-authorisation.

Frequently asked

Everything we get asked about revision knee replacement.

Quick answers on failure modes, infection, function, longevity and cost.

  • How do I know if my knee replacement is failing?

    New or worsening pain, giving way, stiffness, warmth, effusion or wound issues after a previously satisfactory replacement. The commonest causes are aseptic loosening, wear and prosthetic joint infection. Every persistently painful knee replacement needs a specialist review, imaging and joint aspiration.

  • What is a two-stage revision?

    The gold standard for infected knee replacement. Stage 1 - remove the implants, debride the joint, insert an antibiotic-loaded cement spacer, IV antibiotics for 6–12 weeks. Once cultures and inflammatory markers are clear, stage 2 - reimplant a new revision knee. Cure rates 85–95 percent in appropriate centres.

  • Is a one-stage revision ever right for infection?

    Yes, in selected patients with chronic PJI, a single identified organism, good soft tissues and in a bone-and-joint-infection specialist centre. Recent evidence suggests results are comparable to two-stage in the right hands - but two-stage remains the default outside specialist units.

  • How is it different from a first knee replacement?

    Longer operation, more implant hardware (stems, cones, augments, sometimes hinge), longer hospital stay, more blood loss, longer rehab, higher complication rates and - honestly - less predictable pain relief and range of motion than a well-functioning primary. Expectations matter.

  • How long will a revision knee last?

    A well-done aseptic revision typically lasts 10–15 years. Constrained or hinged revisions may last shorter - trading longevity for stability. Regular long-term X-ray surveillance is part of the plan.

  • How much does a private revision knee replacement cost in the UK?

    Roughly £20,000–£30,000 for a single-component aseptic revision, £25,000–£38,000 for a full aseptic revision, £28,000–£42,000 for a hinged revision, and £40,000–£62,000 total for a two-stage infected revision (both stages plus antibiotics).

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