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Revision Joint Replacement Surgery

In this article, Orthopedic Surgeon Dr. John Klibanoff discusses revision joint replacement surgery and when one might be needed.

You’ve just left your orthopedic surgeon’s office and are floored… you need a revision joint replacement surgery.

A what???

A revision?

What is that? How did this happen?

This reaction is common when patients receive news that they need a revision surgery after joint replacement.

Surgery can be a stressful experience. Though many orthopedic procedures result in satisfactory functional outcomes, especially joint replacement, sometimes complications can occur that require another operation.

But, with knowledge and understanding, you can get through this. I’ve found many revision surgeries are highly successful. In this article, we’ll discuss revision surgery so you can feel more informed and more at ease.

Why do I need a revision surgery?

In general, a revision joint replacement might be needed when one of a few complications occur:

  • The implant(s) wear out over time
  • The implant(s) loosen
  • Scar tissue causes trouble

Implant wear

Over time, it’s possible for parts of the implant system to wear out. This is most common years after surgery, such as hip or knees that were replaced many years prior. Picture brake pads or rotors on a car that wear out over time... just like brakes, these parts wear down and need to be replaced.  

There are situations when only a short operation to replace the “cartilage” portion (plastic cushion liner between the metal parts) of the implant needs performed. This often comes with a faster recovery because the work on the bone is minimal. Other times, the metal parts need to be replaced as well. This is a more involved process where the old parts are taken out, the ends of the affected bones are prepared for replacement implants, and a new, usually slightly larger implant is inserted. Hips, knees, and shoulders can all wear over time.

Implant loosening and infection

Another possible complication that can occur is when an implant(s) becomes “loose” or separated from the bone to which it was originally attached. This can occur because of aging and osteoporosis, as the bone loses some of its calcium over time and weakens the attachment of the implant(s) to the bone.

Other times, implant loosening can occur when the body reacts to the cement used to adhere some of the implants to the bone. The use of cement is becoming less common now than it was years ago, as many implants are made of surfaces that support bone on-growth or ingrowth and cement isn’t needed.

Loosening can also occur because of infection in the joint after surgery. 

Uninfected loosening is a more straightforward fix as we just remove the old implants, clean and prepare the bone, and insert a new replacement that’s typically slightly larger with mounting stems.

Infection is, unfortunately, a more complicated problem as bone infections must be eliminated before the new implants can be expected to last. Occasionally, two stages of surgery are required. The first removes all the infected materials – implants, bone, and local tissue. Then, a vigorous cleaning of the remaining bone and healthy tissue is performed. Temporary, antibiotic loaded “spacers” are then placed until the region is sterile. The second procedure removes the spacers and a new implant is placed. From beginning to end, infection treatment can be very brief, or it can take several months to a year to complete. 

Scar tissue

Finally, there can be problems with the tissue around the implants that require revising some, or all, of the parts to fix and stabilize the joint. For example, a knee can become stiff because of excessive scar tissue that needs to be removed. On occasion, a total hip implant can dislocate, or “pop out” and create an unstable joint. This may require a more constrained implant to be placed to restore stability. In a patient with a shoulder replacement, should the individual suffer a rotator cuff tear that can’t be fixed, the replacement may need to be converted to a reverse design implant to restore power and function. In these examples, and those such as traumatic injuries around the replacement parts, revisions may be needed to fix the neighboring problems.

What happens next?

If your orthopedic surgeon believes you need revision surgery, they’ll likely follow the same process they used during your initial appointments. They’ll be a:

  • Diagnosis
  • Plan to treat the problem
  • Consultation with you to explain the problem, process, and solution
  • Surgery that involves removal of the parts in question
  • Careful preparation of the “bony envelope” for the new implant
  • Methodical restoration and re-implantation of your hip, knee, or shoulder
  • Comprehensive joint re-education and post-surgical physical therapy

Joint replacement surgery is more popular than ever as we seek capability for activity and mobility. This growth in demand means more revisions could be needed over time. If you find yourself being told one is in your future, know the facts: revisions can be common, and are typically successful, but also involve risks that should be discussed with your surgeon. 

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