Revision Joint Replacement

Joint replacement surgery is a familiar concept to most people and this type of surgery – especially hip and knee replacement – is now routine for the treatment of severe arthritis and serious joint fractures.

But, fewer people have heard of or understand revision joint replacement surgery. So, to mark Arthritis Awareness week we are looking at what it is, who might benefit and what is involved.

What is revision joint replacement surgery?

Revision joint replacement surgery is an operation to replace an artificial joint that has worn out. The number of revision joint replacement procedures are increasing because growing numbers of people – especially younger people – are having joint replacements. With an average lifespan of 10-20 years for most hip and knee implants, this means that some artificial joints are wearing out and need to be replaced within the patient’s lifetime. Revision joint replacement involves removing the worn-out prosthetic implant and replacing it with a new one.

Because it is a more complicated procedure than a standard hip replacement, involving removal of the original implant and, in some cases, reconstruction of the bones, revision joint replacement takes longer than standard joint replacement surgery. There is also a greater risk of complications as the bone may have grown onto the implant which may make it difficult to remove. Bones become thinner as you age making them more prone to fracturing.  Revision joint replacement is not always as successful as standard joint replacement surgery.

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Who needs revision joint replacement?

You might need revision joint replacement surgery if you have previously had a joint replacement procedure and you are now experiencing problems with the joint that was operated on. These might include:

• Loosening of the implant which causes pain and instability in the joint. This is the result of the cement or fittings used to hold the new joint in place breaking away and loosening the bonds between your bones and the implant.
• Infection of the prosthetic implant. While this is rare it can sometimes occur and may result in the implant having to be removed if the infection cannot be treated.
• Wearing of the implant surfaces or incorrect alignment.
• Dislocation of the joint. This is more common with hip replacements and it can be due to scar tissue interfering with the joint, or weak supporting muscles around the joint or patients not following the correct guidance in relation to rehabilitation after surgery.

If you don’t have surgery to correct the problem it could result in a fracture of the bone.

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What to expect during revision joint replacement?

Revision joint replacement surgery is generally performed under general anaesthetic. Initially, the existing implant will be removed. If there has been significant bone loss, bone grafts might be needed to fill the voids. In some cases metal plates, wires or screws may be used to strengthen the bone. Once the area has been prepared, the new revision implant will be inserted. Temporary drains may be inserted to prevent excessive swelling. These will normally be removed soon after surgery. Post-operative care and rehabilitation is similar to primary joint replacement surgery.

Knee revision joint replacement can take up to two hours depending on the condition of your knee implants and any bone loss. The surgeon makes an incision down the centre of the bone to remove the implant. Once removed the condition of your bone surfaces will be assessed to see if any bone grafts are needed. After preparing the bone surfaces, the revision implant is inserted and soft tissues around the joint are adjusted to hold it in place. The soft tissues will then be sewn back together and the wound closed with staples or stitches. You will normally remain in hospital for several days and you will need a walker or crutches to walk after the operation.

Hip revision joint replacement normally takes longer than standard hip replacement surgery. During the procedure, the surgeon will make an incision over your hip and thigh and divide your muscles. The original implant will be removed and the condition of the bones assessed. If necessary bone grafts will be used before the hip revision implant is inserted. Once correctly positioned, the soft tissues will be sewn into place and the wound closed with staples or stitches.

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What are the risks of revision joint replacement?

Unfortunately revision joint replacement surgery is more complex than the original procedure and there is a great risk of complications than with first-time joint replacement. For this reason, as orthopaedic surgeons we generally recommend trying non-surgical treatments for joint pain before recommending a revision joint replacement.

Among the risks associated with revision knee joint replacements are:

• Infection in the joint or rejection of the prosthetic implant.
• Numbness on the outside of the knee or stiffness which may require further surgery.
• Fluid build-up around the knee joint.
• Bleeding around the joint which may need to be drained.

Among the risks associated with revision hip joint replacements are:

• An infection in the artificial implant.
• Loosening of the hip implant which may require further surgery.
• Joint dislocation which normally occurs in the first three months after surgery. It may require an operation to fix it.
• Differences in leg length which may require a special shoe insert to correct it.
• Extended recovery times if you have to undergo a bone graft.

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Outcomes of revision joint replacement

In some cases, patients may take longer to recover from revision joint replacement than they did from the original joint replacement procedure, particularly if you have to have a bone graft. The risk of complications may be greater (see above) and revision joint replacement surgery may not improve your mobility as well as the original operation did. Nevertheless, joint revision surgery is improving all the time and it is likely to improve your quality of life if you are experiencing pain due to failure of the original implant. In some cases, you may walk with a limp or need to wear a special shoe insert but you will normally be able to return to everyday activities following surgery.

Castle Orthopaedics offers joint replacement and revision joint replacement surgery for knees and hips. Contact us to discuss the possible options.

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