Revision Joint Replacement Surgery
While modern-day joint prostheses are more durable than ever, nearly all artificial joints can be expected to wear out after enough time and wear. Interestingly, many of the revision surgeries we perform at Orthopaedics New England are not so much because the implant failed, but rather because the bone surrounding the implant failed and no longer provides adequate support. The prostheses gradually may become loose.
As described below, there are a number of reasons why joint replacements may need to be revised. Regardless of the reason, revision surgery is complex and demanding. The complexity depends upon many variables, including the diagnosis and underlying problem, scar tissue, potential damage to nerves or blood vessels, and longer surgical time and increased blood loss because of the need to remove the old components.
Because revision joint replacements are among the most complex procedures in modern orthopaedics, relatively few surgeons perform revision surgeries. For that reason, many of our patients undergoing revision surgery have been referred from other centers or surgeons.
Common Reasons for Revision Joint Replacements
When a patient with an artificial hip or knee is involved in a fall or trauma such as a motor vehicle accident, most often it is the bone surrounding and anchoring the artificial joint that breaks before the metal prosthesis fails. This is called a periprosthetic fracture. As a result, the joint replacement needs to be revised as part of the surgery to treat the broken bones.
Mechanical loosening, meaning that the prosthesis becomes loose from the surrounding bone, is another common cause of eventual revision joint replacement. As a patient ages, the bone around the implant may become softer due to age related changes or microscopic particulate wear. With today's modern materials, longevity and the incidence of mechanical loosening have improved dramatically over 50+ years of total joint replacement, and improvements in materials science and engineering mean that most implants will have a service life of decades.
Artificial joints do not often become infected, but when they do, surgery is usually required. If you become ill with a fever or you have a prolonged infection in another part of the body, you should seek medical treatment. Bacteria from an infected body part can travel through the blood to the site of the joint replacement and infect the prosthesis.
If an infection has only been present for a few days, it may be possible to simply “wash out” the joint, a process known as irrigation and debridement. If an infection has been present for a while, chances are the bacteria have had enough time to adhere to the joint hardware. If this happens, it may be necessary to remove the joint prosthesis, treat the infection with antibiotics, and then re-implant the joint replacement weeks or months later when the infection is resolved.
Sometimes a joint replacement becomes unstable, with the artificial joint dislocating or sinking into the underlying bone that anchors it. Hip replacements can be particularly problematic if the ball keeps dislocating, or popping out of the socket. This requires a trip to the hospital to have the joint popped back into place, a procedure that requires anesthesia.
Chronic knee instability or recurrent hip dislocations may lead to the need to revise the joint replacement to stabilize the knee or make it more difficult to dislocate the hip. Sometimes the underlying problem may be more complex and require extensive revision surgery.
Revision surgery is significantly more complex than routine joint replacement surgery and typically only performed at large joint replacement centers with the resources to manage unusual and complex problems. CJRI is among the 10 busiest joint replacement centers in the U.S. As hip and knee replacement specialists, they have years of experience performing the most complex revision surgeries in Connecticut and New England. If you have pain in an artificial joint, visit Orthopaedics New England for a consultation or second opinion. Call (203) 598-0700 today or you can request an appointment online.