Revision Knee and Hip Replacement

Revision total knee and total hip replacement are defined as a re-operation to replace one or more components of a knee or a hip replacement. These operations have evolved into a subspecialty of joint replacement surgery. The complexity of these operations can vary from replacing one of the parts to replacing all of the parts. These operations are usually performed by surgeons with special interest training and experience in hip and knee replacement surgery. As a rule, general orthopedic surgeons who perform many types of orthopedic operations usually refer these cases to a joint replacement specialist.

Revision total joint replacement is performed when the original primary joint replacement has worn out or loosened in the bone. Revisions are also carried out if the primary joint replacement fails due to recurrent dislocation, infection, fracture or very rarely, ongoing pain and significant leg length discrepancy. Total joint replacement implants may fail after 1-2 decades, or occasionally sooner. The parts may become loose or they may wear out. In either case an operation will be required to replace the damaged part or even the entire implant. At times there might be combination of worn joint with ligament insufficiency which might require the use of a specialized prosthesis (artificial joint).

It may also require an increase in the length of the hospital stay. The magnitude of this surgery depends on the difficulty of prosthesis removal and on the quality and quantity of bone left behind after the implant has been removed. The revision operation may require bone grafts from a bone bank to be used. A custom prosthesis is sometimes needed (a prosthesis specially manufactured for a specific patient).

In revision surgery, the surgeon removes the original prosthesis, cement, surrounding tissue and dead bone before inserting a new prosthesis. Postoperative care for revision surgery is the same as that for the original replacement surgery. Patients usually have a combination of home health care, physical and occupational therapy and other forms of rehabilitation.

These complex operations are much riskier than first-time knee replacement surgeries. All the risks associated with first-time knee replacement are present, but the chances of these complications occurring are greatly increased. These technically demanding operations should be performed by a surgeon skilled and experienced in both first-time knee replacement surgery and revision surgery

Possible complications from this procedure are similar to those in the original joint replacement surgery. However, in general the success rate for revision surgery is slightly lower than that of original joint replacement surgery because the bone is weaker and the prosthesis is more likely to loosen. The first operation generally has a 95 percent success rate, while revision hip surgery has an 85 percent success rate. Complications from revision surgery may include:

• Infection (in only two to four percent of cases)
• Loosening of the new prosthesis (in 10 to 15 percent of cases. The likelihood is much greater if the patient is overweight and/or does not use crutches during the first few months)
• Bone fractures during or after surgery (since the bone is weaker and there may be considerable scar tissue around the joint)
• Dislocation (twice as common as for a primary procedure)
• One leg shorter than the other
• Bone loss in the joint (grafting sometimes helps)

If the joint is infected, the implant might be surgically removed and re-implanted with antibiotic-filled cement spacer. In addition, intravenous (IV) antibiotics might be necessary for six to eight weeks, followed by at-home treatment of oral antibiotics. Although these risks may be troubling, many patients experience no complications at all. At our Institute for Joint Replacement, patients' chances for successful outcomes are well above national averages.

Patients that have a failed joint replacement have a different perspective than patients who are undergoing their first operation.

Many patients who have had an unsuccessful joint replacement will research the surgeons and the institutions as they seek help for their failed joint replacement. Even if a patient is referred from one doctor to another doctor, the patients often come with knowledge and experience regarding joint replacement surgery that they didn’t have before their first joint replacement. These patients are often willing to travel long distances or even to a different country in order to find an experienced team to address their particular problem.