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Second Time Around: Revision for an Existing Joint Replacement
Medically Reviewed by Rodney Alan, M.D. McLeod Orthopaedics
Millions of people are enjoying the quality of life and end of pain that a total knee or hip joint replacement delivers. Many of those people will also experience the need for a second replacement – also called a “revision” – of their artificial joint.
WHAT ARE YOUR CHANCES? The younger a person is when they receive their first artificial joint, the greater the likelihood that they’ll need a revision. If a person is 58 years old when they get their artificial joint, there’s a 50% chance they will need revision surgery in their lifetime. Patients older than age 62 when they have their first surgery, the artificial joint will normally last their lifetime.
If revision of the joint is considered, age – even advanced age by itself – is less of a consideration than it was a few years ago. If a person is healthy enough to undergo major surgery of any kind, they can be considered for revision surgery, resulting in less pain and more mobility.
WHY DO I NEED A NEW ARTIFICIAL JOINT?
Over time, the same wear and tear that probably led to the initial joint replacement can cause loosening of the replacement. Loosening leads to bone loss and damage, accompanied by pain.
Infection is another major cause of joint failure. Bacteria are prone to look for surfaces like the metal and plastic found in implants. Infection can lead to pain and swelling. At its worst, the joint may require drainage before the revision surgery.
Occasionally, the implant will shift out of its normal position. Dislocation may result from a number of problems, including a fracture, loosening or scar tissue.
Obese patients put more stress on their artificial joints, causing wear and loosening.
Young patients simply tend to be more active, putting excessive wear on the joint.
There are some non-surgical treatments for problems with the replacement joint. However, most of these options result in lack of mobility or major limits on activity.
A 3-STEP SURGERY
The revision surgery generally is more complex and takes longer, because unlike the original joint replacement procedure, this surgery involves three steps.
Step 1 – Removing the old implant. The surgeon must remove the existing hardware without doing any further damage to the bone, muscle or cartilage.
Step 2 – Preparing the Site. In some cases, deteriorated bone must be built up before the new parts can be implanted. If there is serious infection, this may need to be treated and the new joint implanted at a later date.
Step 3 – Implanting the New Components. Various techniques are used for the new joints, as well as various cemented and uncemented techniques, to ensure stability of the new joint.
AFTER THE SURGERY
Just as with your original surgery, your orthopedic team will try to have you up on your feet within 24 to 48 hours. It may take 3 months of physical rehabilitation following the surgery. And patients may need a protective brace or assistive devices, such as a walker or crutches.
Patients who need joint “revision” tend to be older and, therefore, less tolerant of lengthy operations. The procedure is more complex and difficult than the initial hip or knee replacement. Yet, studies show that more than 9 out of 10 people who undergo revision surgery have good to excellent results.
Sources include: McLeod Health, National Institutes of Health, Medical News Today, Orthopedics.about.com, Healthgrades, Arthritis Research (UK), American Academy of Orthopaedic Surgeons