What You Need to Know About Revision Surgery
Hundreds of thousands of hip and knee replacement surgeries are performed in the United States each year and they are highly successful in eliminating pain, restoring mobility and improving quality of life.
Joint replacement, in which an orthopedic surgeon replaces the arthritic areas of a joint with a metal, plastic or ceramic implant, has changed many lives for the better. The implants used in joint replacement may last up to 15 or 20 years, but they generally do not last forever. When the implant wears out, people often need a second surgery in which the existing implant is taken out and replaced. This is called a revision surgery.
Revision surgery is needed sooner if any of the below occurs:
- Loosening of the implant: The hip or knee replacement may become painful after many years because the components have begun to wear and loosen.
- A fracture: A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.
- Dislocation: If the implant dislocates on repeated occasions, revision surgery is frequently needed to stop this from happening.
- Infection: This can be a serious complication. If a deep infection develops in a hip or knee replacement, revision surgery is often needed to eradicate the infection and to implant new non-infected components.
- Implant recall: On occasion, the implant used in joint replacement is found to be defective; patients are advised to be monitored by their physician to ensure it does not need replacement. Revision surgery is sometimes, but not always, necessary when an implant is recalled.
Patients should be aware of warning signs that there may be a problem. Such signs can include: pain that comes on suddenly, trouble getting around and decreased range of motion. Anyone with a joint replacement experiencing these symptoms should see their doctor immediately.
A revision surgery is more complex than the initial operation and requires a certain level of skill and experience. Many physicians who perform primary joint replacements refer their patients to an expert in revision surgery, if needed. Over the past two years, I have seen an increase in the number of patients coming to me for the procedure.
If someone needs a revision surgery because of an infection or other serious issue, it is critical to find an orthopedic surgeon who performs many of these operations. Hospitals such as Hospital for Special Surgery, an orthopedic specialty hospital and joint replacement center, are equipped with these types of surgeons.
Patients often ask what steps they can take to make their initial hip or knee replacement last longer. The following factors can increase longevity and decrease the possibility of revision surgery:
- Avoid overusing the joint. Patients are advised to avoid high-impact activities, such as running and singles tennis, which can shorten the lifespan of the joint replacement. Try to walk instead of run while exercising and opt for doubles instead of singles tennis.
- Avoid sports that require jumping and landing hard, which can damage or weaken the joint. Instead, engage in non-impact activities that build muscle strength.
- Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
- Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly.
- If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your medical doctor for appropriate antibiotics.
- Pay a visit to your orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.
- Have your primary hip or knee replacement with an experienced surgeon who specializes in the procedure at a center that performs a high number of joint replacements to ensure the best outcome and lower the risk of complications.
Geoffrey Westrich, M.D., specializes in hip and knee replacement, including revision surgery and complex cases at Hospital for Special Surgery. He is director of research in the hospital’s Adult Reconstruction and Joint Replacement Service. He is also co-chair of the hospital’s Infection Control Committee, co-chair of the Thromboembolic Disease Review Committee, and co-chair of the Complex Case Pre-Operative Review Panel.