What You Need to Know About Revision Surgery

by Dr. Geoffrey Westrich
9.10 Blog

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.

Topics: Orthopedics
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


Mac Maynard says:

I am very interested in the HSS hospital in New York, the best for sure! But I wonder if there is an equal quality one in California? At this point I am still trying to find a way to live in New York while this revision is taking place? Thanks for any help! mac@sti.net

HSS on the Move says:

Hi Mac – Thanks for reaching out. Please click the following link for information on our Coast to Coast Program for patients who are traveling to HSS: http://www.hss.edu/coast-to-coast.asp. If you have any additional questions about making the trip to HSS, please email us at socialmediacontact@hss.edu. Thanks!

susan westrup says:

i need revision surgery for a knee replacement from 2010.
The prosthesis is loosening, causing pain,limping,
synovitis. the movement was evident both on bone scan and x-ray. I am 56 years old, and I can’t work because of difficulty walking.
i’d like to make an appointment with Dr. Westrich
Susan Westrup

HSS on the Move says:

Hi Susan, thanks for reaching out. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555.

amol says:

Amol ,goa India.

I am 24 years old suffering from perthese disease.i wanted to have a total hip replacement surgery as the pain ,leg shortening are interferring with my life causing mental stress also. please help

HSS on the Move says:

Hi Amol, thank you for reaching out. If you are interested in receiving care at HSS please call our Physician Referral Service at 877-606-1555

Gene Casazza says:

Dr Westrich did a hip replacement for my Mom (78 at the time) three years ago. All want well and we did not contact Dr W. again until this week.

At 9:45 PM I called the service to say my Mom was experiencing severe pain. We got a return call in an hour and Dr Westrich was very helpful. It turned out that the pain was muscle related, but the doctor and his staff, especially Denise, were very helpful.

The level of service and care we experienced was truly impressive.

HSS on the Move says:

Hi Gene, thank you for sharing! We will share your kind words with Dr. Westrich and his team.

Alex says:

Is there any possible side effect after revision surgery? How to care after operation? Is there any health condition limited to do revision surgery?

HSS on the Move says:

Hello Alex- Thank you for reaching out. Dr. Geoffrey Westrich, Orthopedic Surgeon, says: “There are standard medical and orthopedic risks associated with all surgery and all patients should discuss the specifics of their case with their treating surgeon. Revision surgery can be more complex and there may be additional risks compared to primary surgery. However, the risks of not having the revision surgery can also be problematic and delays in revision surgery can lead to more complicated surgery in the future. The aftercare following revision surgery is similar to the first surgery, but the specific weight bearing, physical therapy, and restrictions vary depending upon specifics of the surgery and this should be discussed with the surgeon before and after revision surgery. There can be severe health conditions that can limit or prevent revision surgery, but this should be discussed with both the surgeon and the medical internist prior to surgery. Many times, some additional testing may better answer this question.” It is important to consult with your treating physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Robert Holland says:

Hello iam a 63 yr old man and i had a LF Knee replaced in 2007 4 months after i had it replaced they put a new disc in it because it had to much play it it It still wants to hing inward if i bring my knee inward it like folds and now i need my Rt knee done as well can and will Dr Westrich do both knees at the same time ? and how much time do i need to make and Appt. I live in West Virginia Thank you for you help

HSS on the Move says:

Hi Robert, thanks for reaching out. We have sent your question to Westley Holiday, Coordinator of HSS’ Coast to Coast Program. You should receive a response shortly.

Michael Cohen says:

Will you agree to just take deductible from me and get the rest from out of network ghi.Ditto for surgery. Need evaluation for possible revision of knee replacement

HSS on the Move says:

Hi Michael, thank you for reaching out. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

carl j goodman says:

I asked for a copy of my most recent blood test and mri results. I would appreciate receiving these so that I can get a second opinion

thank you

HSS on the Move says:

Hi Carl, thank you for reaching out. For more information on how to obtain your medical records, please visit http://www.hss.edu/notice-of-privacy-practices.asp.

Joseph Tonrey says:

I am on workers comp since 10/6/2008.
I have been referred to Dr. Westrich by a neighbor. I would like to know what paper work I will need? I received a authorization for a left knee replacement in October 2013.
My left hip also has a screw and plate which was place 1/17/2013 do to a fall. Rt. knee was replaced 2/17/12 not happy with results.
Rt hip was fractured on 10/06/2008

HSS on the Move says:

Hi Joseph, thank you for reaching out. We have sent over your inquiry to Dr. Westrich’s office and someone shall be reaching out to you soon.

Marguerite Eden says:

Do you do smith and nephew knee replacements

HSS on the Move says:

Hi Marguerite, thanks for reaching out. For more information on Total Knee Replacements and implants, visit http://www.hss.edu/conditions_new-minimally-invasive-technique-improves-recovery-time.asp. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Judi Hammond says:

Revision hip surgery on 03/31/14. My surgeon recommended no physical therapy for 8-10 weeks. The metal on metal completetly destroyed tendons and tissue plus I had virtually NO abductor muscle left.
Needless to say, recovery has been much slower, and I am still using a cane. I would like NOT to use a cane, and am starting another physical therapy location with water therapy. My concern is I hear (and others hear it too. It is NOT in my head) a “clacking” which I”ve isolated to the new hip implant. It”s a Striker, the cup in screwed into my pelvis and the ball fits through a collar and rests in the cup. Would it make a noise as I have suggested? It doesn”t hurt but is very disconcerting nonetheless. Thank you!
Judi Hammond

HSS on the Move says:

Hi Judi, thank you for reaching out. Because your care and comfort is important to us, Hospital for Special Surgery has a Patient Advocate available to assist you with any questions. To reach a Patient Advocate, please call 212-774-2403 for further assistance.

Sanjeev says:

My 78 yr old Mother fell down and fractured her right femur near the hip joint; a repair was performed involving a rod in the femur and 3 screws at the head of the femur; after 10 days or so she developed high fever and was being treated for it; and 18 days later we went to open the stitches, and an x-ray revealed that 2 of the 3 screws had come out of the bone. The local hospital extracted the rods and put in antibiotic Vancomycin beads etc to treat the resulting bone infection. This has been repeated 3 times now; Her leg is in traction I need to get her to the right Doctor to do the revision hip replacement with a customized prosthesis. She would need to be flown in from abroad.

HSS on the Move says:

Hi Sanjeev, thank you for reaching out. If you are interested in care for your mother, please contact our International Center at 212-606-1185 or by email at international@hss.edu for further assistance. For more information on the International Center at Hospital for Special Surgery, please visit http://www.hss.edu/international-center.asp.

Karen Prego says:

I’m looking for a doctor who has extensive experience in revision of a total hip replacement. I have some osteolysis.

HSS on the Move says:

Hi Karen, thank you for reaching out. We have sent your inquiry along to PRS representative Andrea Houston, who shall be contacting you shortly.

Sharon says:

i had a hip revision 11/14/14, cup that fits in socket had deteriorated and was replaced. I was doing fine until 3 weeks ago when walking the hip seemed to not work as smooth I could feel my hip move up and down and can hear a or feel a clicking sound. It seems to happen within a couple of hour of starting my day. I am not in pain and I went to see my surgeon yesterday and exray looked good. Surgeon said I just need to strengthen muscle. Has anyone else experienced this? It is hard to explain how it feels I had a friend touch my hip while I walked and she could feel it move out of place.

HSS on the Move says:

Hi Sharon, thank you for reaching out. It would be best for you to consult with a physician so that he or she can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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