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: Featured, 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.

Comments

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.

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April 19, 2014 at 12:00 pm

The NHL playoffs are underway, and having a strong abdominal and core muscle strength is important for keeping players in top form. Gregory Reinhardt, HSS Physical Therapist, says: "While skating, the activation of a hockey player's oblique muscles is crucial for their ability to constantly push off from their skates." To read more about core strength for hockey players, visit http://hss.edu/onthemove/core-strength-for-hockey-players/.

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