Joint Revision Surgery

What is a joint revision?

A joint revision surgery is the replacement of one’s prosthetic implants for people who had a previously total or partial knee, shoulder, or hip replacement surgery.

During surgery, the original prosthesis is removed and a new prosthesis put in place.

Complete revisions are complex procedures that require extensive preoperative planning, specialized revision implants, longer operating times, and mastery of difficult surgical techniques.

In some cases, joint revision surgeries can be performed as an outpatient depending on the patient’s health status. Most revision hip surgeries are performed in a hospital setting.

Who needs joint revisions?

A joint revision may be necessary for anyone whose prosthetic implant fails due to injury or wear, or who gets an infection in the area around implant.

In elderly people who have a joint replacement, the artificial joint implants may last for life. But in younger patients under 50, especially those who maintain an active lifestyle, a joint prostheses could eventually fail, requiring a replacement. The implant we use is an FDA 30-year rated implant meaning you don’t have to wait until you are older to have your initial or subsequent joint replaced.

The most common reasons people for joint revisions are:

Infection: The risk of infection from a joint replacement is less than 1%, but when infections do occur, a revision of one kind or another is necessary.
Instability: This occurs when the soft tissues around the joint are unable to provide the stability necessary for adequate function while standing or walking.
Stiffness: In some patients, excessive scar tissue may build up around the joint and prevents the joint from moving fully.
Wear and tear: This can include loosening or breakage of prosthesis components due to friction over time.

Frequently Asked Questions

What causes a joint replacement implant to fail?

The primary causes of joint implant failure are wear and loosening, infection, instability, leg fractures, or stiffness. Sometimes, the initial implant was placed inaccurately or improperly. One can usually notice the need for the revision within the first two years.

What causes a joint replacement wear and loosening?

Although implants are firmly fixed at the initial joint replacement surgery, they may become loose over time. The cause of loosening may not always be clear but high impact activities, excessive body weight and wear of the components may all act as contributing factors.

Friction caused by the joint surfaces rubbing against each other wears away the surfaces of the implant, creating tiny particles that accumulate around the joint. to reduce this risk, we often implant joints that are made of an Oxinium ceramicized surface, available exclusively from Smith + Nephew.

When the prosthesis becomes loose, the patient may experience pain, change in alignment, or instability.

What are the risk factors for a failed joint replacement ?

Age, activity level, surgical history and a person’s weight can contribute to implant failure. Younger, active patients, people who are obese, and those who have had prior knee surgeries all have a higher increased risk of a failed implant. Younger, more active patients have a higher rate of revision than older, less active patients because they place more stress on their prosthesis over more time. Obese patients have a higher incidence of wear and loosening because of the increased force of their weight (4 lbs for every pound of one’s body weight), and they are more prone to infections because of their increased risk of wound healing, especially if they are diabetic. Patients with previous knee surgeries are at higher risk for infection and implant failure.

How is the determination made to revise a previous joint replacement?

When the decision for revision knee replacement is made, the surgeon will do a thorough clinical exam and order X-rays and laboratory tests. If you have insurance or Medicare, these costs are generally covered, even for revisions.

If your surgeon suspects an infection, they may draw fluid (aspirate) the joint fluid with a needle and send it to the lab for analysis to identify the specific type of infection.

In addition to X-rays, other imaging modalities may be helpful, such as bone scans, CT scans or Magnetic Resonance Imaging (MRI). These tests can demonstrate changes in the position or condition of the prosthetic components as well help to pinpoint the cause, location and any bone loss to help plan your the surgery.

How long must I wait to investigate a joint replacement revision?

Regardless of who did your original surgery, or where, if you experience any warning signs that there may be a problem, such as pain that comes on suddenly or trouble getting around, or have decreased range of motion and you had a joint replacement surgery, make an appointment to be evaluated, as soon as possible.

Patients come to Dr Hicken for revision surgeries from Southern Utah and also from all across the USA and Canada. And if you suspect an infection or other issue, it is critical to request an appointment as soon as possible.

What are the signs of a joint replacement failure?

Frequently, the symptoms of a failed joint replacement include, but are not limited to pain, decreased joint function, instability, and swelling or stiffness in the joint. Continued pain and swelling may indicate wear or infection, loosening, and the location of the pain can be all over (generalized) or in one particular area (localized). A decline in joint may result in a limp (Knee), stiffness or instability. Patients who demonstrate these symptoms and signs may require revision joint surgery.