What is a joint revision?
A total joint revision surgery is a procedure to ‘redo’ a hip, knee, or shoulder replacement. This could be due to the original components failing due to misposition, incorrect size, or infection.
Although most joint replacements have a wear rate of around 15 years, joint replacement revision surgeries are still needed for 6% of people with implants after five years and 12% of people after 10 years.
Why would I need a joint revision surgery?
The main reasons a revision would be necessary are:
Loosening of the implement the most common problem due to a joint replacement is when the implant becomes loose. In an initial joint replacement surgery, the new components are cemented or press fit to the bone. Over time, however, friction can cause small particles to break away and loosen the bonds between bone and implant. If you're feeling activity related pain or instability in a joint replacement, you may be experiencing the implant loosening.
Dislocation of the joint If the joint dislocates (becomes misaligned and "pops" out), it may need to be revised. Dislocation can be caused by scar tissue interfering with the joint, weak joint-supporting muscles, mispositioned implants, or not following early precautions after the joint is replaced.
Dislocation is a common complication with hip replacement and can usually be returned to its proper place without surgery.
Infection of the joint replacement is less common, sometimes due to hospital standards and available antibiotics. However, infections can occur without known cause making a revision necessary. Symptoms of an infection can include stiffness or pain, swelling, fever and chills, fatigue, and/or redness, warmth around the wound, or wound drainage.
Joint problems that will only get worse
A revision may also be needed if wear, loosening, or another disorder causes or threatens to cause a fracture or deterioration past the point of correction.
How does a joint revision surgery work?
During a joint revision surgery, the surgeon will typically utilize the original incision scar to access the joint and surgically remove any infected appearing portions of the joint and surrounding tissues. The original replacement implant will be removed and examined by the surgeon, and either an antibiotic cement spacer, or new components will be inserted.
After a revision surgery, your doctor will help determine pain management measures and give instructions on how to prevent blood clots and infections. You also may need to see a physical therapist to strengthen the muscles around the joint and restore your range of motion.
How do I know if I need a joint revision surgery?
An orthopaedic surgeon will need to do an exam and take an x-ray or other images of the joint to diagnose the issue and determine if a revision is necessary, but if you experience any of the following symptoms, it may be time to call a revision specialist:
- Pain that persists or is recurring
- You experience aches during and after exercise
- You are experiencing stiffening or swelling of the joint
- You are having trouble sleeping due to pain
- You’re experiencing limited mobility of the joint
- You are experiencing fevers or chills associated with your joint pain
After an exam, your surgeon will help you weigh the advantages and disadvantages of a revision surgery, as well as discuss non-surgical treatment options.
When considering a revision surgery, it’s important to work with an orthopaedic surgeon that has skill and expertise in revisions, because revision surgeries are more complex and have higher rates of post-surgery complications than first-time joint replacements.
Fortunately, most people who work with orthopaedic revision specialists can have a successful revision surgery that leads to years of activity and good joint function.