Revision Joint Replacement

Most people who have revision joint replacement make a good recovery and experience long-term relief from pain and an increased range of movement. However, in some cases, there can be some residual pain or stiffness in the affected hip or knee.

Revision joint replacement is a longer and more complex procedure than the original hip or from the knee knee replacement surgery. It requires extensive planning and specialist tools and implants. The surgeon will need to remove not only the implant but also any cement that was used to fix it in place. This is a precise and time-consuming process.

Some revision joint replacement involves replacing only one component of the original implant. More complex joint replacement entails removing and replacing all three components from the knee – patellar, femoral and tibial – and rebuilding the bone around the knee with bone grafts or metal plates. Similarly in the hip, both the stem and cup are removed, along with any bone cement, and new implants are used to replace them. Damage to the bones can make it difficult to use standard implants for this type of surgery so specialised implants with longer, thicker stems that can fit deeper inside the bones are used.

Metal plates and platform blocks may be needed to compensate for lost bone around the knee or hip cup. A bone graft may also be necessary.

Sometimes revision joint replacement treatment is needed because the implant itself has become infected. In this instance, there are two possible approaches depending on the type of infection and how long it has been there:

• Debridement – washing out the bacteria and replacing the plastic spacers in the implant, while leaving the metal components in place.
• Staged replacement – if the implant needs to be removed and replaced, this will be done in two stages. The first stage is to remove the implant and clean out all the infection. Then the wounds are closed with antiseptic swabs inside and the operating theatre fully cleaned with you still asleep. After 30 minutes, a new set of drapes and instruments are used to prepare your joint for the second stage surgery. The second stage is where all the clean new implants are placed. This surgery normally takes 6 hours and has a 90% success rate in eradicating infection.

Because revision joint replacement is a longer process than primary total knee replacement, there is a greater risk of complications and recovery tends to be slower. Risks include:

• Infection in the wound or implant
• Blood clots
• Pulmonary embolism – a blood clot in the lungs
• Stiffness in the knee or reduced movement
• Damage to nerves or blood vessels
• Heart attack, stroke or lung complications
• Bleeding and inability to heal properly
• Fractured bones

Your doctor will discuss the risk levels with you before surgery and will advise on steps to take to reduce your individual risk.

The technique is suitable for anyone who has previously had total hip or knee replacement surgery and who is experiencing a range of symptoms as the original implant starts to fail and wear. It is also suitable for patients who have developed an infection in the site of their hip or knee implant.

Each year, knee replacements enable thousands of patients to enjoy an active life, free of chronic knee pain.

Our patient-care process

• Once all of your diagnostic procedures are completed, we will be able to explain whether surgery is recommended.
• We will go through the procedures with you, covering the operation itself, the recovery process and the future prospects.
• Your orthopaedic surgeon will also explain the risks: these are small, but it is important for you to understand them.
• You can feel reassured that you will receive expert care from the start of the process, including your after-care.

Public and Patient Guide on hip replacements, published by the National Joint Registry. This gives detailed explanations about hip operations and their various outcomes, and is revised each year.

More information about adult hip pain can be found on the NHS website.

Children can also suffer from a specific type of hip pain known as irritable hip. The NHS website also has information on this condition.