A joint replacement – whether conventional or customised – will normally last 15-20 years if it is cared for correctly.
Eventually, however, the joint will start to fail and wear out. It may become loose. When this happens your joint can become painful and swollen and may start to feel stiff or unstable. You may be offered revision joint replacement surgery, which involves removing some or all of the original implant and replacing it.
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Benefits
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.
How it works
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.
Risk factors
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.
What does a revision joint replacement treat?
Over time a hip or knee implant can loosen from the underlying bone, causing the joint to become painful. When the implant was originally fitted, it may have been cemented into place or bone may have been expected to grow into it to hold it in place. Loosening may occur as the implant itself or the plastic spacers between its two metal components start to wear out. It can also loosen if the patient has been doing a lot of high impact activities or is overweight.
Sometimes, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body’s immune system. Unfortunately, the immune system can also attack healthy bone around the implant causing a condition called osteolysis.
Another reason you may need a revision joint replacement is if you develop an infection in the artificial joint. Symptoms of this include pain and stiffness.
Finally, hip and knee replacement implants are designed to work with your ligaments. If the ligaments become damaged or unbalanced, the joint may become unstable. You might experience recurrent swelling or a feeling that the hip or knee is weakening. You may be offered bracing and physical therapy. If this doesn’t work, revision joint replacement may be needed.
Who it helps
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.
FAQ’s
Why do I need revision replacement surgery?
Over time, hip or knee replacement implants can wear and fail. This may be due to lifestyle factors, such as your weight or involvement in high impact activities, or it may simply due to the fact that implants have a maximum lifespan of 15-20 years. When an implant starts to fail it can become loose and cause pain, instability and loss of movement. Revision replacement surgery can reduce or alleviate these symptoms.
How long does the operation take?
Revision replacement surgery normally takes three to six hours. The surgeon may follow the incisions made when you had the original replacement surgery although they may be longer to enable all of the old components to be removed. The original implant will be removed very carefully to preserve as much bone as possible. Cement that was used to fix the implant in place will be removed. Bone surfaces will be prepared for the new implant, which may entail adding metal plates and platforms to compensate for any bone loss.
Will I experience complete relief from pain after surgery?
Not in every case. If it is not entirely alleviated, your pain levels should improve significantly.
Personal outcomes – what to expect
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.
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