Revision
total knee and total hip replacement are defined as a
re-operation to replace one or more components of a knee
or a hip replacement. These operations have evolved into
a subspecialty of joint replacement surgery. The complexity
of these operations can vary from replacing one of the
parts to replacing all of the parts. These operations
are usually performed by surgeons with special interest
training and experience in hip and knee replacement surgery.
As a rule, general orthopedic surgeons who perform many
types of orthopedic operations usually refer these cases
to a joint replacement specialist.
|
|
| |
|
Revision
total joint replacement is performed when the original
primary joint replacement has worn out or loosened in the
bone. Revisions are also carried out if the primary joint
replacement fails due to recurrent dislocation, infection,
fracture or very rarely, ongoing pain and significant leg
length discrepancy. Total joint replacement implants may
fail after 10 to 15 years, or occasionally sooner. The
parts may become loose or they may wear out. In either
case an operation will be required to replace the damaged
part or even the entire implant. At times there might be
combination of worn joint with ligament insufficiency which
might require the use of a specialized prosthesis (artificial
joint). |
|
| |
|
It
may also require an increase in the length of the hospital
stay. The magnitude of this surgery depends on the difficulty
of prosthesis removal and on the quality and quantity of
bone left behind after the implant has been removed. The
revision operation may require bone grafts from a bone
bank to be used. A custom prosthesis is sometimes needed
(a prosthesis specially manufactured for a specific patient). |
|
| |
|
In
revision surgery, the surgeon removes the original prosthesis,
cement, surrounding tissue and dead bone before inserting
a new prosthesis. Postoperative care for revision surgery
is the same as that for the original replacement surgery.
Patients usually have a combination of home health care,
physical and occupational therapy and other forms of rehabilitation. |
|
| |
|
These
complex operations are much riskier than first-time knee
replacement surgeries. All the risks associated with first-time
knee replacement are present, but the chances of these
complications occurring are greatly increased. These technically
demanding operations should be performed by a surgeon skilled
and experienced in both first-time knee replacement surgery
and revision surgery |
|
| |
|
Possible
complications from this procedure are similar to those
in the original joint replacement surgery. However, in
general the success rate for revision surgery is slightly
lower than that of original joint replacement surgery because
the bone is weaker and the prosthesis is more likely to
loosen. The first operation generally has a 95 percent
success rate, while revision hip surgery has an 85 percent
success rate. Complications from revision surgery may include: |
|
| |
|
If
the joint is infected, it might be surgically removed and
re-implanted with antibiotic-filled cement. In addition,
intravenous (IV) antibiotics might be necessary for six
to eight weeks, followed by at-home treatment of oral antibiotics.
Although these risks may be troubling, many patients experience
no complications at all. At our Institute for Joint Replacement,
patients' chances for successful outcomes are well above
national averages. |
|
| |
|
- Infection
(in only two to four percent of cases)
- Loosening
of the new prosthesis (in 10 to 15 percent of cases.
The likelihood is much greater if the patient is overweight
and/or does not use crutches during the first few months)
- Bone
fractures during or after surgery (since the bone is
weaker and there may be considerable scar tissue around
the joint)
- Dislocation
(twice as common as for a primary procedure)
- One
leg shorter than the other
- Bone
loss in the joint (grafting sometimes helps)
|
|
Patients
that have a failed joint replacement have a different perspective
than patients who are undergoing their first operation.
Many patients who have had an unsuccessful joint replacement
will research the surgeons and the institutions as they
seek help for their failed joint replacement. Even if a
patient is referred from one doctor to another doctor,
the patients often come with knowledge and experience regarding
joint replacement surgery that they didn’t have before
their first joint replacement. These patients are often
willing to travel long distances or even to a different
country in order to find an experienced team to address
their particular problem. |
|
| |
|
