Revision Surgery after Hip or Knee Replacement
Hundreds of thousands of hip and knee replacement surgeries are performed in the United States each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life.
"Joint replacement, in which an orthopedic surgeon replaces the arthritic areas of a joint with a hip or knee implant, has been life-changing for people who are freed from constant pain," says Dr. Geoffrey Westrich, Director of Research Emeritus in the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery.
Over time, the implant may wear out, or another problem may develop that necessitates a "re-do,"—a second surgery in which the existing implant or components are taken out and replaced. Dr. Westrich specializes in this surgery, which is called revision joint replacement. Revision hip and knee replacements are more complex than the initial operation, and many orthopedic surgeons who perform primary joint replacements will refer their patients to an expert in revision surgery. "Because of the complexity of revision hip and knee replacement, a certain amount of skill and experience are required," notes Dr. Westrich, who has had patients referred to him from around the country.
Reasons for Revision Surgery
The implants used in joint replacement generally last 10 to 15 years, although some newer prostheses may last 20 years or longer. Sometimes, a revision surgery is needed sooner, though, and Dr. Westrich says the main reasons include:
- Loosening of the implant. The hip or knee replacement may become painful after many years because the components have begun to exhibit wear and start to loosen.
- A fracture. A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.
- Dislocation. If a hip implant dislocates on repeated occasions, revision surgery is frequently needed to stop this from happening.
- Infection. This can be a very serious complication. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection, remove the original implant and replace it with a new joint replacement.
When to See a Doctor to Check a Joint Replacement
Dr. Westrich says patients should be aware of warning signs that there may be a problem, such as pain that comes on suddenly or trouble walking. They also may have decreased range of motion. Anyone with a joint replacement who starts experiencing these symptoms should see their doctor, Dr. Westrich advises.
"If someone needs a revision surgery because of loosening, wear, dislocation, or infection, it is critical to find an orthopedic surgeon who performs these operations on a regular basis, preferably at a hospital such as Hospital for Special Surgery, an orthopedic specialty hospital and joint replacement center," Dr. Westrich says.
He advises patients to make an appointment with their orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good. The physician can check for early loosening or implant wear before it becomes a major issue.