In short,
- Understanding Revision Surgery: This procedure replaces a failed or worn-out hip or knee implant to restore mobility and reduce pain. Common reasons for implant failure include loosening, infection, and instability.
- Recognizing the Signs: Symptoms of a failing implant can include persistent pain, stiffness, instability, or clicking sounds. Signs of infection, like redness or fever, require immediate medical attention.
- When to Seek Help: Extend your implant’s lifespan by maintaining a healthy weight and following your surgeon’s advice. Contact your doctor immediately if you experience persistent pain, mobility issues, or signs of infection.
What Is Revision Hip and Knee Replacement?
Revision hip and knee replacement is a surgical procedure to replace a previous joint replacement that has failed or is no longer functioning properly. This complex surgery addresses issues like persistent pain, joint instability, infection, or implant loosening that can develop months or years after the original replacement. The primary goal is to restore joint function, eliminate pain, and improve your quality of life.
The specifics of the surgery depend on the extent of the failure:
- Partial revision: Involves replacing only the worn or damaged implant components while keeping the well-fixed parts.
- Total revision: Requires replacing all implant components if the failure is more extensive.
In some cases, bone grafting may be necessary to rebuild areas of bone loss before the new implant is placed. If the joint is infected, a temporary antibiotic spacer may be used to clear the infection before the final implant revision.
Due to their complexity, revision procedures require specialized expertise and surgical techniques compared to initial joint replacements.
Common Causes of Joint Replacement Failure
Understanding why joint replacements fail helps patients recognize warning signs and seek timely intervention.
Aseptic Loosening
Aseptic loosening occurs when the bond between the implant and bone weakens over time, often years after the original surgery. This condition develops when your body’s inflammatory response to microscopic particles shed from the implant components triggers osteolysis, the gradual destruction of bone tissue surrounding the implant.
As bone deteriorates, the implant loses its stable attachment, causing pain and instability.
Infection
Bacterial infection of the joint replacement, though relatively uncommon, represents a serious complication requiring prompt treatment. Deep infections typically necessitate a two-stage revision procedure.
During the first stage, the infected implant is removed and replaced with a temporary antibiotic-impregnated spacer that helps eradicate the infection. Several months later, after confirming the infection has cleared, a new permanent implant is placed during the second stage.
Instability and Dislocation
Joint instability occurs when the artificial joint components do not remain properly aligned, causing the joint to dislocate or feel unstable during movement. This problem may result from damaged surrounding ligaments, improper implant positioning, or inadequate soft tissue balancing during the initial surgery.
Periprosthetic Fracture
Fractures occurring in the bone around an implant may require revision surgery to stabilize the bone and potentially replace damaged implant components. These fractures can result from trauma, weakened bone structure, or stress on compromised bone tissue.
Recognizing Symptoms That May Require Revision Surgery
Being aware of warning signs helps ensure timely evaluation and treatment of failing joint replacements.
Persistent Pain and Stiffness
Gradual or sudden increases in joint pain, particularly during activity or even at rest, may indicate implant problems. Progressive stiffness and limited range of motion that interfere with daily activities also warrant evaluation.
Joint Instability
Sensations that your joint might give way or buckle during weight-bearing activities suggest instability that increases fall risk. Unusual clicking, popping, or grinding sounds accompanied by pain often indicate implant loosening or component wear.
Signs of Infection
Systemic symptoms, including fever and chill,s may indicate joint infection. Localized signs such as redness, swelling, warmth around the joint, or drainage from the incision site require immediate medical evaluation.
Diagnosing Failed Joint Replacements
Accurate diagnosis combines clinical evaluation with advanced testing to determine the cause of implant failure and guide treatment decisions.
Physical Examination
Your orthopedic surgeon will perform a comprehensive assessment of joint range of motion, stability, and pain patterns. A thorough review of your medical history, including details about your original surgery and any subsequent complications, provides important context.
Imaging Studies
Standard X-rays reveal implant positioning, potential loosening, fractures, and changes in bone density around the implant. Bone scans identify areas of increased bone activity that may indicate infection or loosening.
MRI scans provide detailed visualization of soft tissues surrounding the joint, helping identify ligament damage or other structural problems.
Laboratory Testing
Blood tests measuring erythrocyte sedimentation rate and C-reactive protein levels help detect inflammation that may indicate infection. Elevated levels suggest active inflammation, though they cannot definitively distinguish between infection and other inflammatory causes.
Joint aspiration, which involves extracting and analyzing fluid from the joint, can detect bacteria and confirm infection.
Preventing Joint Replacement Failure
Proactive measures can help extend the lifespan of your joint replacement and reduce the risk of complications.
Maintaining a Healthy Lifestyle
Weight management reduces stress on artificial joints and decreases wear. Regular low-impact exercise, such as walking, swimming, or cycling, maintains joint health and surrounding muscle strength. Avoiding high-impact activities that place excessive stress on implants helps preserve their longevity.
Following Post-Operative Protocols
Completing your prescribed physical therapy program is essential for optimal recovery and long-term joint function. Attending regular follow-up appointments with your orthopedic surgeon enables early detection of potential problems. Taking medications as prescribed, particularly antibiotics after surgery, helps prevent infection.
Managing Medical Conditions
Properly controlling chronic conditions such as diabetes and rheumatoid arthritis reduces the risk of complications. Avoiding tobacco use is critical, as smoking impairs bone healing and increases infection risk.
When to Seek Medical Attention
Contact your orthopedic surgeon if you experience persistent pain, progressive stiffness, joint instability, or any signs of infection. Early evaluation and intervention can prevent further damage and improve outcomes.
Seek immediate medical attention for severe pain unrelieved by medication, a joint that appears hot, red, and swollen, fever exceeding 101 degrees Fahrenheit, or inability to bear weight on the affected leg.
Find Revision Hip and Knee Replacement Surgery in Baltimore, Maryland
If you are experiencing problems with a previous hip or knee replacement in Baltimore, Maryland, prompt evaluation by an experienced orthopedic surgeon can help determine the best course of treatment. Our revision surgery specialists, Dr. Sydney, Dr. Xie, and Dr. Serino, specialize in complex revision procedures using advanced techniques to restore function and relieve pain.
A testimonial from one of our patients about our revision surgery specialist, Dr. Serino:
“I have had the misfortune of having three knee replacements on my left knee. (Not here and not Dr. Serino) It is an absolute Godsend that I met Dr. Serino for this last replacement two days ago. He is a fantastic communicator who patiently provides great information and insight on the problem and how to fix the problem. He is methodical, detail-oriented, and most importantly, he absolutely cares about his patients. He performed a very complex replacement revision on my left knee. The surgery was a complete success, and the PT folks had me up and walking four hours out of surgery. One last important point: I had gone to two other surgeons who couldn’t tell me why my knee was hurting so badly. It took Dr. Serino less than 10 minutes with me and looking at X-rays to show me what the problem was and what was needed to fix it. I will not ever let any Orthopedic Surgeon operate on me. THANK YOU, DR. SERINO!!!!!!!!!! “
Call The Centers for Advanced Orthopaedics Orthopaedic Associates of Central Maryland Divisionus today at (410) 644-1880 or schedule a consultation online and discuss your treatment options.
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