Revision joint replacement surgery is a joint replacement surgery that needs to be redone, commonly because of a failed implant. Advancements in implant design and surgical technologies have increased the longevity of joint implants to about 20 years in most patients; however, about 10% of joint replacement patients will need to have revision surgery.
Why Do Joint Implants Fail?
Implants fail for a variety of reasons:
- Wear and loosening: implants will wear down and may become loose naturally over time. Active, younger patients who have a joint replacement have an increased chance of needing to have revision surgery in their lifetime.
- Infection: occurs in less than 1% of joint replacement surgeries due to advancements in surgical technologies and antibiotic regimens.
- Soft-tissue laxity: the ligaments in the joint can stretch out after surgery, causing instability during standing or walking. Typically, issues with soft-tissue laxity can be treated using bracing or physical therapy.
- Fractures: bone fractures around the joint implant can decrease the stability or fixation of the implant.
- Scar tissue: excessive scar tissue can build up around a joint implant, preventing you from having the full range of motion necessary to carry out daily activities. Surgeons can perform a manipulation procedure to regain flexibility of the joint to try to avoid revision surgery.
- Medical comorbidities: rheumatoid arthritis, Ehlers Danlos syndrome, and diabetes can also increase risk of needing a revision surgery.
What Are The Risk Factors For Implants To Fail?
- Age: younger patients have a higher rate of revision than older patients.
- Activity level: more active patients have a higher rate of revision because of the stress placed on their implant.
- Surgical history: patients who have had prior joint surgeries have an increased risk of a failed implant.
- Weight: obese patients have a higher risk of wear and loosening due to the increased force of their weight on the implant.
How Do I Know If I Need Revision Surgery?
The most common symptoms of a failed implant include pain, instability, swelling, stiffness, and decrease in joint function.
What Happens During Revision Surgery?
Typically, revision surgeries are more complex than primary joint replacement surgeries due to the cause of implant failure. Excess scar tissue, worn-out ligaments, or fractured bones will require a more involved procedure due to your surgeon having to address the underlying problem. During a revision surgery, your surgeon will remove the old implant, assess the quality of your bone surrounding the implant, reconstruct the bone and/or soft tissue if necessary, and affix the new implant.
What Is The Recovery Process For Revision Surgery?
Postoperative care for revision surgery is very similar to postoperative care for primary joint replacement surgery. You will be prescribed pain medications and antibiotics and attend physical therapy. Some patients take longer to recover from revision surgery due to age, weight, and extent of bone and soft tissue repair needed.
You may need to wear restrictive bracing to support your healing process. Braces can include knee immobilizers, hinged knee braces, and hip spica braces. Your provider will determine if a brace is necessary for you and for how long you’ll need to wear it for.