Revision Joint Replacement

Revision joint replacement surgery is a procedure to replace an artificial joint that has become infected, loose or worn out. This type of surgery may also be necessary if there is a fracture or ligament damage that causes the implant to fail.

Although revision joint replacement is an increasingly common procedure, it is less straightforward than joint replacement surgery and there is a greater risk of complications. This is because the surgeon needs to remove the existing joint implant and any cement that was used to hold it in place. Some implants can be difficult to remove, for example, if the thigh bone has grown onto the implant. In older people the bones can be thinner which means they are more likely to fracture. If this happens, they might need to rebuild the bone using bone from another part of the body – called a bone graft.

This can make the operation longer than the original joint replacement surgery and recovery may also take longer.

Only people who have previously undergone joint replacement surgery will be offered revision joint replacement. You may need this type of surgery if:

• Your original joint implant has started to loosen or wear out, which can cause pain. In some cases, tiny particles may become detached from the plastic spacer in the implant and accumulate around the joint. The immune system may attack these, along with healthy bone around the implant, leading to a condition called osteolysis. This causes deterioration in the bone around the implant, leading to further instability and loosening. Damage to ligaments may also prevent the implant from working properly.
• You have developed a deep infection in your prosthetic implant. This can occur soon after surgery or months or years afterwards. If the implant gets infected it may become stiff and painful. There may also be swelling and discharge from the infection.
• A periprosthetic fracture is a broken bone around the total knee implant. They are normally caused by a fall. If the bone is shattered or weakened from osteoporosis you may need a larger revision implant.

Revision joint replacement surgery normally take longer than the original joint replacement as the surgeon needs to remove the old implant and may need to reshape the surrounding bones structures. This type of surgery requires extensive planning and specialised implants and tools.

There are different types of revision surgery. In some cases only one part of the prosthetic implant may need to be replaced whereas in other cases all components of the implant need to be replaced. Sometimes the bone around the hip or knee needs to be rebuilt using bone grafted from other parts of the body or metal plates. If there is damage to the bone, the surgeon may need to use specialised implants that have longer, thicker stems and fit deeper inside the bone for extra support.

If you have an infection in your prosthetic implant, it may be treated in one of two ways, depending on the extent of the infection and how long you have had it:

• Debridement involves washing out any bacteria and placing a temporary implant called a spacer that provides some hip stability and delivers antibiotics to the infected area.
• Staged surgery involves two separate surgeries. The first removes the implant and places a temporary cement spacer in the hip or knee joint. The spacer contains antibiotics which fight the infection. It remains in the knee for several weeks during which time you will also be given intravenous antibiotics. Once the infection has cleared you will be given a second surgical procedure to remove the spacer and insert a new prosthetic implant. This procedure has a longer recovery time than debridement but is generally more effective at treating the infection.