Revisions

Joint Revisions

While today’s modern implants typically last 20-40 years, older hip or knee implants may have loosening from the underlying bone. Possible causes of failure of a previous hip[ or knee replacement may include wear, rejection, infection, and fractures.

Patients usually experience joint pain, swelling, stiffness, or instability. In many cases the treatment is a second surgery, or revision, to replace the original components. A revision operation is different than primary total joint replacement. It is a longer, more complex procedure that requires extensive planning, and specialized implants and tools to achieve a good result.

Dr. Shah performs more hip and knee revisions than many Chicago orthopedic surgeons. His goal is the same as that with an original replacement joint: to minimize joint trauma, maximize function and make your recovery as fast as possible.

Hip Revision Surgery

Hip revision surgery is similar to primary hip replacement surgery but the procedure is more complicated and lasts longer. The nature of the surgery varies with the age and reason for the failure of the prosthetic. The repair can range from simply as replacing a disc and liner to replacing the hip stem. Infection or replacing multiple components may require two separate procedures.

The typical procedure lasts two-to-four hours and Dr. Shah may use a variety of techniques. In general the surgeon first removes the cup, liner, and stem of the original replacement. Next he prepares both surfaces of the joint for the new implant (if necessary bone may have to be grafted to secure the new prosthesis), finally Dr. Shah secures the new artificial hip joint.

If the prosthesis failure is caught early, the socket and stem may still be well-fixed. In that case, Dr. Shah can sometimes simply replace the femoral head and socket liner (called a head and liner exchange).

The goal with revision surgery is the same as an initial implant: to minimize tissue damage and produce the quickest possible recovery. Patients typically will spend 2-3 days in the hospital.

The recovery time after a hip revision varies depending on the surgery involved and the underlying bone quality. Some patients may be able to walk soon after surgery; others may need crutches or a walker, with minimal weight bearing, for 6 weeks-three months. for with Aftercare for hip revision surgery is essentially the same as for hip replacement surgery. While Dr. Shah’s revision patients recover faster than the nationwide average, the recovery time is still longer than that following an initial hip replacement.

Physical therapy at home or at an outpatient IBJI center includes exercises to begin toning and strengthening the thigh and hip muscles. Ankle and knee movements are used to help pump swelling out of the leg and to prevent the formation of blood clots.

Physical therapy may include recommendations that you use a raised commode seat and bathtub bench, and that you raise the surfaces of couches and chairs in your home. This keeps your hip from bending too far when you sit down. Bath benches and handrails can improve safety in the bathroom. Other suggestions include the use of strategic lighting and the removal of loose rugs or electrical cords from the floor.

Dr. Shah will see you one or more times during outpatient visits. It’s important to realize the operation is more complicated than primary replacement surgery and the period of walking on crutches or a cane may take longer. The vast majority of patients have less pain and are far more active after revision surgery. However, the recovery time may be longer and heavy activities like contact sports are often discouraged.

Patients with so-called metal-on-metal hip implants may face a greater chance of revision as certain of these devices have been recalled. These patients need close monitoring and regular check-ups to catch any potential failure as soon as possible. In addition those patients will benefit if they have copies of their operation report and the type of implant used.

Knee Revision Surgery

Dr. Shah makes as small an incision as possible to remove your original knee replacement. Next the kneecap and tendons are moved to the side to reveal the original replacement.

After making sure the old joint is free of infection, Dr. Shah assesses the metal and/or plastic parts of the prosthesis to determine which parts have become worn or loose or shifted out of position. Next he removes the old prosthesis while preserving as much bone as possible. Next, if necessary, comes the complex task of removing the joint cement from the bone.

After removing the original implant, Dr. Shah prepares the bone surfaces for the revision implant. If significant bone loss has occurred, special extensions can be added to the new prosthesis to make up for any bony deficits.

Most knee revision patients will be able to walk with a walker or cane on the day of surgery. However recovery is slower than an initial knee replacement. Some patients require months to be fully active. In addition, those who are extremely active usually have to place some limits on their activities.

Although recovery after revision surgery is usually slower than an original replacement, the type of care you will receive is very similar.

Pain management includes the injection of an anesthetic into the joint during surgery. Post-operative pain relief is achieved with minimal use of narcotics (if necessary) and over-the-counter pain medications.

As in original joint surgery, physical therapy includes exercises to strengthen your leg and restore your range of motion. Physical therapy can be home based or take place at one of IBJI’s many PT centers across Chicagoland.