What patients need to know about revision surgery after hip or knee replacement

"Joint replacement, in which an orthopedic surgeon replaces the arthritic areas of a joint with a metal, plastic or ceramic implant, has given countless people a new lease on life," says Dr. Geoffrey Westrich, an orthopedic surgeon and Director of Research, Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery in New York City.

Over the past two years, Dr. Westrich has seen a sharp increase in the number of people coming in for a second hip or knee replacement, called a revision surgery. When the implant wears out or another problem develops, people often need a second surgery in which the existing implant or components are taken out and replaced.

The implants used in joint replacement generally last 10 to 15 years, although some newer prostheses may last up to 20 years. 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 wear and loosen.

• A fracture. A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.

• Dislocation. If the 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 and to implant new non-infected components.

• Implant recall. On occasion, the implant used in joint replacement is found to have a problem and patients who received the implant are advised to be monitored by their physician to make sure it does not need replacement. Revision surgery is sometimes necessary when an implant is recalled.

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 getting around. They also may have decreased range of motion. Anyone with a joint replacement experiencing these symptoms should see their doctor immediately, Dr. Westrich adds.

A revision joint replacement is much more complicated than the initial operation and many physicians 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.

"If someone needs a revision surgery because of an infection or other issue, it is critical to find an orthopedic surgeon who performs many of these operations, preferably at a hospital such as Hospital for Special Surgery, which is an orthopedic specialty hospital and joint replacement center."

Patients often ask Dr. Westrich if there are steps they can take to make their initial hip or knee replacement last longer. Dr Westrich says a number of factors are within a patient's control to increase longevity and avoid the problems requiring a revision:

• Avoid overusing the joint. Patients are advised to avoid high impact activities, such as running and singles tennis, which can shorten the lifespan of the joint replacement. Walking for exercise is better than running; opt for doubles instead of singles tennis.

• Avoid sports in which jumping and landing hard can damage or weaken the joint, and engage in nonimpact activities that build muscle strength.

• Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.

• Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly.

• If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your medical doctor for appropriate antibiotics.

• Pay a visit to your orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.

• Have your primary hip or knee replacement with an experienced surgeon who specializes in the procedure and at a center that performs a high number of joint replacements to ensure the best outcome and lower the risk of complications.