REVISION JOINT REPLACEMENT SURGERY
Though we hope that the first joint replacement you receive will be the last, this is not always the case. There are numerous reasons that a joint replacement may require revision surgery, and include:
- infection not clearing with antibiotics
- fracture of the bone holding the implants
- loosening of the implants
- wear of the implants
- excessive stiffness
- instability or dislocation
Common symptoms for such problems include:
- increased pain, particularly when getting up and moving
- instability of the knee
- frank dislocation
- hot, red, swollen and painful joint
- decreased range of movement
- inability to weight bear on the limb
If something has failed with the joint, there are options to address these. Dr Host has done specialised training in such cases whilst on Fellowship at the Royal Infirmary in Edinburgh, as well as that experience gained whilst training in Australia and on international arthroplasty courses. Should you have a joint replacement in place and you are at all concerned with how it is functioning, your first port of call should be the surgeon who performed it. If you are in Bathurst or surrounds and cannot return to that surgeon, Dr Host would be more than happy to review you and offer advice on further investigations and treatment.
How can I tell if something is wrong with my joint replacement?
The list of symptoms above are the common reasons people will seek review following a joint replacement. If you are experiencing any of them, seek review with your local doctor or treating surgeon. The first step will be a thorough history and examination, followed by focused investigations such as plain X-rays or a CT scan. Your doctor will always try and rule out infection as a cause, as it can mimic all other presentations. This will involve blood tests, and possibly nuclear imaging studies and joint aspiration. Once infection is excluded as a cause, the other potential causes will be assessed until a diagnosis is made. In some cases, no problems can be identified. It must be remembered, that despite the procedure being performed successfully, 5-10% of total knee replacements and 5% of hip replacements will have poor outcomes. Some of these are due to correctable problems, but some are not and there is no treatment other than symptom control available.
How can a joint replacement wear out?
Like everything man-made, a joint replacement will not last forever. As the joint surfaces rub together, small particles break free of the surface. The effect that these particles has is dependent on what the bearing surface is made out of. For metal-on-metal implants, microscopic metal fragments are released into the joint fluid, and absorbed into the tissues around the joint and the blood. There are well-documented effects that this can have, both locally and systemically, and include pain, stiffness, fatigue and formation of an inflammatory tissue mass called a pseudo tumour. This can lead to destruction of normal tissue and loosening of the implants. For more conventional metal-on-plastic, the wear tends to be greater on the plastic component. The microscopic particles released are taken up by the joint lining, and when they reach a critical concentration, can cause an inflammatory response that leads to destruction of local tissue, implant loosening, and failure. Ceramic bearings show promising results by having a much slower rate of particle production, with particles that are less likely to cause an immune response.
How long will the revised hip or knee replacement last?
The results for revision hip and knee surgery are improving as new and improved technologies and techniques are discovered. A general statement about revision surgery is that the results are not as good as those for a primary joint replacement. Many patients do have full return of function, however, some pain and loss of motion is not uncommon. The Australian Joint Replacement Registry, which tracks all implants used in Australia, shows that at 15 years post revision, 80% of the joints inserted will still be functioning. For a primary hip or knee, this figure is around 95%, so though still good, a revision is not a guaranteed cure.
Will my pain be resolved with a revision of the joint replacement?
If pain is the only problem that you are experiencing with your joint replacement, revision surgery is less reliable. For those with a clear reason for pain or mobility issues with the joint replacement, such as aseptic loosening, implant failure or wear, fracture or dislocation, revision has more predictable results. If the joint is functioning normally, albeit painfully, surgery is not usually recommended. Dr Host would be happy to review you and discuss the best treatment options with you if you are experiencing pain following a joint replacement.
How long will I be in hospital?
A revision joint replacement is a big operation, and recovery is generally slower than that for the first joint replacement surgery. You can expect to be in hospital for 1-2 weeks, and will often spend the first night or two in the high dependency ward for closer monitoring. Longer periods of rehabilitation may be required depending on your fitness and function prior to the surgery. The risks of all complications are higher in revision surgery as compared to primary joint replacements, and this can also lead to longer admissions. Dr Host will discuss these with you in detail prior to any surgery.