Complex Revision Hip and Knee Joint Replacement

Revision hip or knee replacement is a complex surgical procedure performed in individuals who already had knee or hip replacement surgery but had certain complications that led to failure of the previous surgery. Revision joint replacement is a more complicated surgery when compared to the initial joint replacement surgery. Joint revision surgery requires extensive pre-operative planning, specialized implants and tools, and mastery of difficult surgical techniques to accomplish good results.

Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities. Some replacement will last longer, while other hip replacement implants can fail due to various reasons and may need to be replaced. When implant failure occurs another surgery may be needed to replace the failed implant, known as revision hip replacement surgery.

Revision Knee Replacement means that part or all of your previous knee replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone. The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).

Indications

Revision surgery is performed for various reasons such as

  • Persisting pain after the surgery
  • Wearing of implants or plastic lining
  • Instability
  • Loosening of the prosthesis
  • Surgical site infections
  • Weakening of bone around the replacement (osteolysis) Stiffness.

Procedure

Revision hip replacement

In revision total hip arthroplasty, your surgeon removes the old plastic liner and the metal socket from the acetabulum. The acetabulum is prepared using wire mesh to make up for the socket space. Then the new metal shell is inserted into the socket using screws or special cement. A liner made of plastic, ceramic or metal is placed inside the metal socket. To prepare the femoral component, the top of the femur is cut into several pieces to remove the implant. The segments of bone are cleaned and the new femoral implant is inserted into the femur either by a press fit or using bone cement. The segments of the femur are held in place with surgical wire. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place to form the new hip joint. The muscles and tendons around the new joint are repaired and the incision is closed.

Revision knee replacement

Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. The Patient is positioned on the operating table and the leg prepped and draped. A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilizing solution. An incision around 7cm is made to expose the knee joint.  The bone ends of the femur and tibia are prepared using a saw or a burr. Trial components are then inserted to make sure they fit properly. The real components (Femoral & Tibial) are then put into place with or without cement. The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.

Risks and complications

As with any major surgery, there are potential risks involved. Some of the complications associated with complex revision hip or knee replacement include infection, dislocation, injury to blood vessels, blood clots, limb length inequality, and failure to relieve pain.

Rehabilitation

Post-surgery rehabilitation is essential to avoid further complications such as reduction in the range of motion, muscle weakness and recurrence. Physical therapy may be initiated immediately after surgery and may be continued for up to three months. Physical therapy includes uses of crutches or walker along with strengthening and mobilization exercises to regain the strength and mobility of the join

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