Since its introduction to the United States in the 1950’s, total joint replacement surgery has become one of today’s safest and most commonly performed surgical procedures. Total joint replacement, also known as joint arthroplasty, has helped millions of patients restore quality of life by increasing activity level, improving a joint’s range of motion, and easing joint pain caused by traumatic injuries or debilitating musculoskeletal conditions.
Also known as revision joint arthroplasty, revision joint replacement is performed for a number of reasons; however, it is only necessary in approximately 10% of all patients who receive prosthetic joints. These reasons include natural wear-and-tear of the implant, traumatic injury to the surrounding bone, as well as bacterial infection of the joint. While implants have become more sophisticated, it is always possible for them to degrade or loosen over time. Damage to the bone surrounding the joint can also cause problems for the implant, and require a revision to restore its functionality. Additionally, because of the nature of the components involved, bacterial infections can occur, and the component itself cannot fend off the infection.
Because only a small percentage of joint replacement patients will require future revisions, patients should consult with an orthopedic surgeon before considering this surgical solution.
Common factors for revision joint replacement include:
Traditional joint replacement is typically performed to relieve severe pain in patients with debilitating osteoarthritis. It is also performed when the patient has experienced a traumatic injury that causes severe damage to a joint. Components can become infected during the procedure if proper measures are not taken, both before and after the surgery. Bacterial infections can arise and cause pain, making a revision procedure necessary.
Most hip and knee replacement prosthetics will perform well for the remainder of a patient’s life; generally, these components are expected to last about 20 years in 90% of patients.
When diagnosing a patient whose prosthetic implant may have become infected or worn down, a standard assessment is performed, including a history of the patient and physical examinations. These tests include:
In most cases, physical therapy will be initiated within 24 hours of the procedure, and may continue up to three month after the surgical procedure. Protective braces may be utilized, depending on the outcome of each patient, and weight lifting may be restricted initially. In addition, assistive devices, such as a walker, might be used early in the recuperation period. Patients will eventually feel more comfortable with their new replacement joint, and should be able to move without assistance in time.
Revision joint replacement is always more complicated than traditional primary joint replacement surgery. The procedure requires extensive preoperative planning, and mastery of difficult surgical techniques to achieve the desired result. Dr. Harwin has extensive experience treating patients with failed joint replacements, and has served a Fellowship in adult reconstructive surgery, making him one of the most adept orthopaedic surgeons in New York City. These are some of the reasons that Dr. Harwin was appointed Chief of Adult Reconstructive Surgery of the Hip and Knee at Beth Israel Medical Center in New York City.
By Dr. Steven Harwin