What is Revision Hip & Knee Surgery?

Revision hip and knee surgery refers to procedures performed to replace or repair a previously implanted hip or knee prosthesis that has failed or worn out. This type of surgery is more complex than the initial joint replacement and requires specialised surgical skills to address issues such as implant loosening, infection, wear and tear, or fractures around the implant. The goal is to restore function, relieve pain, and improve the patient’s quality of life.

How is Revision Hip & Knee Surgery Done?

1. Preoperative Assessment: A comprehensive evaluation, including medical history, physical examination, and imaging studies such as X-rays, CT scans, or MRI, is conducted to plan the surgery.
2. Anaesthesia: The procedure is performed under general anaesthesia or regional anaesthesia (spinal or epidural), ensuring the patient is pain-free during the surgery.
3. Incision: An incision is made over the hip or knee to access the joint.
4. Removal of the Old Prosthesis: The surgeon carefully removes the old prosthesis, along with any surrounding scar tissue or bone cement.
5. Preparation of the Joint: The joint surfaces are cleaned and prepared to receive the new implant. This may involve bone grafting to rebuild lost bone stock.
6. Implantation of the New Prosthesis: A new prosthesis is implanted, often with special components designed for revision surgery to ensure better stability and longevity.
7. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Why is Revision Hip & Knee Surgery Done?

Revision hip and knee surgery is performed to address issues with a previous joint replacement that may include:

• Implant Loosening: The prosthesis becomes loose from the bone over time, causing pain and instability.
• Infection: Infection around the implant necessitating removal and replacement.
• Wear and Tear: Over time, the components of the prosthesis can wear down, leading to pain and decreased function.
• Fractures: Fractures around the implant that compromise its stability.
• Dislocation: Recurrent dislocation of the hip or knee prosthesis.
• Allergic Reactions: Rare reactions to the materials used in the prosthesis.

Who Might Need Revision Hip & Knee Surgery?

Revision hip and knee surgery is recommended for individuals who experience:

• Persistent or increasing pain in the replaced joint.
• Instability or difficulty using the joint.
• Signs of infection, such as redness, swelling, and fever.
• Decreased function or range of motion in the replaced joint.
• Noticeable changes in the positioning of the implant, as seen in imaging studies.

Conditions Treated with Revision Hip & Knee Surgery

• Implant Loosening: Due to bone loss or mechanical failure.
• Prosthetic Joint Infection: Requiring removal of the infected implant.
• Periprosthetic Fractures: Fractures around the joint replacement.
• Polyethylene Wear: Wear of the plastic components leading to osteolysis.
• Recurrent Dislocations: Chronic instability of the joint replacement.

Recovery Times

Recovery time after revision hip and knee surgery varies depending on the complexity of the surgery and the patient’s overall health. Generally:

• Hospital Stay: Patients usually stay in the hospital for 3-7 days post-surgery.
• Initial Recovery: Walking with the aid of crutches or a walker is encouraged within a few days after surgery.
• Physical Therapy: A structured rehabilitation programme begins soon after surgery to restore strength and mobility.
• Full Recovery: Most patients resume normal activities within 6 to 12 months, though recovery can take longer depending on individual circumstances.

Tips for a Good Recovery

1. Follow Postoperative Instructions: Adhere to your surgeon’s guidelines on wound care, activity restrictions, and medication.
2. Physical Therapy: Engage in prescribed physical therapy exercises to enhance strength and mobility.
3. Rest and Elevation: Keep the joint elevated and avoid strenuous activities to reduce swelling.
4. Ice Therapy: Apply ice packs to the surgical site to reduce pain and inflammation.
5. Healthy Diet: Maintain a balanced diet to support healing and overall health.
6. Monitor for Complications: Watch for signs of complications such as increased pain, swelling, or infection, and report them to your doctor promptly.

Conclusion

Revision hip and knee surgery is a complex but necessary procedure for individuals experiencing issues with their previous joint replacement. By replacing or repairing the failing prosthesis, this surgery can significantly reduce pain, improve joint function, and enhance quality of life. If you are experiencing problems with your hip or knee replacement, consult with Professor Ali Ghoz to discuss your condition and develop a personalised treatment plan tailored to your needs.