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How is revision joint replacement surgery performed?

Dr. William A. Leone, MD
Orthopedic Surgeon

Joint replacement prosthetics are designed so that during revision, only the bearing (ball and liner or tibial plastic liner) needs to be changed. However, revision surgery is typically more difficult; often, more than just the bearing will need to be revised.

Dr. Scott D. Martin, MD
Orthopedic Surgeon

Loosening, bone loss, being very active or overweight, and the wearing away of the artificial joint that typically occurs after 15 to 20 years can all necessitate revision joint replacement surgery. Knee and hip replacements typically last longer in older people, who tend to be less active than their younger counterparts, who put more wear and tear on a replacement joint. For knee or hip replacement surgery, there is a 1% failure rate per year (that means that revision surgery is needed within one year).

If your implant fails, surgery to replace it takes longer and may be more complicated than your original operation. There is also more risk involved. The in-hospital death rate for revision hip replacements is more than double that of first-time total hip replacements. Patients who have less pain and fewer additional medical conditions before revision surgery are more likely to experience better pain relief as a result of the surgery.

During surgery, the surgeon removes the old implant and damaged bone or joint tissue surrounding it. Depending on the amount and condition of the remaining bone tissue, you may need bone repairs or a bone graft to create a stable site for the new implant. Rehabilitation is similar to the initial replacement but takes longer after revision, and the outcome is often inferior. For example, your range of motion in the joint may be more restricted or your leg alignment less even, and even after healing you may need to use a cane to keep full weight off the joint.

Hopefully, with improved implant designs and newer materials such as cross-linked polyethylene, total joint replacements will last longer, making revision surgery less likely in the future.

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