What Is Revision Joint Replacement?
Most hip and knee replacements work well for many years. Sometimes, though, an implant loosens from the bone, the plastic liner wears, the joint becomes unstable or dislocates, infection develops, or the bone around the implant breaks. A revision removes the problem components and replaces them. Depending on the cause, this can mean exchanging a single part, such as a plastic liner, or replacing the entire implant and rebuilding lost bone.
Revision surgery often uses specialized implants, bone grafts or augments to make up for bone loss. When infection is the cause, treatment may take place in two stages, with a temporary spacer and antibiotics between operations.
Dr. Martin completed a fellowship in hip and knee reconstruction at Harvard Medical School and has special expertise in complex revision cases. Dr. Kerr trained in adult reconstruction at Cleveland Clinic Florida and also treats complex hip and knee cases. Dr. Martin's site covers revision hip and revision knee surgery in more detail, and his FASTREC recovery pathway and P3 concierge program are available to revision patients where appropriate.
Performed at a hospital where our surgeons operate, with evaluation, imaging and physical therapy here in our Boynton Beach office.
Who Is a Candidate?
You may need an evaluation for revision if your replaced hip or knee has new or worsening pain, swelling, a feeling of instability or giving way, stiffness that limits motion, repeated dislocations, or signs of infection. Not every painful replacement needs another operation. Pain can come from nerves, tendons, the spine or other sources.
Our job is to find the cause first. Dr. Baskin, our physiatrist, also treats pain after total knee replacement, and some patients do well without more surgery.
What to Expect
Your workup begins in our Boynton Beach office with an exam, X-rays and a review of your previous surgical records. Depending on your symptoms, you may need blood tests, a sample of joint fluid drawn with a needle to check for infection, or advanced imaging. If you had your first surgery elsewhere, bringing the operative report and implant information helps a great deal.
Revision surgery usually takes longer than a first replacement and is typically done in a hospital. Hospital stays are often longer as well. Our on-site physical therapists can prepare you before surgery and continue your rehabilitation afterward.
Risks and Side Effects
Revision surgery carries higher risks than a first joint replacement. These include infection, blood clots, dislocation, fracture, nerve or blood vessel injury, stiffness, blood loss, a need for further surgery and the risks of anesthesia. Your surgeon will talk with you about your specific risks and how they are managed.
Recovery
Recovery after revision is usually slower than after a first replacement, and it varies widely depending on why the revision was done and how much bone was rebuilt. You may be asked to limit weight on the leg for several weeks. Many patients continue to improve for six months to a year.
Physical therapy in our office is coordinated with your surgeon, since therapists share your chart and adjust your program as healing allows.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Revision joint replacement is usually covered by Medicare and most commercial PPO plans when medically necessary, and prior authorization is commonly required. HMO and managed-care plans need your primary care physician's referral before the visit. Co-pays, co-insurance and deductibles apply. P3 concierge membership benefits are not covered by insurance. Call our office and our staff will verify your coverage.
When to Talk to a Specialist
Schedule an evaluation if a hip or knee replacement becomes painful, swollen, unstable or stiff, even many years after surgery. Go to the emergency room or call 911 if you have fever with a red, hot or draining joint, a sudden dislocation, or you cannot bear weight after a fall.
