Revision Total Joint Replacement

What Happens if I need a "Re-Do"?

Joint replacements are generally very successful at relieving pain, restoring mobility, and improving function for patients. Unfortunately, despite excellent overall results, there are times when a joint replacement surgery needs to be re-done (revised). This can be indicated if you have increasing pain, swelling or stiffness. In these situations, often a revision joint replacement is necessary for a variety of reasons. These can include: infection, loosening, instability/dislocation, polyethylene wear, fracture, failure of the implant or other causes. In order to diagnose the cause of pain or failure, often an extensive workup is required with blood tests, imaging and physical exam.

Revision Joint Replacement for Prosthetic Joint Infection (PJI)

An uncommon, but dreaded complication after a total joint replacement, is a prosthetic joint infection (PJI), which is an infection deep in the joint replacement. Many of our pre-surgical optimization strategies are aimed at reducing this risk. Despite these efforts, some patients still may develop a PJI, even many years after a successful joint replacement. Patients who are diabetic, smokers, have autoimmune disease or other chronic health problems, are at higher risk.

If this occurs, you will likely require a revision surgery in order to clear the infection. This is because the bacteria adhere to the metal and in order to eradicate the infection, the metal must be removed. Historically, this was performed as a "2 stage" revision with an antibiotic spacer. However, we have found that often times now we are able to do a functional spacer (known as a "1.5 antibiotic spacer"), where we remove the infected components, and place new components with high dose antibiotic cement. If the infection clears and the new joint replacement functions well, we don't have to return for a second surgery.

After the surgery, you will then be placed on IV antibiotics for approximately 6 weeks, in conjunction with an infectious disease specialist, and sometimes longer oral antibiotics to fully treat and clear the infection. If the infection is cleared at that point, we don't need to return for another surgery. However, if the infection does not clear or the components loosen or fail, an additional surgery may be required.

This is a long process, but successful in eradicating the infection in approximately 80% of patients, depending on the bug or organism causing the infection.

For more information please visit: https://hipknee.aahks.org/revision-knee-replacement/