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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 may require what is called a “2 stage revision”. This involves complete removal of all the joint components and placement of an antibiotic spacer (stage 1). You will then be placed on IV antibiotics for 6 weeks, in conjunction with an infectious disease specialist, followed by a 4 week “holiday” or break from antibiotics. At that time (approximately 10 weeks from the removal), labs will be followed and the joint will be aspirated to confirm the infection is eradicated. If the infection is confirmed to be gone, 2 weeks later a new joint would be implanted (stage 2), approximately 12 weeks from the initial removal. (in rare cases, if the infection is not gone, it may require an antibiotic spacer exchange and repeat IV antibiotic treatment). We then continue antibiotics until confirmation that cultures are negative from the 2nd stage (replant of a total joint). 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. 

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