Revision Hip & Knee Arthroplasty

Overview

Revision joint arthroplasty is surgery performed to replace, repair, or revise a previous joint replacement when the original implant is no longer functioning properly. Although modern joint replacements can provide many years of reliable service, problems can occasionally develop that require additional surgery. Revision procedures are generally more complex than primary joint replacement because the surgeon must work around existing implants and may need to address bone loss, scar tissue, infection, instability, or changes in the surrounding soft tissues.

Revision Hip Replacement

Common reasons for revision hip replacement include:

• Implant loosening or wear — Components can loosen or wear over time, causing pain and reduced function.
• Infection — Infection around a hip replacement may require removal of implants and staged or single-stage reconstruction.
• Dislocation or instability — Recurrent instability may require revision to improve implant position, stability, or soft-tissue tension.
• Fracture — A fracture around the implant may compromise the stability of the replacement.
• Implant failure or breakage — Damaged or worn components may need to be replaced.
• Leg-length or mechanical problems — Significant differences in leg length or component positioning may occasionally warrant revision.

Revision Knee Replacement

Common reasons for revision knee replacement include:

• Loosening or wear of components
• Infection
• Instability or ligament imbalance
• Persistent pain or stiffness
• Malalignment or component positioning
• Bone loss
• Fracture around the implant
• Polyethylene wear or implant failure

Planning a Successful Revision

A successful revision begins with identifying why the original joint replacement failed. This may require a detailed history, physical examination, X-rays, advanced imaging, and laboratory testing to evaluate for infection or other causes.

Revision surgery may involve replacing one component, several components, or the entire joint replacement. In more complex cases, specialized implants, augments, stems, or bone grafting may be necessary to reconstruct lost bone and restore stability.

The overall goal is to address the underlying cause of failure, relieve pain, restore stability and function, preserve bone whenever possible, and provide a durable reconstruction. Because revision surgery is individualized and technically demanding, careful preoperative planning is an important part of achieving the best possible outcome.

Dr. Assini and his team are happy to see patients who have undergone previous total joint replacement and are not happy with the result. Each week his team takes care of patients in this situation. There is usually a fix to a painful TKA or THA, and a proper work up is very important.