Treating Signs of Hip & Knee Replacement Failure
Our orthopedic surgeons at University of Utah Health provide exceptional care for revision hip replacement surgery and revision knee replacement surgery. We see patients from all over the Mountain West region who underwent a hip or knee replacement and need to have another procedure to correct a problem, reduce instability, or treat infection.
We perform revision surgery on anyone who needs our help. It does not matter if your hip or knee replacement surgery was performed at U of U Health or another facility.
Our team-based approach to hip and knee revision surgery incorporates the expertise of:
- orthopedic surgeons,
- medical doctors,
- physician assistants
- resident and fellow surgeons
- infectious disease doctors,
- physical therapists,
- occupational therapists,
- dietitians, and
- other non-clinical professionals.
Hip & Knee Revision Criteria
A total hip or knee replacement does not replace your original joint perfectly. Some patients may still experience minor pain or discomfort or mobility challenges even after a joint replacement procedure. However, not everyone who experiences symptoms or issues will be a good candidate for a revision hip or knee replacement.
To determine whether you are a good candidate for a revision surgery, your orthopedic surgeon will:
- schedule an appointment for a physical exam;
- order imaging tests, such as an X-ray or CT scan to further evaluate the joint; and
- diagnose the cause of your joint instability, pain, or dysfunction.
Due to the complexities of revision surgery, our orthopedic surgeons will not perform these procedures unless they can clearly identify a mechanical or structural problem that they can fix with surgery. The first step is to schedule an appointment with an orthopedic surgeon to discuss your symptoms and concerns.
Benefits Of Hip & Knee Revision Surgery
If you experience complications after a joint replacement surgery (immediately or several months or years later), a hip or knee revision procedure will:
- relieve pain,
- increase mobility,
- improve strength and coordination,
- reduce the frequency of hip or knee dislocations,
- treat infection, and
- improve stability in the joint.
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Preparing For Hip & Knee Revision Surgery
Below are some important things you can do to prepare for a hip revision or knee revision surgery that will reduce the risk of complications and help improve your recovery process.
- Lose weight or maintain a healthy body weight. Most surgeons will require you to have a BMI below 40, but a BMI below 35 can further reduce your risk of complications. Being underweight is also a potential risk, especially if you are malnourished. If you need help with nutrition or weight loss before surgery, talk to your orthopedic surgeon about resources available through U of U Health.
- Work with your primary care provider or specialist to get other health conditions under control, such as diabetes or high blood pressure.
- Stop using nicotine at least four to six weeks before surgery.
- Decrease your alcohol intake or stop drinking alcohol at least one to two weeks before your procedure.
- Reduce your narcotic use prior to surgery. This will give you the best chance of controlling your pain after revision surgery.
Plan for a Caregiver
You will need to have a family member, friend, or caregiver take you home when you are discharged and provide assistance at home. You will need help for several weeks with daily tasks like shopping, bathing, laundry, and cooking. You will not be able to drive and will need a ride to and from doctor’s appointments or other necessary trips. Our social workers will help you with resources and referrals if you do not have anyone who can help after your surgery.
You will need to prepare your home so you can get around with a walker, crutches, or other assistive devices while you are recovering. If your home is not suitable for recovery and you cannot make modifications, you may need to stay in a rehabilitation center or skilled nursing facility following your hip revision or knee revision replacement procedure.
How Long Does Hip Or Knee Revision Surgery Take?
Revision surgeries usually take between three and five hours, but some could take longer, depending on the type of hip or knee revision surgery. Your surgeon will have multiple potential surgery plans and contingencies so that he or she can modify and adapt depending on what they find during surgery. Our orthopedic surgeons have the experience and resources to adapt to changes and or unpredictable events that may occur during these surgeries.
What Happens during Surgery
You will be placed under anesthesia (put to sleep) for the duration of the surgery. In some cases, your surgeon may recommend a spinal epidural where you are awake, but your body is numb from the waist down. Your anesthesiologist will discuss any additional pain control methods with you prior to your surgery.
Once the hip replacement or knee replacement revision surgery begins, your surgeon will:
- Make an incision (cut) in the area of your joint. This typically follows the same incision line from your initial replacement surgery. However, it may need to be longer than the original incision to permit your surgeon to remove the joint components.
- Check the soft tissues and the joint for evidence of loosening and instability once the joint is exposed.
- Examine all the pieces of your hip replacement or knee replacement prosthesis (artificial body part) to find which pieces are out of place, loose, or damaged.
- Remove the original implant (or parts of the implant) carefully to avoid damaging the existing bone. If cement was used during your original hip or knee replacement surgery, your revision procedure may take longer because your surgeon may remove the cement while attempting to avoid unnecessary bone loss.
- Occasionally a controlled break of the bone is needed to remove components such as the femoral stem (a long piece of the hip replacement joint that extends from the hip into your thigh bone). Your bone will then be reattached to heal.
- Perform revision bone cuts to get the bone surfaces ready for new implants, once your surgeon removes the original parts from your hip or knee replacement. If there is significant bone loss, your surgeon may add bone grafts or augment some areas with metal.
- Place the revision implant parts in your hip or knee, and any necessary bone cement, screws, or other devices to hold them in place while it heals.
- Make any other necessary repairs to surrounding tissue that was damaged before or during surgery, then close the incision (cut).
- Your surgeon may insert a drain or an incisional vacuum dressing to prevent fluid or blood from accumulating below or on your skin. You may need this for several days to several weeks following surgery.
When your surgical procedure is complete, you will be taken to a recovery room until you wake up from your anesthesia. We will transfer you to a hospital inpatient room. Most patients stay in the hospital for one to two nights before being discharged home or to a skilled nursing facility.
Your doctor may keep you in the hospital longer if you had an infection and need IV (intravenous) antibiotics or a peripherally inserted central catheter (PICC) line. A PICC line is a thin, flexible tube inserted into a vein that will remain connected to your vein for a longer period of time. Doctors may recommend a PICC line instead of getting frequent needle sticks for IV (intravenous) antibiotics.
If your hip or knee revision is the result of an acute (recent) infection, your doctor may recommend a surgical procedure called an incision and debridement. During this procedure, the surgeon will:
- open the hip or knee joint,
- wash out the bacteria,
- switch out the liner and the ball within your joint (for hip revisions) or the plastic spacer (for knee revisions) while leaving the metal implant parts attached to your bone in place, and
- close the incision (cut).
You will need intravenous (IV) antibiotics for four to six weeks after the surgery to treat the infection.
Severe or chronic infections may require the removal of your whole hip or knee joint. When this happens your surgeon will usually perform the procedure in stages.
- Stage 1: Remove the implant and put in a temporary device filled with antibiotics that can fight off infection in the area of the joint. This temporary spacer may need to remain in your hip or knee for several months while you receive IV (intravenous) antibiotics.
- Stage 2: Once your surgeon is satisfied that the infection is gone, he or she will perform a second surgery to remove the spacer and put in a new permanent hip or knee prosthesis (artificial body part).
How to Make An Appointment with Our Joint Replacement Specialists
If you experience symptoms of a hip replacement failure or knee replacement failure, schedule an appointment to see one of our orthopedic surgeons who specialize in joint replacements. You can get a referral from your primary care provider or another provider, or you can contact us directly by calling 801-587-7109 to schedule a consultation.
Some insurance plans require that you get a referral from your primary care provider to see a specialist. Check with your insurance provider before you make an appointment to find out if you need a referral. Your insurance carrier will help answer any questions about your coverage and costs for hip or knee revision surgery.