The vast majority of hip and knee replacements are very successful and provide great results for patients for many years. However, in some cases patients may need additional surgery, whether due to infection, wear out of the implant, or a poorly performed initial surgery. This is called revision joint replacement.
Dr. Lucian Warth has extensive experience with both revision hip and knee replacement. Dr. Warth completed his fellowship training at the Hospital for Special Surgery, one of the top facilities in the country for joint replacement surgery. In his practice, he frequently takes on the most complex cases in hip and knee replacements including patients that have been turned away by other surgeons. He is also involved in the design of revision hip and knee implants and enjoys teaching other surgeons how to perform revision joint replacements at courses and cadaver labs both locally and across the nation.
Why Might a Patient Need a Revision Hip or Knee Replacement?
There are several reasons why a patient might need a revision hip or knee replacement either soon after the initial surgery or many years down the road. Below are some of the most common reasons patients need a revision hip or knee replacement.
Infection After the Initial Surgery
Though serious complications are rare after joint replacement surgery, no surgery is without risk. Surgeons and support staff take great care to minimize the risk of infection after surgery, but infections can occur in a small percentage of patients. With an infection, bacteria can develop in and around the surface of the implants. This can cause pain, instability, implant loosening, and wound drainage at the surgical site. In these cases, revision surgery is needed to clean out the bacteria in the joint, and in some cases, replace the implants.
Frequent Dislocation of Hip Implants
Like the natural hip bones, the ball component of the hip replacement implant must remain in the socket in order to function properly. If a patient has recurring dislocations after a hip replacement, a revision may be required to better align the joint or place new implants.
Wear or Loosening of Implants
Hip and knee replacement implants can function well for many years. However, like our natural joints, hip and knee replacement implants can have wear and tear over time. In some cases, wear on the joint can lead to implant loosening as the bone cement breaks down. If a patient had a hip or knee replacement at a younger age, a revision may be needed after several years to replace the implants and keep the joint functioning properly.
Ligament Instability after Knee Replacement
Knee replacements require very specific balancing or ‘tensioning’ of the ligaments which support the knee (medial collateral ligament, lateral collateral ligament). When the balance of these ligaments is not appropriate, patients often feel as if their knee is unstable, and this can cause significant pain and poor function. Revision surgery to re-balance the ligaments and place revision implants designed with more inherent mechanical stability can significantly improve many such patients.
In most cases, patients can tell when there is a problem with the hip or knee replacement. If something doesn’t feel right, or if symptoms get worse, it is always a good idea to check with your doctor.
Revision Hip & Knee Procedures
Revision hip and knee replacements are much more complex than the original procedure, so it is important to select a surgeon who has extensive experience with revision procedures. Patients are often referred to Dr. Warth for revision surgery, and this is a part of his practice in which he takes great pride.
The first step with revision joint replacement is an initial clinical visit to determine the extent of the problem and what will be needed to fix it. The procedure itself is highly variable based on the reason for the revision and extent of the problem. In general there revision surgery involves removing the original implants and replacing them with revision implants in improved alignment. In the case of joint infections, Dr. Warth uses a staged approach for revisions. (Learn more about joint infections.)
Revision hip and knee implants are typically more complex than the original implants. Dr. Warth is well-versed on implant options and uses implants from several different implant companies to select the option that best fits each patient’s individual needs.
Recovering from Revision Hip & Knee Replacement
Like the revision procedure itself, the recovery period is highly variable from patient to patient and depends largely on the complexity of the problem. Some patients are able to return home the same day, while others will need to stay at the hospital for observation. Safety is especially critical for revision procedures, so Dr. Warth will not clear a patient to return home until he has confirmed that it is safe to do so.
The recovery process for revision hip and knee replacements generally takes an average of 2-4 weeks longer than a first-time surgery to fully recover. As with the original procedure, physical therapy is an important part of recovery. Dr. Warth works closely with physical therapists to help patients progress safely in their recovery.
Revision Hip & Knee Replacement in Indianapolis & Surrounding Communities
Dr. Lucian Warth has extensive experience in joint replacement surgery, including highly complex cases like revision hip and knee replacement. Patients are frequently referred to Dr. Warth for joint revision surgery when other surgeons are uncomfortable or unable to help. Because revision joint replacements are so complex and there are many factors at play, it is important to choose a surgeon who is very experienced. Dr. Warth not only performs revision procedures on a regular basis, but is also involved in the design of revision hip and knee implants and teaches other surgeons about revision techniques.
If you would like to schedule a consultation with Dr. Warth, please call our office at (317) 817-1200 or use our appointment request form.