Joint replacement surgery is undoubtedly one of the greatest medical advances of our time.
Knee replacements have been performed in millions of Americans over the last four decades. These procedures have improved patients’ quality of life by easing pain, improving range of motion, and increasing activity levels.
Although joint replacement surgery has been amazingly successful, approximately ten percent of implants will fail and require a second procedure, called revision, to remove the old implants and replace them with new components.
Joint revision surgery is a complex procedure that requires extensive preoperative planning, specialized implants and tools, and mastery of difficult surgical techniques to achieve a good result.
Most knee replacement procedures will perform well for the remainder of the patient’s life. Current knee replacements are expected to function at least 10 to 20 years in 90 percent of patients.
This is due to several factors:
- There are more surgeries performed on older individuals
- Older individuals tend to put lower demands on their implants.
- Current state-of-the-art materials and techniques have improved the quality of implant fixation to bone. This had historically been a weak link that created a potential site of failure.
Innovations in Implant Technology
Innovations have significantly decreased the amount of wear particles that are created by friction on joint surfaces.
As increasing numbers of young patients have these procedures, and as seniors continue to live longer, a growing segment of joint replacement patients will outlast their implants.
The decision to perform a revision joint replacement surgery will be based on several factors.
- The joint may become painful or swollen, due to loosening, wear, or infection.
- The function of the implant may decline, resulting in a limp, stiffness, or instability.
- Finally, serial examinations or X-rays may demonstrate a change in the position or condition of the components. All of these factors will determine when joint revision surgery is needed.
Joint revision surgery is usually performed as a planned surgical procedure.
Patient condition and characteristics of the failed and new components will contribute to the planning process. Most surgical methods will proceed along a similar stepwise pattern.
- Reconstruction of the knee bones must then be performed.
- Some procedures will have bone almost equal to a primary procedure.
- Others will have more-severe bone loss. In these cases, revision will require the use of bone graft and/or metallic plates, special components, cages and screws.
- Once bone has been reconstructed, the process of implantation can begin.
Knee Revision Implants
- May be about the same size as primary implants, or they can have extensive stems, wedges, and build-ups if bone quality is poor.
- May substitute for damaged or absent ligaments.
- Will often use cement for fixation, but occasionally uncemented techniques are selected.