Revision Joint Replacement
Revision hip, knee, and shoulder replacement with Dr. Steven Ward in Tucson and Oro Valley — fixing a joint replacement that has loosened, become infected, become unstable, worn out, or broken, and converting failed hip fracture repairs to a hip replacement.
Call 520-881-1394Typical ranges for general education. Dr. Ward’s plan for you may differ.
What it treats
Joint replacements are among the most successful operations in medicine, and a modern hip can last 20 or more years. When one does fail, a revision removes some or all of the original parts and replaces them. Common reasons include:
- Loosening — the implant loses its grip on the bone, sometimes from wear particles that cause bone loss (osteolysis)
- Infection — bacteria on the implant, which can appear soon after surgery or years later
- Instability — a hip that keeps dislocating, a knee that gives way from ligament imbalance, or an unstable shoulder
- Wear of the plastic liner, which is less common with modern materials
- Periprosthetic fracture — a break in the bone around an implant, usually from a fall
- Failed hip fracture fixation — when screws or a nail did not lead to healing, or the ball of the hip collapsed, the hardware is removed and the hip is converted to a replacement
On Dr. Ward’s hip replacement page he notes that revision, when needed, is more often for fracture or infection than for wear.
Is surgery right for you?
A painful or failing joint replacement needs a careful work-up before any decision:
- X-rays, and sometimes a bone scan, CT, or MRI, to look for loosening, wear, or fracture
- Blood tests and often a joint aspiration (fluid drawn with a needle) to check for infection before antibiotics are started
- A complete medical evaluation with your primary care doctor, and specialists if needed, because revision is a bigger operation
Some problems do not need revision. A stiff knee may improve with a manipulation under anesthesia, and knee instability sometimes responds to bracing and therapy. Warning signs of infection include pain that does not change with activity, redness and swelling at the incision, drainage, and new pain or stiffness in a joint that used to feel good.
How the surgery is done
Revision is longer and more complex than the first replacement and often takes several hours. The old incision is usually reopened and may be extended. The surgeon then:
- Checks the tissues for infection and every part of the implant for wear, loosening, or shifting
- Removes only the parts that need to come out, carefully preserving bone, along with any old cement
- Rebuilds missing bone with metal augments or bone graft, and uses revision implants, often with longer stems, for extra support
- For infection: a washout with exchange of the liner or ball when caught early; or removal of the implant, an antibiotic cement spacer for several weeks with IV antibiotics, then a new implant in a second surgery; a single-stage exchange is appropriate in some cases
Shoulder revisions often convert to a reverse shoulder replacement. See total shoulder replacement.
Infection treatment is a team effort
Infected joint replacements usually cannot be cured with antibiotics alone because bacteria form a protective film on the implant. Dr. Ward works with infectious disease doctors, who choose the antibiotics, decide how long they are needed, and track blood work.
Removing the implant gives a better chance of curing the infection but means a longer recovery.
Recovery overview
Typical expectations based on AAOS OrthoInfo patient education. Recovery after revision is usually slower than after a first replacement, and Dr. Ward’s plan for you may differ.
In the hospital
- A hospital stay of several days is common, though some knee revisions go home the same day
- Weight-bearing may be limited at first, depending on the repair; hip revisions may come with positions to avoid
- Blood clot prevention, antibiotics around surgery, and pain control
First weeks
- A walker, crutches, or cane for days to weeks, longer if weight is restricted
- Help at home, or a short stay in a rehab facility, for several weeks
- Do not soak the incision until it has fully sealed; stitches or staples come out several weeks after surgery
Months
- Home exercises and physical therapy to restore motion and strength; after a knee revision, the goal is a straight leg and at least 90° of bend
- If you had a two-stage infection treatment, the new implant goes in once the infection has cleared, usually at least 6 weeks later
- Most people have good long-term relief and function, though not everyone becomes completely pain-free
When to call the clinic
Call 520-881-1394 if you notice any of the following after surgery or while you are recovering:
- A fever of 101°F or higher, or chills
- Redness spreading around an incision or pin site, or drainage that is cloudy, foul-smelling, or keeps soaking the dressing after the first few days
- Fingers or toes that turn pale, blue, or cold, or numbness or tingling that does not go away once the anesthesia has worn off
- A cast, splint, or dressing that feels too tight: throbbing pain, swelling, or numbness under it that does not ease after you raise the arm or leg above your heart. Do not cut or remove a cast yourself
- Pain that is not controlled by your prescribed medication, elevation, ice, and rest
- Pain, swelling, or tenderness in the calf that is new or getting worse
- New or increasing drainage from the incision, or a joint that becomes red, swollen, or suddenly more painful or stiff
It is normal to have swelling, bruising, and soreness for a while after surgery, and for the arm or leg to feel numb or weak until a nerve block or spinal anesthetic wears off. Follow your weight-bearing and splint instructions exactly. Call if something feels different from what you were told to expect.
for chest pain, shortness of breath, or trouble breathing. These can be signs of a blood clot in the lungs and need emergency care.
Blood clots are uncommon, but the risk is higher after hip surgery and joint replacement. Take your blood thinner exactly as directed, do ankle pumps while resting, and walk as instructed. Call the clinic for new calf pain, swelling, or tenderness.
If something does not match the instructions you were given, call the office. Dr. Ward or one of his physician assistants will get back to you.
Related resources
Total hip replacement
Dr. Ward’s anterior-approach hip replacement page, from scheduling through recovery.
Open pageTotal knee replacement
Total vs. partial knee replacement and what the first twelve weeks look like.
Open pageTotal shoulder replacement
Anatomic and reverse shoulder replacement, including when a reverse is used for revision.
Open pageHip post-op hub
Hip replacement and hip fracture packets, rehab guides, and post-op instructions.
Open pageKnee post-op hub
Knee arthroscopy and knee replacement packets, rehab protocols, and anatomy guides.
Open pageOrthoInfo: Revision total hip replacement
Patient education on revision hip replacement from the AAOS. OrthoInfo also covers revision knee replacement and infection after joint replacement.
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