More and more people are undergoing total hip and knee replacements annually as they try to stay active in their later years. As this number continues to rise, so does the number of revision joint replacement surgeries.
Endeavor Health orthopaedic surgeon Anand Srinivasan, MD, an expert in minimally invasive hip and knee replacement, explains the trend and the potential benefits of revision surgeries.
“As the population grows, the replaced joints are aging as well. We expect most hips and knees to last at least 15-20 years,” said Dr. Srinivasan. “But as people continue to stay active that can increase the burden and wear and tear on the new joints.”
What leads to revision surgery?
In general, Dr. Srinivasan and his colleagues encourage patients with new knees and hips to avoid higher impact activities, like running, in favor of things like biking and swimming that put less load bearing pressure on joints.
Still, over the years implants can loosen as the fixative erodes. Our bodies, tendons and ligaments can also stretch out over time, changing how the new joint fits and operates. Plastic in implants can also fail, though that happens far less commonly than it used to, said Dr. Srinivasan.
And there is a small, but not insignificant, number of joint replacements that need revision surgery early on — either from infection, instability or fractures that can occur in the early stages of post-surgical recovery.
Instability can be due to multiple reasons, including pre-existing deformity or individual anatomical complexity, explained Dr. Srinivasan. Fractures can also be the result of multiple causes, including a patient’s compliance with post-surgical instructions, pre-existing ambulatory ability or bone quality, he added.
What’s involved?
Revision joint surgeries are typically more complicated and can be more involved than the original replacement procedure, said Dr. Srinivasan. Sometimes knee revision surgery requires removing the entire implant and starting over, though that is less common in hip revision procedures. “We’re trying to do as little as possible in the procedure to avoid the need for further surgery,” he said.
“We don’t want patients with implants that need revision to be scared off,” said Dr. Srinivasan. “It’s important to maintain your quality of life and we see this with patients well into their 80s and 90s. The revision surgery can provide 10-15 years of relief and improved function.”
Who is eligible?
Patients who are good candidates for revision procedures are generally in otherwise good health and still have significant ambulatory ability.
“We have a long discussion with patients to discuss their individual risk profile and the potential benefits, especially for individuals who may need more mobility to remain independent,” said Dr. Srinivasan.
People with severe medical conditions including serious cardiac or kidney disease or other major comorbidities are likely not good candidates for revision surgery.
What’s recovery like?
It’s also important to note that post-surgical restrictions may be longer and more limiting than for original joint replacement procedures, added Dr. Srinivasan.
“We don’t want to jump in and just do surgery without thoroughly reviewing individual patients, but it can be very gratifying for the right candidates to help them retain quality of life and independence,” he said.
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