Joint Revision Surgery: Why Implants might fail

Wednesday, May 27, 2009

Joint Replacement Surgery has greatly improved the quality of life for many patients. Although the surgical procedure has been extremely successful in the majority of the cases ,however chances are that a small percentage may fail necessitating a procedure known as joint revision.

While Hip and knee replacements have been performed in millions of Americans over the last four decades and today joint replacements are a very common surgical procedure which has improved patients' quality of life by easing pain, increasing mobility and activity levels.

Today, over 400,000 hip and knee replacements are performed in the United States annually. However approximately ten percent of implants will fail and require a second procedure, called a Joint revision, to remove the old implants and replace them with new components.

Reasons why Implants May Fail

Post operative Infection :Iinfection may set in after surgery particularly if the surgery was performed in a non sterile environment. Joint replacement surgery requires extremely sterile environment and many leading hospitals have dedicated Operation Theaters only for Joint replacement due to the risk of infection. Extreme caution should be taken during the surgery to avoid infection as it could lead to very disastrous situations. At times the large foreign metal and plastic implants can serve as a surface for bacteria to latch on thereby increasing the risk of getting infected.

Loosening of the implant :During the initial joint replacement the metal or plastic implants are firmly fixed to the bone but sometimes they may come loose due to normal wear and tear or if the patients leads a very active lifestyle

Technical Failure :In rare occasions the prosthesis may fail leading to instability of the joint, dislocation may occur causing the prosthesis to pop out or move from its initial position

Damage caused due to a fall or an accident Ab accident or any damage may loosen the joints, cause a dislocation or damage the prosthesis

Age Related Factors: Young Adults or young people who are more active may have a higher chance of getting a Joint Revision done,compared to someone who is older and less active.Patients whose primary surgery was performed for inflammatory arthritis and patients with a previous hip fracture are at higher risk for joint revision surgery since the chance of the implants loosening for such patients are high.

Joint revision is also done for implants or prosthesis that have reached the end of their life span or if damage occurs due to a fall or an accident or it may be even caused by the abnormal walking pattern in certain patients .


Together with the symptoms, an X-Ray of the infected part can reveal if there is need for revision. A surgeon may conduct a standard physical examination followed by lab tests and in some cases a CT scant
Generally a joint revision is generally done as a last resort due to its complexity and cost.

An Orthopedic Doctors View

Patients need to choose the centers for joint replacement with care as there are only a few hospitals that have the required infrastructure to perform primary total joint replacements and to deal with any complications if at all any.

Since these surgeries are performed in elderly individuals and invariably they do suffer from hypertension, diabetes, heart diseases, hypothyroidism and obesity. To control the medical conditions there should be a team of specialist who can handle these medical conditions. There should be ICU facilities in case it is required .Blood bank should be there in the hospital for emergency needs.


M.S. (Orthopedics)
Consultant Orthopedic Surgeon
Wockhardt Hospitals, Bangalore

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