| Approximately, 500,000 Americans undergo either | | | | whole thing. This presents another problem since |
| total hip or total knee replacement surgery | | | | the orthopedist must find a correct-sized mate |
| annually. The underlying reason is usually end-stage | | | | for the remaining implant section. This can be a |
| arthritis- when the cartilage which cushions the | | | | complicated process since the part may need to |
| joint has worn away. | | | | be sculpted to fit just right. |
| Technology has improved to such a point that | | | | Surgery can take anywhere from an hour for a |
| these replacements which consist of metal, plastic | | | | partial replacement to five or six hours for a |
| or ceramic materials and mimic the function of a | | | | completely new hip or knee joint. |
| normal joint, are usually very effective. | | | | Age does not appear to be a limiting factor and |
| Most patients can return to activities they | | | | people of any age are eligible for revision surgery. |
| enjoyed before their joint became diseased. But | | | | The primary factor that determines whether a |
| after 10 to 20 years these replacement joints | | | | patient will be suitable is their overall health. If they |
| may also wear out, requiring a second or even | | | | are in good health, then revision is a good option. |
| third replacement surgery. This procedure is called | | | | Another factor is quality of life. If a patient cannot |
| a revision joint replacement. As one might | | | | function without a revision, then surgery is |
| imagine, these subsequent replacements can be | | | | probably indicated. |
| much more complicated than the earlier surgery. | | | | The rehabilitation following revision surgery is |
| There can be several reasons why a revision | | | | much harder and takes much longer than a first |
| could be required. Sometimes the hip begins to | | | | time replacement. While patients can bear weight |
| dislocate. This can happen either many years later | | | | almost immediately after a first joint replacement, |
| from overuse of the joint, or shortly after the | | | | revision patients must wait six weeks or longer. |
| first surgery if there were technical problems or | | | | The rehabilitation also is much more gradual than |
| errors in getting the prosthetic joint in place. | | | | for first timers. So how can a person prevent the |
| Patients don't always heed instructions so that | | | | need for having a revision? |
| they may exert too much stress on a fresh | | | | Joint replacements nowadays generally last 20 |
| prosthesis before they should. This can cause the | | | | years compared with 10 to 15 years for older |
| replacement to fail. | | | | models. There are things people who have |
| A dreaded complication of joint replacement is | | | | undergone revision can do to prolong the lifespan |
| infection occurring shortly after surgery. The | | | | of their replaced joint and lower the odds of |
| appliance needs to be removed and the patient | | | | eventually needing a revision surgery. |
| will require long term intravenous antibiotics. After | | | | Patients must realize that though they no longer |
| the infection is totally cleared up, the patient will | | | | have pain, this does not mean they can return to |
| require a revision operation. | | | | their previous activity level, particularly if that |
| The most common cause for revision surgery is | | | | activity level was extreme. |
| progressive wear and tear of the initial prosthesis. | | | | While regular exercise and recreational activities |
| Over time, these prostheses can loosen or wear | | | | are recommended, it's important for a patient to |
| away. A patient can experience symptoms such | | | | use moderation. |
| as pain, and reduced range of motion of the joint. | | | | Some examples... an elliptical trainer is better than |
| There are a number of reasons why a revision | | | | a treadmill. Cycling is more advisable than running. |
| surgery is so difficult. Firstly, the original implant | | | | If a patient is a tennis player, they should play on |
| has to be taken out. Over the years, soft tissue | | | | soft courts rather than hard. And so on... |
| structures around the joint can change. There is | | | | Maintaining ideal weight is critical. |
| the development of scar tissue, alteration of bone | | | | Regular visits to the joint replacement surgeon |
| structure, loosening of ligaments and so on. These | | | | are advisable since they can sometimes spot |
| changes make a revision surgery very different | | | | problems before they occur. |
| and much more difficult from a first surgery | | | | It's also important to remember that patient |
| where the anatomy is not distorted. | | | | should go to a hospital that specializes in joint |
| Prior to surgery, different imaging procedures | | | | replacements, especially revision replacements, if |
| such as x-rays with multiple views, CAT scanning | | | | they need a revision. |
| and MRI are required to give the surgeons a road | | | | These operations require extensive training and a |
| map. | | | | well-coordinated team of experts to get the best |
| Sometimes, the bone around the joint has eroded | | | | results. Surgical errors by inexperienced doctors |
| and grafting of new bone is required. | | | | can lead to complications and the need for |
| While most patients require total implant | | | | additional operations. |
| replacement, sometimes only a portion of the | | | | The best place to go is an orthopedic specialty |
| prosthesis needs to be replaced, rather than the | | | | hospital or a teaching hospital. |