Total Joint Revision: A Second Lease on Life
Total joint replacement, comprised of hip or knee replacements, is one of the most common surgical procedures in the U.S. These devices have given millions of people continued or increased activity and mobility even as they age— they’ve gotten a new lease on life.
Now, younger people are seeking primary joint replacements. Many of them are active and want to live pain-free to work and do more into their golden years. These devices may last a lifetime post-surgery, but people increasingly need to have them replaced due to instability or wear and tear.
As such, we’re seeing an increase in the number of total joint revision surgeries in younger adults. This procedure is the replacement of a total knee or hip device. Total joint revision can restore or even improve mobility for decades. By 2030, total hip replacement revisions will reach 72,000 (a 142 percent increase), and total knee replacement revisions will reach 120,000 (a 190 percent increase), according to data from the American Academy of Orthopaedic Surgeons.
Most patients who are living with total joint replacements and who develop pain or instability are candidates for total joint revision. A revised knee or hip can give some patients up to another 30 years or more of the improved activity that they’ve gotten used to.
LISTEN: Dr. Savyasachi Thakkar discusses total joint hip or knee revision in the Medical Intel podcast.
Signs a patient might need total joint revision
A patient might need a revision if their implant fails because of wear and tear with subsequent loosening of the device. Less common causes of implant failure are infection, fracture or stiffness. Patients usually first notice one or two indicators when a knee or hip implant needs to be replaced:
- Instability: After having a stable, pain-free joint, patients find they’re tripping or falling more. Sometimes they need a cane or walker to get around.
- New or worsened pain: They may notice a specific incidence that is associated with the pain. This sometimes leads to increased reliance on pain medications.
Most of our patients seeking a revision hip or a revision knee replacement are 60 to 70 years old. They’ve had their primary hip or knee for 15 or 20 years, and they’re typically active individuals who want to live pain-free with the maximum mobility they can.
How long do knee or hip replacements and revisions last?
This is largely dependent upon the particular patient and the type of implant they received. Older implants often would last only about 10 or 15 years. Current primary knee or hip replacements last an average of 20 to 30 years.
Typically, revised joint devices don’t last as long as primary joint devices. On the higher end, they last 20 to 25 years. As people tend to live longer, we may need to revise their knee or hip joint more than once. However, re-revisions happen less commonly as devices continue to improve.
What should total joint revision patients expect?
First and foremost, we need to understand why the primary joint device needs to be replaced, whether it is from a fracture, wear and tear or some other reason. Total joint knee or hip revisions tend to be more complicated than first-time replacements, and many doctors who perform initial joint replacements refer patients to experts for revision surgery. We often see patients who are referred to us from the surgeons who performed their initial joint replacement surgeries.
Our work for total joint revisions is centered on learning patient’s expectations. We have conversations about their usual activity level and their hopes for what they’d like to be able to do after surgery.
Second, we learn their overall physical condition in collaboration with our experts in cardiology, neurosurgery and other specialties. Many of our patients are older and some have complex needs or other concurrent conditions. It’s important to care for each patient as a whole, not just the knee or hip that we’re replacing.
Next, we create a detailed medical plan for the patient, which spans from pre-surgery imaging to post-surgery recovery and includes:
- Dedicated imaging studies focused on X-rays, computed tomography (CT) scans and sometimes magnetic resonance imaging (MRI) scans to get detailed information as to why that joint replacement prosthesis has failed
- Blood work to make sure there’s no infection
- Surgical planning, including assessment of the appropriate implant
- Physical therapy evaluation to assess the patient’s mobility before surgery
- Anesthetic protocols for the surgery
- Multimodal pain control post-surgery
Most patients who have a single knee or a single hip revised can go home and have an outpatient physical therapist visit them for the first two weeks after surgery. Then they can transition to outpatient physical therapy. However, if a patient’s recovery needs are more significant, they can go to a rehabilitation facility for the week or two after surgery and then transition home.
Recovery time from a total knee or hip revision will depend on the reason for the revision. For example, if the revision is for a simple bearing surface that has worn out, recovery will not be lengthy. However, if the revision is for a more significant problem, such as an infection or a fracture, the period of recovery may last three to six months. After that time, most patients come back to their pre-revision activity level and even surpass that because there’s relief from instability or pain.
Tips for patients with total joint revisions
Total joint devices are mechanical objects, which means they’re subject to failure. However, one of the things that we routinely discuss with patients is to use these joints for the maximum activity with which they are comfortable. The device is working as it should when they can take part in their normal daily activities without compromising on pain or worrying about instability.
Patients who have a total joint replacement and have developed an issue should never ignore new symptoms. For example, we saw a patient who was being treated for lupus, an autoimmune disorder. This patient had undergone several hip replacement surgeries that had failed due to instability issues. We identified and then replaced a certain component that had worn out in the prosthesis. Today, the patient is back to regular daily activities.
We recommend primary and revision knee and hip replacements be checked regularly, continuing in the years after surgery, even if the joint feels good. It’s better to check for early loosening of the implant or another minor problem before it causes a bigger problem. And if you ever develop pain, instability or another issue with your joint, get an appointment right away.
For many patients, a total joint revision can give them their lives back. They can do the things they love without pain and instability. It truly is a second chance to live the kind of lives they want to lead, and we’re proud to play a part in their successes.