Revision Total Joints

Revision total joints will become more prevalent during the next decade. This premise is based on the large number of joint replacements performed over the past forty years.

Initial total joint replacements did not contain either the engineering or bearing surfaces that are present today. Replacing a previously placed joint replacement is more difficult and requires expertise, specialized equipment, and experience in performing this procedure.

As Chief of Adult Reconstructive Surgery at Mount Sinai Hospital in New York, I have developed a subspecialty in performing these surgical procedures. Over thirty years of experience has helped me understand the unique problems as well as the increased risks associated with revision arthroplasty.

Why are they difficult?

Soft tissue exposure is compromised due to scarring from previous procedures.

Bone stock is deficient, thus rebuilding a stable construct may be compromised; specialized implants and bone grafts may be needed.

These procedures can take a long time. Where primary joint replacement may take two hours of surgical time, revision arthroplasty can take six hours or more.

Complications rates are greater in all areas of the procedure. They can include a limp, nerve injury, dislocation, leg length discrepancy, infection, and implant failure.

Some of the causes of a failed primary joint replacement neccessiting a revision arthroplasty:

  • Infection
  • Aseptic loosening
  • Wear debris synovitis
  • Recurrent dislocation
  • Periprosthetic fracture

Testing to determine if the primary procedure requires revision:

  • Radiographs
  • Nuclear Imaging
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Blood Studies
  • Joint Aspiration (Removal of Fluid)

This type of surgery must be performed by an expert in the field of revision surgery. Having the procedure done in a medical center such as Mount Sinai is an asset because of expertise in the associated disciplines of radiology, anesthesiology, and rehabilitation.

Please call our office for a consultation involving your problem. I am looking forward to speaking with you.