Joint replacement surgeries for hips and knees affected by arthritis are almost always successful, restoring joint function and easing pain for nearly all patients who have them.
But as more and more people undergo a joint replacement—including younger patients—it brings an interesting dilemma: More patients now need a second joint replacement, called a joint revision surgery, as they outlive their original joint implant.
In general, statistics show that knee and hip replacements will last 10 to 20 years for 90% of patients. The likelihood of needing a revision grows as time passes. One survey examining patient registries of hip and knee replacement patients found an average revision rate of 6% after 5 years and 12% after 10 years.1
Here are the main problems that can occur after a joint replacement to trigger a need for revision surgery:
- Loosening of the implant. This is the most common problem from a joint replacement. When a joint is replaced, the new joint components are cemented or fitted into place. But over time, friction can cause tiny particles to break away and loosen the bonds between bone and implant. This can cause pain in the joint, as well as instability.
- Dislocation of the joint. Sometimes, the new joint will become unaligned and “pop” out. This is a more common complication with hip replacement. It can be caused by scar tissue interfering with the joint, weak joint-supporting muscles, or patients not following treatment guidelines after their joint replacement.
- Infection. If an infection takes hold at the site of the joint replacement, it can cause enough pain and swelling that a revision is needed. With current hospital standards and available antibiotics, the risk for an infection that would trigger joint revision is very small. Doctors may do a blood test or joint aspiration to detect an infection.
- Joint problems that will only get worse. If wear, loosening, or any other disorder of the replaced joint is threatening to cause a bone fracture or deterioration past the point of correction, a revision may be needed. This may be revealed as the result of an X-ray of the joint.
Revision surgeries are more complex and have higher rates of post-surgery complications than first-time joint replacements. It’s important that revision surgeries are done by surgeons with skill and experience in that type of surgery.
Because of this, surgeons and patients alike have to weigh the advantages and disadvantages of joint replacements for younger patients. This also means that non-surgical treatment for joint pain or problems following a replacement should be considered before pursuing a revision surgery.
Fortunately, most people can still have a successful revision surgery that leads to years of activity and good joint function.
- Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011 Mar;93(3):293-7.