Revision Joint Replacement is a surgical procedure that may be indicated in failed prior joint replacement surgery. Patients with failed joint replacements may complain of pain, instability, stiffness, joint infection, leg length discrepancy, limping, functional disability. Common reasons for failure of joint replacement surgery include implant component loosening, periprosthetic joint infection, joint dislocation, periprosthetic fracture, osteolysis, bearing surface wear. The failure can occur in both primary and revision joint replacements.
The surgeons at the Limb Reconstruction Centre manage a large number of patients with failed hip and knee primary and revision joint replacements. These procedures are highly complex not only from a technical and surgical point of view but also because the patients requiring revision surgery are commonly older with associated medical comorbidities. At the Limb Reconstruction Centre every patient undergoes complex clinical assessment of their joint condition to accurately diagnose the reason for failure. A correct diagnosis is the most important factor in ensuring an optimal surgical outcome. This process is aided by a comprehensive medical and surgical history, clinical examination, extensive radiographic examinations including calibrated digital X-rays, limb alignment X-rays, EOS scan, computer tomography (CT), MRI scans. A multidisciplinary team approach is used to assess the majority of our patients and to formulate a comprehensive management plan. Our team includes orthopaedic surgeons, physicians, infection diseases specialists, pain specialists, nurses, psychologists, physiotherapists.
Once a diagnosis has been made and the patient has been deemed to benefit from revision joint replacement a surgical plan is formulated. In some cases, this is a straightforward plan and procedure however, a large number of patients require an individualized approach due to bone loss, soft tissue deficiency, medical comorbidities. In a significant number of patients customized implants need to be designed and 3D printed to reconstruct the normal anatomy.
The revision joint replacement like any surgical procedure commences with the planned surgical approach. In the case of a revision hip replacement, the surgical approaches used include direct anterior approach, extended direct anterior approach and the posterior approach. The choice of approach is dependent of a variety of factors such as: the pathology that requires management, previous surgical approach, existing implants, bone deficiency. As much as possible either the direct anterior or the extended direct anterior approaches are preferred. More information about the surgical approaches can be found at the section Complex Joint Replacement (Link here).
In the case of a revision knee replacement, a lateral parapatellar approach is used in most cases. Even though this is more difficult compared with a medial parapatellar approach, it allows a better patella mechanics by not disturbing the medial patellar retinaculum and preserving the vastus medialis oblique and the medial part of the quadriceps tendon. Additional techniques such as tibial tubercle osteotomy may be require during the surgical exposure.
Once the joint has been exposed, the existing implants will be removed. This is an extremely delicate step of the procedure and extreme care is used to minimize the bone loss during implant removal. Flexible osteotomes, osteotomy, ultrasonic devices are just some of the techniques used for implant removal. Once the old implants have been removed a new joint is reconstructed based on the preoperative surgical plan. These may involve standard implants, revision implants or custom 3D printed Titanium implants according to patient anatomy and requirement for anatomical reconstruction.
