With the use of latest technology support in the involved surgical procedures and latest implants, the success rates of Primary Joint Replacement Surgeries have increased manifolds. But as some implants fail, there rises the requirement of Revision Joint Replacement Surgery. As a second follow up surgical procedure (revision), the process is undertaken by us under guidance of leading Orthopaedic Surgeon Dr. L. Tomar for removing old implants and replacing them with new ones.
Why the Need for Revision
Dr. L. Tomar’s decision for performing a revision joint replacement surgery is based on several factors. These may include:
· Joints becoming painful/swollen because of wear down, loosening or infection
· Declining of the primary function of implants that result in limp/stiffness/instable body
· Post surgery follow up examinations may show a change in position or condition of implants
Reasons of Implants Failure –
Anatomy of hip/knee is different after joint replacement as compared with the preoperative state. Some of the factors that make revision joint surgery an unavoidable procedure include:
Loosening - Revisions become a necessity when implants get loosened.
Infection - Infections also cause implant failure as the foreign metal/plastic implants used in the process can become a carrier of bacteria. Other than this, as the altered blood supply of the previously operated tissues may not have adequate strength to fight infection.
Dislocation – Here, there is migration of implant from its normal position and results in failure of joint replacement surgery. As some patients experience multiple dislocations, it requires a revision surgery. Some of the reasons for dislocations can be –
· Inadequate soft tissues
· Bony/scar tissue impingement
· Incompatible positioning of the implant
· Due to neurologic factors like Parkinsonism
· Patient’s non-compliance to the defined post surgical guidelines
Factors Related to Patients – Some of the factors related to patients that call for the need of Revision Joint Replacement Surgery include:
· Younger/more active patients
· Obese patients who have higher possibility of wearing and loosening
· Patients who had primary surgery performed for inflammatory arthritis
· Patients having avascular necrosis
· Patients with a condition of previous hip fracture
Diagnosis
Joint replacement surgery helps in decreasing pain and increasing the joint function in majority of patients. Once patients progress through postoperative period, the symptoms of pain and stability and motion of joints remain stable for extended period of time. The diagnosis conducted by us includes performing standard assessments including:
· Patient history
· Physical examination
· X-rays
· Laboratory tests
· Aspiration or scintigraphic studies
Physical Examination -
The physical examination done by us helps in identifying patients having change in pain levels. Here, mechanical failure/infection can be noticed with redness/warmth of affected joint. Further, a limp/deformity may also be identified.
X-Rays –
X-rays that are taken of area around joint replacement provide us necessary information regarding stability of implants. This process helps in providing information of failures because of causes like aseptic loosening. Other than this, areas of bone loss can also be identified through this process.
Laboratory Tests –
Some of the laboratory tests that are done by us for identifying possible failed joints include:
· Complete blood count
· Erythrocyte sedimentation rate (ESR)
· C-reactive protein test (CRP)
These studies help us in detection of infected joint replacements.
Additional Tests –
Some of the additional tests that can be done by us as per the situation demands include removing of the Joint fluid using needle and then analyzing it through process called aspiration that provides clues to possible infection. Scintigraphic studies that make use of short-acting radioactive isotopes may also be used by us for detection purposes.
Techniques Used for Revision Implants
In most of the cases, the procedures used for the reconstruction of hip/knee bones followed by us are almost equal to primary procedure. Several techniques are effectively used for implanting revision joints. These include:
Hip Implants – These can be:
· Porous-coated for allowing bone in-growth
· Fixed close to joint if quality of the bone is acceptable
· The fixation may be done down the bone if there is poor tissue remaining
· Implant done using combination of bone graft and cement
Knee implants – These can be:
· Of the same size as primary implants
· These can have extensive stems/wedges, and build-ups if there is poor bone quality
Rehabilitation
There are aggressive rehabilitation processes that are followed by us after conducting joint revision surgery. In most cases, physical therapy is initiated within 24 hours of procedure that continues for up to three months following the surgery.
Some of the cautions that need to be undertaken by patients during the post surgery period include:
· Restricting weight bearing
· Use of assistive devices like walkers or crutches
· Precautions regarding sitting, bending, and sleeping positions
These restrictions are for a period of 6 to 12 weeks. Further, the improvement in strength and limp may continue towards the improvement phase over one to two years.
Potential Surgical Complications
Medical conditions can be aggravated by extensive revision procedure and may result in heart/lung complications. The complex nature of the revision joint surgery also increases these chances if not handled properly. Some of the complications that may occur include:
· Possibility of bleeding, infection and trauma to blood vessels/nerves
· Loosening of new implants
· Pulmonary embolism and deep venous thrombosis
· Dislocation of hip implants
Our Advantages -
The positive feedbacks received from the patients and the high preference for the Revision Joint replacement surgeries has proved that the surgeries done by us have helped in decreasing pain and increasing body functions in majority of patients. As leading surgical experts in the field of Revision Joint Replacement Surgery, Dr. L. Tomar and his expert team of surgeons and post operative care specialists offer patients a depth of expert total joint care.
Some of the added advantages of our services include:
· Team led by leading Orthopaedic Surgeon Dr. L. Tomar
· Utilizing specialized focus in evaluation and treatment of revision joint disorders
· Services offered by recognized and board-certified surgeons
· Extensive experience in carrying out joint revision surgeries
· Customized care
· Commitment to patient education and care by looking at both surgical and non-surgical intervention possibilities
· Extensive research-driven practice and approach
· Expertise in utilizing latest technological innovation and prosthesis design in involved surgeries
· Use of latest technology based implants and procedures that help in reducing pain associated with the surgery
· Well defined surgery and post surgery procedures that remove restriction of motion that can severely limit person's functional day-today lifestyle
· Ready availability of state-of-the-art techniques and technologies for addressing even most complex surgical issues
Why the Need for Revision
Dr. L. Tomar’s decision for performing a revision joint replacement surgery is based on several factors. These may include:
· Joints becoming painful/swollen because of wear down, loosening or infection
· Declining of the primary function of implants that result in limp/stiffness/instable body
· Post surgery follow up examinations may show a change in position or condition of implants
Reasons of Implants Failure –
Anatomy of hip/knee is different after joint replacement as compared with the preoperative state. Some of the factors that make revision joint surgery an unavoidable procedure include:
Loosening - Revisions become a necessity when implants get loosened.
Infection - Infections also cause implant failure as the foreign metal/plastic implants used in the process can become a carrier of bacteria. Other than this, as the altered blood supply of the previously operated tissues may not have adequate strength to fight infection.
Dislocation – Here, there is migration of implant from its normal position and results in failure of joint replacement surgery. As some patients experience multiple dislocations, it requires a revision surgery. Some of the reasons for dislocations can be –
· Inadequate soft tissues
· Bony/scar tissue impingement
· Incompatible positioning of the implant
· Due to neurologic factors like Parkinsonism
· Patient’s non-compliance to the defined post surgical guidelines
Factors Related to Patients – Some of the factors related to patients that call for the need of Revision Joint Replacement Surgery include:
· Younger/more active patients
· Obese patients who have higher possibility of wearing and loosening
· Patients who had primary surgery performed for inflammatory arthritis
· Patients having avascular necrosis
· Patients with a condition of previous hip fracture
Diagnosis
Joint replacement surgery helps in decreasing pain and increasing the joint function in majority of patients. Once patients progress through postoperative period, the symptoms of pain and stability and motion of joints remain stable for extended period of time. The diagnosis conducted by us includes performing standard assessments including:
· Patient history
· Physical examination
· X-rays
· Laboratory tests
· Aspiration or scintigraphic studies
Physical Examination -
The physical examination done by us helps in identifying patients having change in pain levels. Here, mechanical failure/infection can be noticed with redness/warmth of affected joint. Further, a limp/deformity may also be identified.
X-Rays –
X-rays that are taken of area around joint replacement provide us necessary information regarding stability of implants. This process helps in providing information of failures because of causes like aseptic loosening. Other than this, areas of bone loss can also be identified through this process.
Laboratory Tests –
Some of the laboratory tests that are done by us for identifying possible failed joints include:
· Complete blood count
· Erythrocyte sedimentation rate (ESR)
· C-reactive protein test (CRP)
These studies help us in detection of infected joint replacements.
Additional Tests –
Some of the additional tests that can be done by us as per the situation demands include removing of the Joint fluid using needle and then analyzing it through process called aspiration that provides clues to possible infection. Scintigraphic studies that make use of short-acting radioactive isotopes may also be used by us for detection purposes.
Techniques Used for Revision Implants
In most of the cases, the procedures used for the reconstruction of hip/knee bones followed by us are almost equal to primary procedure. Several techniques are effectively used for implanting revision joints. These include:
Hip Implants – These can be:
· Porous-coated for allowing bone in-growth
· Fixed close to joint if quality of the bone is acceptable
· The fixation may be done down the bone if there is poor tissue remaining
· Implant done using combination of bone graft and cement
Knee implants – These can be:
· Of the same size as primary implants
· These can have extensive stems/wedges, and build-ups if there is poor bone quality
Rehabilitation
There are aggressive rehabilitation processes that are followed by us after conducting joint revision surgery. In most cases, physical therapy is initiated within 24 hours of procedure that continues for up to three months following the surgery.
Some of the cautions that need to be undertaken by patients during the post surgery period include:
· Restricting weight bearing
· Use of assistive devices like walkers or crutches
· Precautions regarding sitting, bending, and sleeping positions
These restrictions are for a period of 6 to 12 weeks. Further, the improvement in strength and limp may continue towards the improvement phase over one to two years.
Potential Surgical Complications
Medical conditions can be aggravated by extensive revision procedure and may result in heart/lung complications. The complex nature of the revision joint surgery also increases these chances if not handled properly. Some of the complications that may occur include:
· Possibility of bleeding, infection and trauma to blood vessels/nerves
· Loosening of new implants
· Pulmonary embolism and deep venous thrombosis
· Dislocation of hip implants
Our Advantages -
The positive feedbacks received from the patients and the high preference for the Revision Joint replacement surgeries has proved that the surgeries done by us have helped in decreasing pain and increasing body functions in majority of patients. As leading surgical experts in the field of Revision Joint Replacement Surgery, Dr. L. Tomar and his expert team of surgeons and post operative care specialists offer patients a depth of expert total joint care.
Some of the added advantages of our services include:
· Team led by leading Orthopaedic Surgeon Dr. L. Tomar
· Utilizing specialized focus in evaluation and treatment of revision joint disorders
· Services offered by recognized and board-certified surgeons
· Extensive experience in carrying out joint revision surgeries
· Customized care
· Commitment to patient education and care by looking at both surgical and non-surgical intervention possibilities
· Extensive research-driven practice and approach
· Expertise in utilizing latest technological innovation and prosthesis design in involved surgeries
· Use of latest technology based implants and procedures that help in reducing pain associated with the surgery
· Well defined surgery and post surgery procedures that remove restriction of motion that can severely limit person's functional day-today lifestyle
· Ready availability of state-of-the-art techniques and technologies for addressing even most complex surgical issues