Replacing A Joint Replacement: When and Why

by Vignesh Alamanda, MD

Replacing A Joint Replacement: When and Why

When is it time to replace the joint replacement?

Although joint replacement materials have advanced in the past few years, there are still things that we need to keep in mind. After all, a joint replacement is an artificial joint, and it will eventually wear out. Our best estimate at this is point is about 10% of total joint replacements need to eventually be replaced.

It might be as simple as taking out an old part and putting in a new modular part, or it might be as extensive as taking everything out from the knee or hip and putting in brand new parts. The lifespan of joint replacements is between 15 and 20 years. That number is growing with recent innovations, better technology, and better plastic materials.

There are other factors to consider, not just the material. For instance, how much do you use the joint? Your activity levels play a significant role. A recent article published in 2019 looked at knee and hip replacements from the past 25 years. They found that 82% of those knees and 58% of those hips lasted longer than the 25 year mark.

Medical technology is responsible for tremendous advancements related to joint replacements. They take away arthritic pain that you might’ve had before, but it’s important to keep mind and look for the warning signs for when joint replacements need to be serviced.

What are the warning signs for when a joint replacement needs to be serviced?

  1. Pain suddenly develops that you didn’t have before. For example, if your joint replacement has functioned properly for 20 years, but a sudden onset of sharp pain occurs, then that’s an indicator that your joint replacement needs to be examined.
  2. You lose range of motion. If you’ve had great range of motion with your knee after surgery, but suddenly your knee becomes swollen, and you can’t really bend the knee or fully extend it, that’s another sign that your joint replacement may need to be serviced.
  3. Your knee starts to look slightly crooked. This phenomenon means that something inside the joint replacement is loosening and giving way. The alignment is changing.
  4. Your quality of life decreases. If you have new stiffness or swelling, and you have trouble getting around or need the assistance of a cane, that’s a step backwards in day-to-day function. Anything that negatively affects your quality of life means it’s time to see a joint replacement specialist.

What should I expect at my appointment?

At your initial appointment, we go through your personal medical history first and foremost. We look at the surgical history. We talk about when the surgery was done and where it was done. We look at the radiological studies, X-rays, CT scans, and MRIs, depending on what is appropriate for your individual condition.

The second thing that will happen, and the most important thing that should be done, is to rule out an infection. Blood samples are taken, and fluid samples from the joint are taken as well. These samples are tested in the lab to ensure that there isn’t a superimposed infection. Once we figure out what’s going on, then we come up with a game plan. We talk about what surgery is, what exactly we’re going to do, what we’re going to achieve, and what our goal is.

After that, we’ll dive into rehabilitation after surgery. We’ll talk about the therapy involved and what we can expect in terms of recovery.

What are the highlights to remember from this blog?

  1. If you have any change from your baseline, especially if it’s a new change, that’s a big red flag that something is going on that needs to be further evaluated.
  2. Always rule out an infection. There’s often an identifiable cause of the joint replacement issue on the X-ray, but there can also be a superimposed infection.
  3. Always discuss with your surgeon the expected course of action. What’s going to happen preoperatively, intraoperatively, and postoperatively? What does recovery look like? We need to set up good expectations.
  4. If you have prior X-rays, those are very valuable. They allow us to keep a chronological check on things. X-rays are a snapshot in your medical history, so the more time points that we have, the better we are able to see what’s going in your joint replacement.

Frequently asked questions

For joint replacement surgery, your BMI must be a certain number. But it’s difficult to exercise when my knee or hip are in pain. How can I lose weight?

That can be a tough problem. It’s a what do you do first scenario. You’re trying to lose weight to get your knee or hip replacement done, but you can’t lose weight until your knee or hip is functioning.

In this difficult position, one of the best recommendations I have for my patients is aquatic therapy. Aquatic therapy is a fantastic exercise option because it takes away the equation of gravity. You don’t have to be a swimmer. You can walk laps in the pool lane, and you will start to strengthen your quadriceps. The more you can strengthen your muscles around the knee or hip, the less pressure there is on the bone.

I also have patients who are seen by diet specialists. Here at OrthoVirginia, we have patients meet with these specialists one-on-one to discuss recommendations on modifying diets to help achieve weight goals.

What is the typical recovery time for hip revision?

Hip revision surgery is very different than a primary replacement. A lot of factors go into recovery time.

Is it an infection? Is it metallosis (metal reaction)?

What was your functional level before revision? How active were you? How strong were you? What is the extent of the revision surgery? These factors affect recovery in different ways.

Do we have to do something special during the surgery to get certain parts of the old joint replacement out? For instance, we might have to do what is called an osteotomy that changes weight-bearing restrictions, and that changes the picture on recovery time.

Unfortunately, there’s no blanket answer to this question. Recovery time is very personalized and very much down to your unique individual situation.

What activities cause more wear and tear on a new joint replacement?

Our goal as joint replacement surgeons is to get you back to doing the activities you want to do in a happy, pain-free manner. Sometimes, you may be worried that you’re damaging your artificial joint by partaking in an activity that you’re not supposed to do. But for most of my patients, I really don’t put any restrictions on them.

The only restrictions I have, especially for hips, are no “pounding” activities such as long-distance marathon running. That doesn’t mean that you can’t go for a short run. That is totally fine. It’s the prolonged periods of high impact or repetitive pounding motions that really take a toll on the joint.

You have no restrictions placed on you regarding range of motion. That usually doesn’t cause much wear.

After a hip revision, I’m still having trouble laying down and sleeping. What can I do?

It depends on where the discomfort is, and again, what the revision was done for. It’s hard to make a blanket statement that may or may not apply to your individual case.

But therapy is a great option to help relieve pain. Therapy helps loosen up and strengthen the muscles to get some of that stiffness out. If it’s pain around the incision site, assuming that the incision has healed well, and there are no concerns with wound issues, desensitization with ointments and creams can take some acute sensitivity away.

I always say ice or heat is your friend. Whatever works best for you to help take down inflammation past the acute stage of surgery is great.

How long is physical therapy for a knee replacement?

It really varies. There’s no set number of weeks or months.

Our thinking as joint replacement specialists has evolved significantly. It used to be that we would send everybody to PT after a hip or knee replacement, but what we’ve found out in the last few years is that we’re not always sending patients to therapy after a hip replacement.

For knees, it’s a little bit different. Knees tend to become stiffer, so we want to make sure that you’re working with your therapist regularly. The therapist will work with you on your progress, and they’ll keep the physician updated. It’s a team effort. Surgery involves me making and putting the artificial joint in, and then a therapist plays the vital role of getting your range of motion back to where it should be.