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Joint replacements can fail for many reasons, with infection being a very common cause, whether it’s in the knee or hip. Due to all of the precautions and advancements over the past couple of decades, infection rarely occurs during the initial replacement surgery. However, patients may experience a hematogenous, or blood stream, infection from another health condition afterwards. Bacteria can enter the body from an area remote from the knee or hip, then travel through the blood stream to the joint, attacking the hardware.
Blood tests, and possible subsequent joint fluid analysis, are used to rule out or determine infection as a cause of joint pain. Depending on the acuity and severity of the infection, your orthopedic surgeon may be able to irrigate the implant to remedy the infection. The other option is to replace the original implant with an antibiotic-loaded temporary spacer (that remains until the infection is eradicated), which is later replaced with a new joint implant.
Another common reason for replacement failure is normal wear. Hip and knee replacement hardware produced before the year 2000 was made of a plastic that would thin and break down after about 10 to 15 years, resulting in inflammation, fluid, and weakening of the bone around the joint. Replacement hardware produced since 2000 has been constructed of ultra-high-molecular-weight polyethylene, which is far more resilient to wear. We are now beginning to see 15-year patient follow-ups with little to no wear. The hope is that these newer joint replacements will last 30 years or more.
Another cause of replacement failure is joint instability — either hip dislocation or loose knee. The first or second episode of hip dislocation can be treated by putting the hip back in the socket, followed by physical therapy and temporary restriction of activity. Recurrent hip dislocation often requires revision surgery. Loose knee, or flexion instability, occurs when there is either too much or too little a gap between the femur and tibia. This also may require revision surgery.
Whatever the cause, pain and swelling are the telltale signs of the possible need for revision surgery. Some degree of discomfort or pain during the first year after the initial replacement is not atypical, given the residual stiffness and adaptation to the new joint. But if pain occurs or persists one year or more from the date of replacement, then you should be reevaluated by your surgeon or get a second opinion from another orthopedic specialist.
The important thing to remember is that your joint replacement should alleviate the pain and improve your joint function. If not, please seek the advice of an orthopedic specialist right away. And, feel free to contact me if you’d like a second opinion or have any concerns. We can put you back on the road to recovery.
Author of this article
Khalid Azzam, MD, specializes in orthopedic surgery. He is a guest columnist and located at IU Health Saxony Hospital, 13100 E. 136th Street, Suite 2000 in Fishers. He can be reached by calling the office at 317.688.5980.