Modern hip and knee implants are better than ever. For most patients, they function well for at least 20 to 30 years.

However, about 10 percent of all implants will fail, requiring a second procedure. In this procedure, called a revision, the old joint is removed and replaced with a new one.

When revision is necessary

Revision surgery is complex. It requires planning, special implants and a high level of surgical skill.

Deciding when a joint revision may be needed depends on several factors:

• The joint no longer functions well, leaving wearers with a limp, stiffness or instability
• The joint is painful or swollen as a result of wear, infection or loosening
• X-rays show that the joint has changed position or is no longer in optimal condition

Treatments

Nonsurgical

Revision surgery is a major procedure that has some risks. The complication rate tends to be higher than that of primary surgery, and some patients are not medically able to handle a long surgical procedure.

For these reasons, nonsurgical treatments are often used before revision is considered. Some of the nonsurgical treatments may include:

• Pain medications
• Using a cane, crutches or a walker
• Lifestyle and activity modification
• Antibiotics, if the joint is infected

Surgical

Although revision surgery is complex, there are several elements each procedure has in common

• The quality of the bone surrounding the implant is assessed
• The old joint is removed
• The remaining bone and soft tissue is reconstructed
• The new implant is affixed to the bone