Revision or redo surgery of joints involve removing the earlier / older implants from the patient and replacing them with new implants.

. There are three main reasons for revision or for the Joints to fail. These reasons may coexist or exist in isolation.

• Implant Loosening (with Infection / without Infection / Fracture)
• Wear related damage to the implant primarily Polyethylene inserts or liners
• Instability (recurrent dislocation or other symptoms of instability)

Recurrence of earlier symptoms like pain and swelling not preceded by any known injury, gradually worsening start up pain that remains unrelieved after short course of anti-inflammatories or analgesics should warrant a evaluation and could possibly be due to loosening or wear.

Instability may present with frank dislocation and abnormal movement at joint or subtle symptoms like Vague Anterior Knee Pain, Recurrent Effusions, Soft Tissue Tenderness and Difficulty Climbing up and down stairs.

Infection may present with Increased pain, swelling in joint and discharging sinus. Fever may also be present without any other appreciable cause.

Regular follow-ups with the clinician and interval radiographs are important to detect polyethylene wear or failure due to bone collapse earlier and limit the bone damage that may sue.

Once the loosening, infection, Instability or wear of component has been diagnosed, long delays increases the amount of bone damage and stretching of the soft tissues / ligaments and may increase the magnitude of revision surgery.

At the time of primary surgery the bone and ligaments are in their natural state, but during the revision surgery there is variable bone loss and soft tissue imbalance due to loosening / infection which need to be addressed, moreover, older implants, bone cement and debris need to be carefully removed to limit the damage (some bone loss is always accompanied with removal of implant). These things add to complexity and duration of the revision procedure.

Yes, the revision implants are more bulky, more constrained (for stability due to ligament deficiency) and expensive.

Longevity or Life of revision surgery is generally expected to be lesser than the Primary or First Surgery. As the constraint in the implant (provisions for extra stability) increases the longevity of the implant decreases. Poor quality of Bone and significant bone loss at the time of revision surgery also adversely affects the life of revision surgery.

Extensive exposure, increased duration of procedures, poor soft tissue difficulty in removing the older components, poor bone quality and bone loss may increase the period required for recovery and may also the risk of complications. E.g. Infection, early loosening, fractures during surgery and Instability (especially in Hips)

Taking care of all these issues, patients requiring revisions have to be evaluated thoroughly and surgery planned meticulously to minimize the risk of complications and improve longevity