Prosthesis revision

Why is it necessary to have an annual check-up after the implantation of a prosthesis?

Patients must attend a mandatory annual check-up after prosthesis implantation. This should be done even if the patient is completely asymptomatic.

The follow-up examination is intended not to treat a specific problem, but to prevent potential complications. In addition to the physical examination, X-ray diagnostics are also performed. The annual X-ray is extremely important, as the images may reveal issues that do not yet cause symptoms but, if left untreated, could lead to serious complications such as osteolysis.

Osteolysis is the abnormal breakdown of bone around the implant. In this case, revision surgery is lengthy and bone grafting may be necessary.

When should revision surgery be performed?

During the primary prosthesis implantation, the patient and doctor decide together whether you want to replace your worn/damaged joint with an implant. It can then take up to months to make a decision.

In contrast, there is usually no time to delay replacing an existing implant. If the doctor considers a revision to be justified and necessary, it should be carried out immediately. Delaying surgery can worsen problems and lead to serious complications, which can have long-term negative consequences for the patient's health.

An annual check-up can detect incipient problems even in the absence of complaints:

• Prosthesis loosening
• Implant wear or breakage of prosthetic components
• Inflammation caused by infection in the tissues around the prosthesis
• Weakened bone tissue due to bone fracture, a so-called periprosthetic fracture
• Dislocation

What symptoms indicate the need for revision surgery?

In many cases there are no clear signs, complaints. The onset of prosthetic wear often has no warning signs, and the presence of low virulence pathogens often goes unnoticed.

Without regular medical check-ups, years can go by without warning signs. But this is very dangerous because conditions can develop that can lead to serious infection or bone tissue damage.

Of course there are also cases where there are clear signs warning the need for a revision:

• Pain around the prosthesis
• Pain radiating into the limb
• Restricted movement
• Dislocation

Procedure of the operation

• The joint is explored using a minimally invasive procedure.
• The surgeon removes (partially or completely) the previous prosthesis. - For cemented prostheses, this is a slightly longer process.
• The ends of the bones, including the socket in the case of shoulder and hip replacements, are cleaned and prepared.
• The doctor inserts the new prosthesis.
• Especially in the case of hip and shoulder revisions, a component with a longer stem than the original prosthetic stem may be implanted.
• If necessary, the implant is also secured with screws.
• The surgeon checks the fit of the new elements.
• The surgical site is then infiltrated and the wound is closed with staples or sutures.

Recovery time and life after the revision

The extent of the recovery time depends on the type of revision surgery.

• For milder revision surgery you can expect a recovery similar to or slightly faster than the first implantation.
• More serious revision surgeries require a longer rehabilitation time compared to primary prosthesis surgery. One reason is that the surgery itself is longer and often involves more blood loss.

In both cases, it is important to follow the instructions of the doctor and physiotherapist to the letter to avoid complications and optimise rehabilitation.

The expected recovery time is 3-6 months. After that, the patient can return to a pain-free and full life.

What are the complications of revision surgery?

As with any surgery, there can be unforeseen consequences with prosthetic revision. Repeated operations on a joint may lead to a higher risk of complications than the primary operation.

• Blood clot
• Wound infection
• Hematoma
• Dislocation
• Nerve damage
• Fracture of surrounding bones
• Fracture of prosthesis

It is worth being aware of the possible risk factors, but it is also important to bear in mind that postponing or refusing surgery can have more serious consequences than possible complications.