Revisional joint replacement, also called revision joint replacement or revision arthroplasty, is an operation to remove or correct a knee, hip or shoulder replacement that has failed and to replace some or all of its parts. Joint replacements often work well for a long time, but some become painful, loose, worn, unstable or infected, and a further operation may then be needed.
Revision surgery is usually more complex than a first joint replacement, because of scar tissue, loss of bone around the old implant and, in some cases, infection. Finding the cause of failure before surgery is an essential step, because it decides how the revision is planned.
PMG Hospital (PMG Orthopedic Hospital), Gota, is an orthopedic hospital for revisional joint replacement in Ahmedabad, where revision of knee, hip and shoulder replacements is performed. This page explains why joint replacements fail, warning signs, tests, types of revision surgery for each joint, recovery, risks and cost factors.
What Is Revisional Joint Replacement?
In a revision operation, some or all of the parts of an earlier joint replacement are removed and replaced. In some cases only the removable parts are changed, such as the plastic insert of a knee or the ball and liner of a hip; in others the whole implant is replaced. Because bone is often lost around a failed implant, revision implants may use longer stems, metal augments, cones, sleeves or cages, or bone graft, to rebuild support.
Related pages: Joint replacement·Revision knee replacement·Revision hip replacement·Revision shoulder replacement
Why Do Joint Replacements Fail?
| Cause | What happens |
|---|---|
| Loosening (aseptic loosening) | The implant gradually loosens from the bone, without infection |
| Wear and osteolysis | The plastic or other bearing surface wears, and the wear particles can cause bone loss around the implant |
| Infection around the implant (periprosthetic joint infection) | Bacteria settle on the implant; some infections are low-grade and cause only pain and stiffness, without fever |
| Instability or dislocation | The joint feels loose, gives way or comes out of position |
| Fracture around the implant (periprosthetic fracture) | A bone breaks near the implant, often after a fall |
| Stiffness | Scar tissue limits movement, mainly after knee and shoulder replacement |
| Component position | Parts of the implant are not positioned well, which can cause pain, instability or wear |
| Rotator cuff failure (shoulder) | The rotator cuff tendons tear or fail after an anatomic shoulder replacement, causing weakness |
| Wear of the remaining joint after a partial replacement | Arthritis develops in another part of the knee, or the natural socket of the hip or shoulder wears |
Signs That a Joint Replacement May Be Failing
- Pain that returns after a period of good function
- A feeling that the joint is loose, unstable or giving way, or one or more dislocations
- Swelling or stiffness that does not settle
- A new limp, a change in leg length, or new weakness of the arm
- Warmth, redness, wound discharge or fever, which can be signs of infection and need urgent assessment
- Sudden pain after a fall
Not every painful joint replacement needs revision. Pain can also come from the spine, neck, tendons, nerves or other structures around the joint, so a careful assessment is needed before any decision. A revisional joint replacement doctor in Ahmedabad first finds out why the joint is painful, because the cause decides the treatment. Because wear and bone loss can occur without symptoms, regular follow-up X-rays are advised after joint replacement.
Tests Before Revision Surgery
- 1History and examination: details of the first operation, when the problem started, stability, movement, strength, nerve function, and the spine or neck
- 2Records of the first surgery: operation notes and the implant details, if available
- 3X-rays: to look for loosening, wear, bone loss, fracture and implant position, compared with earlier X-rays
- 4CT scan or other imaging: in selected cases, to assess bone loss and implant position and to plan the revision
- 5Blood tests for infection: such as ESR and CRP; these can be normal in a low-grade infection, especially in the shoulder, so a normal result does not rule out infection
- 6Joint aspiration or tissue samples: fluid or tissue from the joint may be tested for infection when infection is suspected. Laboratory cultures may need to be kept for longer, because some bacteria grow slowly. Antibiotics should not be started before samples are taken unless the doctor advises; if you are already taking antibiotics, tell the doctor.
- 7Other tests in selected cases: blood tests for metal levels with some older metal-on-metal hip implants, or nerve tests when nerve injury or muscle weakness is suspected
- 8Fitness for surgery: heart, lung, kidney and blood sugar checks, and correction of anaemia and nutrition when needed
Revisional Joint Replacement Treatment in Ahmedabad
The type of operation depends on the joint and the cause of failure. The main options are similar in any revisional joint replacement surgery hospital in Ahmedabad:
| Type of revision | When it is used | What it involves |
|---|---|---|
| Exchange of removable parts | Wear or some cases of instability, when the main parts are well fixed | Only the removable parts are changed, such as the plastic insert of a knee or the ball and liner of a hip |
| Revision of one or more parts | A loose, worn or badly positioned part | The affected part, or the whole implant, is removed and replaced with revision implants |
| Conversion to another type of replacement | A failed partial knee replacement, a failed partial hip replacement, or a failed anatomic or partial shoulder replacement | Conversion to a total knee or total hip replacement, or to a reverse shoulder replacement |
| Revision for infection | Infection around the implant | Early infection: washing out the joint, changing the removable parts and giving antibiotics, while keeping the implant. Long-standing infection: a single-stage revision or a two-stage revision with a temporary antibiotic-loaded spacer, depending on the bacteria, the soft tissues and general health. Antibiotics are usually given for several weeks |
| Revision for fracture around the implant | A fracture near the implant | Fixing the fracture with plates, screws or wires, or revision with a longer stem if the implant is loose |
Removing an implant that is still firmly fixed to the bone can be difficult. Sometimes a section of bone is cut and opened (an osteotomy) to remove the implant, and is then fixed back in place. Bone loss is rebuilt with revision implants, augments, cones, sleeves, cages or bone graft, depending on the joint.
A revisional joint replacement treatment hospital in Ahmedabad needs a range of revision implants for the knee, hip and shoulder, laboratory and microbiology support, blood transfusion support and access to intensive care for patients who require it.
Revision of the Knee, Hip and Shoulder
Revision Knee Replacement
A knee replacement may need revision for loosening, wear of the plastic insert, infection, instability, a fracture around the implant, stiffness, or arthritis in another part of the knee after a partial replacement. Sometimes only the plastic insert is exchanged; more often, the parts are replaced with revision implants that use stems and metal augments, cones or sleeves to make up for lost bone. Revision for stiffness alone has less predictable results. See Revision knee replacement.
Revision Hip Replacement
A hip replacement may need revision for loosening, wear of the liner with bone loss (osteolysis), infection, repeated dislocation, a fracture around the implant, or a reaction to metal wear particles with some older metal-on-metal implants. Depending on the cause, the ball and liner, the cup, the stem or the whole implant is replaced, using longer stems, special cups, metal augments or cages, and bone graft where needed. See Revision hip replacement.
Revision Shoulder Replacement
A shoulder replacement may need revision for loosening or wear of the socket component, infection, instability, failure of the rotator cuff tendons after an anatomic replacement, or wear of the natural socket after a partial replacement. A failed anatomic or partial replacement is often converted to a reverse shoulder replacement, which lets the deltoid muscle move the arm. Shoulder infection can be low-grade, caused by a skin bacterium (Cutibacterium acnes) that grows slowly in the laboratory. See Revision shoulder replacement.
| Joint | Common reasons for revision | Common revision options |
|---|---|---|
| Knee | Loosening, wear, infection, instability, stiffness, fracture, arthritis after a partial replacement | Exchange of the plastic insert; revision implants with stems, augments, cones or sleeves; conversion of a partial to a total knee replacement |
| Hip | Loosening, wear and osteolysis, infection, repeated dislocation, fracture, reaction to metal wear particles | Exchange of the ball and liner; revision of the cup or stem with longer stems, special cups, augments, cages or bone graft |
| Shoulder | Socket component loosening, rotator cuff failure, instability, infection, socket wear after a partial replacement | Conversion to a reverse shoulder replacement; revision of the socket component with bone graft or augments |
First Joint Replacement vs Revision
| First joint replacement | Revision joint replacement | |
|---|---|---|
| Starting point | A damaged natural joint | A failed implant, scar tissue and often bone loss |
| Removal of old parts | Not needed | Often needed, and can be difficult |
| Implants | Standard implants | Revision implants, augments or bone graft as needed |
| Duration of surgery | Usually about one to two hours | Usually longer |
| Recovery | Several months | Usually slower and more gradual |
| Risk | Lower | Higher, with less predictable results |
Recovery After Revision Surgery
| Time | What usually happens |
|---|---|
| First few days | Hospital stay; pain control; first exercises with the physiotherapist; antibiotics if infection was found |
| First weeks | Walking with support after knee or hip revision, sometimes with limited weight on the leg; sling after shoulder revision, often for longer than after a first replacement; wound healing |
| Several weeks to months | Gradual increase in activity and exercises as allowed; strength slowly returns |
| Up to a year or more | Continued improvement, depending on the joint, the cause of revision and the bone |
Recovery depends on the joint, why the first implant failed and how much bone or soft tissue damage there was. When infection is treated in two stages, the joint may have limited use between the two operations. Regular follow-up visits with X-rays are advised.
Risks and Possible Complications
Revision surgery carries higher risks than a first joint replacement. The surgeon explains these risks before taking consent.
- Infection, including infection that returns or cannot be cleared, which may need further operations, a permanent spacer or removal of the implant
- Wound-healing problems
- Instability or dislocation of the new joint
- Injury to nerves or blood vessels, which is more likely than in a first replacement because of scar tissue
- Fracture of the bone during removal of the old implant or afterwards
- Blood loss needing transfusion
- Blood clots in the leg or arm veins or lungs
- Stiffness, weakness or continuing pain, and a difference in leg length after hip revision
- Loosening of the new implant or failure of bone graft to heal, which may need further surgery
- Anaesthesia-related and general medical risks, especially in older patients or those with other illnesses
Revisional Joint Replacement Surgery Hospital in Ahmedabad
When choosing a revisional joint replacement hospital in Ahmedabad, check that the treating surgeon is a qualified orthopaedic surgeon with valid medical council registration, that the hospital regularly performs this operation, how infection is prevented, which revision implants and tests for infection are available, what physiotherapy and follow-up are provided, and what the written estimate includes.
Look beyond general phrases such as "a revisional joint replacement hospital with modern facilities" and ask which facilities are actually available on site.
Revisional Joint Replacement Surgery Cost in Ahmedabad
- The joint, the reason for revision, and whether one or two operations are needed
- The implants used, and any bone graft or augments
- Length of hospital stay and room category
- Antibiotics and tests for infection
- Other medical conditions and any extra care needed
- Physiotherapy and follow-up
A written, itemised estimate can be requested from the hospital after assessment.
Insurance
- Medically necessary revision joint replacement is generally covered under health insurance policies, subject to policy terms, waiting periods and insurer approval
- Some policies have limits on room rent or implant costs, or specific terms for revision surgery; check these with your insurer before surgery
- Ask the hospital whether cashless treatment is available with your insurer, and which documents are needed
Revisional Joint Replacement Doctor in Ahmedabad
Revision of a failed knee, hip or shoulder replacement is performed by an orthopaedic surgeon who works in joint replacement. Because a joint replacement can fail for more than one reason, several doctors may be involved at different stages:
| Doctor | Role in revision joint replacement care |
|---|---|
| Family physician or the surgeon who did the first operation | First assessment of a painful, loose or unstable joint replacement; referral when revision may be needed |
| Orthopaedic (joint replacement) surgeon | Finds the cause of failure, plans the type of revision and the implants, and performs the surgery |
| Radiologist | Reports the X-rays and CT scans, and may perform image-guided joint aspiration |
| Microbiologist | Tests joint fluid and tissue samples for infection and guides the choice of antibiotics |
| Infectious diseases physician | Advises on long antibiotic courses in difficult infections, at some centres |
| Neurologist or neurophysiologist | Performs nerve tests when nerve injury or muscle weakness is suspected, mainly around the shoulder or hip |
| Anaesthetist | Checks fitness for surgery, gives the anaesthesia and plans pain relief |
| Physician | Manages diabetes, heart, kidney and other medical conditions before and after surgery |
Revisional Joint Replacement Surgery Doctor in Ahmedabad
Revision surgery is planned around the joint and the reason the first implant failed, so it is reasonable to ask your revisional joint replacement surgery doctor in Ahmedabad a few specific questions before giving consent:
- What is the cause of failure in my joint, and which tests confirmed it?
- Has infection been ruled out, and were joint fluid or tissue samples tested?
- Will only the removable parts be changed, or will the whole implant be replaced?
- Will the operation be done in one stage or two?
- How much bone loss is there, and will augments, cones, cages or bone graft be needed?
- Will I need to limit weight on the leg, or wear a sling, and for how long?
- Is a blood transfusion likely, and how will blood clots be prevented?
- How often will I need follow-up visits and X-rays in the long term?
Revisional Joint Replacement Treatment Hospital in Ahmedabad
Revision surgery needs more resources than a first joint replacement, so the hospital should be able to investigate the cause of failure, carry out complex surgery safely and support a longer recovery. These are the facilities that matter most:
| Facility | Why it matters |
|---|---|
| Operation theatre with strict infection-control practices | Infection is a common cause of failure and a risk in every revision |
| Revision implants for the knee, hip and shoulder, with augments, cages and bone graft | The full extent of bone loss is sometimes clear only during surgery |
| Laboratory and microbiology tests, with extended cultures when needed | Some bacteria that infect joint replacements grow slowly and can be missed on short cultures |
| X-ray and access to CT scan | Shows loosening, bone loss and implant position for planning |
| Blood transfusion support | Revision surgery can involve more blood loss than a first operation |
| Access to intensive care for high-risk patients | Some patients need close monitoring after long surgery |
| Physiotherapy | Recovery after revision is longer and needs supervised rehabilitation |
The facilities available at PMG Hospital are listed further below on this page.
Treating Surgeon
At PMG Hospital, revisional joint replacement is performed by:
| Detail | Information |
|---|---|
| Name | Dr. Hiren Patel |
| Qualification | MS (Ortho), B.J. Medical College, Ahmedabad |
| Specialty | Orthopaedics |
| Designation | Director & Head Joint Replacement Surgeon, PMG Hospital |
| Registration status | Registered Medical Practitioner |
| Registration number | Gujarat Medical Council Reg. No. G-20583 |
| OPD availability | Monday to Saturday, 10:00 AM - 8:00 PM |
Facilities at PMG Hospital
- Orthopaedic OPD, Monday to Saturday
- Emergency and trauma care, 24×7
- Orthopaedic physiotherapy centre
Frequently Asked Questions
When should I see a doctor about a problem with a joint replacement?
See an orthopaedic surgeon if a knee, hip or shoulder replacement that was working well becomes painful again, feels loose or unstable, dislocates, becomes stiff or weak, or if there is warmth, redness, wound discharge or fever. Fever, a red, hot joint or discharge from the wound needs urgent assessment.
What is revisional joint replacement?
Revisional joint replacement, also called revision joint replacement, is an operation to remove or correct a knee, hip or shoulder replacement that has failed and to replace some or all of its parts. It is usually more complex than a first joint replacement.
Why do joint replacements fail?
Common causes include loosening of the implant, wear with bone loss around the implant (osteolysis), infection, instability or dislocation, a fracture around the implant, stiffness, and problems with the position of the parts. In the shoulder, failure of the rotator cuff tendons is another common cause. Finding the exact cause is essential before planning revision surgery.
Is revision surgery riskier than the first joint replacement?
Yes. Revision surgery usually takes longer and carries a higher risk of infection, instability, blood loss, fracture, nerve injury and further surgery than a first joint replacement, and the results are often less predictable. Careful tests before surgery, planning for bone loss and the right implants help to manage these risks.
How is an infected joint replacement treated?
It depends on how long the infection has been present, the bacteria and general health. An early infection with a firmly fixed implant (usually one that develops within a few weeks of surgery, or that has been present for only a short time) may be treated by washing out the joint, changing the removable parts and giving antibiotics while keeping the implant. A long-standing infection is usually treated either in one stage, in which the infected implant is removed and a new implant is fitted in the same operation, or in two stages, in which the implant is removed, a temporary antibiotic-loaded spacer is placed and a new implant is fitted later. Antibiotics are usually given for several weeks.
How is a failed knee replacement revised?
Depending on the cause, only the plastic insert may be exchanged, or some or all of the metal parts may be replaced. Revision knee implants often use stems that extend into the bone, and metal augments, cones or sleeves to make up for lost bone. A failed partial knee replacement is usually converted to a total knee replacement.
How is a failed hip replacement revised?
Depending on the cause, only the ball and liner may be exchanged, or the cup, the stem or both may be replaced. Revision hip implants may use longer stems, special cups, metal augments or cages, and bone graft to rebuild support. Regular follow-up X-rays are advised after revision.
How is a failed shoulder replacement revised?
A failed anatomic or partial shoulder replacement is often converted to a reverse shoulder replacement, especially when the rotator cuff no longer works, the socket is worn or the joint is unstable, because the reverse design lets the deltoid muscle move the arm. Lost bone in the socket may be rebuilt with bone graft or metal augments.
How long does recovery take after revision surgery?
Recovery is usually slower than after a first joint replacement. After knee or hip revision, weight on the leg may need to be limited for a period, and after shoulder revision the sling may be needed for longer. Improvement can continue for up to a year or more, and the total treatment takes longer when infection is treated in two stages.
What facilities should a hospital have for revision joint replacement?
It should have an operation theatre suitable for complex joint surgery with strict infection-control practices, a range of revision implants, X-ray and access to CT scans, laboratory and microbiology tests, blood transfusion support, access to intensive care, anaesthesia services and physiotherapy.
What decides the cost of revision joint replacement?
The cost depends on the joint, the reason for revision, whether one or two operations are needed, the implants and any bone graft, the length of hospital stay, room category, antibiotics, other medical conditions and physiotherapy. Some insurance policies have specific terms for revision surgery, so check your policy. A written, itemised estimate can be requested from the hospital after assessment.
Contact and Location
PMG Hospital
3rd Floor, Athena Avenue, B/H Jaguar Showroom, Nr. Eulogia Inn Hotel, Gota, Ahmedabad, India
- Phone / WhatsApp:
- +91 96627 70141
- OPD:
- Mon – Sat · 10:00 AM – 8:00 PM
- Emergency and trauma care:
- 24×7