In recent years, due to the increase in average life expectancy, the number of prosthetics implanted, and the functional requests of the patients that undergo prosthetic interventions, there has been a marked increase in people that have problems with regards to their protheses and thus need a revision surgery.
The reasons for prosthesis failure and the need for revision are varied:
Wear and mobilization of prosthetic components
After several years, the natural wear of the materials provokes the release of debris. These trigger an immunological process that causes the prosthesis to loosen from the bone and the mobilization of the implant (or rather movement between the surfaces) which often causes the loss of bone substances and the migration of prosthetic components.
A trauma, usually from a fall, in the presence of a prosthesis, can be a serious problem. The rigidity and different elasticity between bone and prosthesis lead to a non-harmonic distribution of stress, greatly increasing the risk of fracture. The treatment is particularly complex, not only due to the presence of the prosthesis which limits the use of normal means of synthesis, but also due to the poor quality of the bone.
The dislocation of the prosthetic joint (in most cases the hip), is another big cause of revision. Dislocations can happen immediately during the post-operative period due to poor positioning of the components or for extreme movements by the patient, or even after years due to a loss in muscle and tone or the migration of components due to their mobilization. Sometimes, after reducing the dislocation, it is sufficient to wear a brace and later tone the muscles to resolve the problem. However, if the dislocations become frequent or are due to poor positioning of components, it will be necessary to fix the implant using surgical solutions and special prostheses.
They are probably the most serious reason for a revision. They may be early (due to an intraoperative contamination) or late, caused by an infection from other sites (eg dental, urinary or gastrointestinal tract). It is, therefore, essential for the patient to undergo specific antibiotic prophylaxis (on indication of the orthopedic surgeon) for any invasive procedure (especially dental) and not overlook any local or general infectious symptoms.
To reduce the risk of revisions to a minimum or to render them less complicated, it is fundamental that the patient not underestimate any symptoms related to the prosthetic joint (pain, reduction in movement, sensation of instability, etc) as well as getting a specialist check-up and x-ray at least every two years.
Revision surgery is certainly more complicated and more risky with respect to the first implant; it is therefore important that the patient refers to competent structures and professionals.
Even if the average life span of a prosthesis is limited (approximately 15-20 years according to the latest statistics), there are some factors that the patient can control to contribute to lengthening the life span of the implant:
- maintain body weight within normal range; obesity, in fact, due to the excessive load that the joint must support can lead to early mobilization of the prosthesis
- maintain good muscle tone. Stretching exercises and muscle reinforcement help to maintain the joint in good condition, reducing the load on it and increasing performance.
- avoid overstressing the joints. High impact sports and other activities that require jumping or running (even if possible) can damage or weaken the prosthetic joint and increase wear. There are, on the other hand, low-impact activities such as walking, biking and swimming which contribute to maintain good muscle tone.
- undergo check-ups at least every two years (unless otherwise indicated) and don’t underestimate any negative symptoms with regards to the prosthetic joint (in particular pain)
- entrust the first prosthetic intervention to an expert surgeon specialized in this procedure and in a center that does a high number of joint prosthetics, to guarantee the best result and reduce the risk of complications to a minimum.