Complex joint replacement and revision: A FAQ

Joint Health

by Al Mollabashy, MD

Sep 21, 2021

Joint replacement procedures have been around for decades. They are considered safe and effective at relieving pain—usually from osteoarthritis—and improving quality of life. For most people, getting a joint replacement is a straightforward proposition.

But what if you’re experiencing other issues with your joints, making your case a bit more complicated?

In this case, you may have a complex joint problem that requires a different approach to treatment. Having spent my career caring for these individuals, there are questions I often receive regarding complex joint issues and how we can address them. Let’s walk through those questions together. 

What makes a complex joint problem?

When someone has an arthritic joint that also has significant deformity, previous infection or disease, it is typically classified as a complex joint problem. This may include a previous fracture that didn’t heal properly (malunion), a developmental deformity of the joint, or some type of infection that altered the joint or its function.

Additionally, patients who previously had a joint replacement and experience some type of issue with the artificial joint—like significant wear, loosening, infection or other complication—have a complex joint issue that needs to be addressed so they can move better.     

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What joints are usually affected by complex joint problems?

The vast majority of complex joints occur in the hip and knee, though technically, these problems could affect any joint. 

Why is it necessary to see a complex joint specialist rather than an orthopedic surgeon who does joint replacements?

It is a question of experience and practice focus more so than job title. Just as there are orthopedic surgeons who focus their practice on primary joint replacements, there are orthopedic surgeons who focus on complex joint care and joint revision surgeries after primary joint replacement.   

The best way to find out the level of experience an orthopedic surgeon has with revision procedures and complex joint cases is to simply ask what percentage of their practice is made up of these types of cases and how often he or she performs them.

What should I expect from surgical repair for a complex joint issue?

The diagnostics may require a larger work-up such as additional lab tests, a nuclear medicine bone scan, and/or a CT scan to assess bone quality and volume.

Of course, the nature and approach to each procedure can vary greatly depending on what is needed to correct the problem. The important thing is that the surgeon is skilled in the constructive component and familiar enough with normal alignment and anatomy of the joint so you can be functional soon after your procedure.    

How is the recovery different from primary joint replacement surgeries?

During a standard joint replacement procedure, muscles and tendons either have not had a previous surgery or are not being realigned like they often are in complex replacement. Therefore, extra precautions may need to be taken to protect the muscles and tendons around the joint because they may need time to heal after the procedure.

Sometimes, you may need to take weight bearing precautions to allow the bone time to heal to the prothesis. Specific recovery steps vary on a case-by-case basis, but physical therapy is often recommended.

Are there alternatives to surgery for complex joint conditions?

Unfortunately, no. Unlike primary joint replacement surgery where weight loss, physical therapy and bracing may be a short or medium-term solution before exploring surgical options, the anatomy of the complex joint means it needs to be surgically repaired. These other alternatives will not make any meaningful difference in improving your motion and quality of life. The good news is, there are skilled orthopedic surgeons who can help figure out whether complex joint surgery is right for you.

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About the Author

Al Mollabashy, MD, is an orthopedic oncology surgeon and medical director of musculoskeletal tumor services for Baylor Scott & White Health. He focuses his practice on caring for patients with potentially life-threatening orthopedic issues, addressing complex joint conditions and performing joint revision procedures for patients with failed joint replacements.

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