Specialist care when joint replacement is more complex
Explore specialist assessment and surgical options for complex primary hip and knee replacement, painful existing implants and revision joint replacement surgery.
Detailed assessment before any decision about further surgery
- Complex primary hip replacement
- Complex primary knee replacement
- Revision hip and knee replacement
- Painful joint replacement assessment
Complex cases need careful investigation and planning
Not every painful or poorly functioning joint replacement requires revision surgery, and not every primary replacement is straightforward.
Complex primary surgery may be needed where anatomy, previous injury, deformity, bone loss or another clinical factor makes the first joint replacement more challenging.
Revision surgery involves assessing and, where appropriate, replacing or reconstructing part or all of an existing hip or knee replacement. The cause of the problem must be understood before treatment is recommended.
Investigations may include a detailed review of previous surgery, examination, X-rays, specialist imaging, blood tests and other targeted tests depending on the concern.
Symptoms may have several possible causes. A structured assessment helps determine whether the implant, surrounding bone, soft tissues, infection or another condition is responsible.
Complex and revision surgery pathways
Select a pathway to learn more about why specialist assessment may be required, how the problem is investigated and what treatment may involve.
Complex primary hip replacement
Specialist planning for a first hip replacement where anatomy, deformity, bone loss or previous surgery makes treatment more challenging.
Learn about complex primary hip replacementComplex primary knee replacement
Individualised planning for a first knee replacement where deformity, stiffness, previous injury or other factors increase complexity.
Learn about complex primary knee replacementRevision hip replacement
Assessment and surgery for selected problems affecting a previous hip replacement, including loosening, wear, instability, infection or fracture.
Learn about revision hip replacementRevision knee replacement
Specialist investigation and surgery for selected problems affecting a previous knee replacement, including pain, instability, stiffness, wear or infection.
Learn about revision knee replacementPainful joint replacement assessment
A structured assessment for ongoing or new pain, stiffness, instability or reduced function following previous hip or knee replacement surgery.
Explore painful joint replacement assessment- Review of previous surgery and implants
- Clinical examination and imaging
- Investigation for loosening, wear or infection
- Clear explanation of surgical and non-surgical options
Problems that can affect a previous joint replacement
Symptoms following joint replacement can have several possible causes. Identifying the cause is essential before deciding whether revision surgery or another form of treatment is appropriate.
Loosening or wear
Changes around the implant or bearing surfaces may cause pain, reduced function or damage to the surrounding bone.
Instability
The joint may feel unreliable, give way, dislocate or move in a way that affects confidence and everyday activity.
Possible infection
Infection may present with pain, swelling, wound concerns or more subtle symptoms and requires careful investigation.
Stiffness
Restricted movement may affect walking, dressing, stairs, sitting and the ability to perform normal daily activities.
Fracture or bone loss
A fracture around an implant or loss of supporting bone may require specialist reconstruction and implant planning.
Unexplained pain
Pain may arise from the implant, soft tissues, spine, another joint or a non-orthopaedic cause, so investigation is important.
How a complex or revision case is investigated
Reviewing the history
The original problem, previous operations, recovery, onset of new symptoms and any earlier treatment are reviewed carefully.
Clinical examination
Movement, stability, strength, walking pattern, tenderness and the surrounding joints and spine may be assessed.
Imaging and investigations
X-rays, previous scans, blood tests and further targeted investigations may be required to clarify the cause.
Explaining the options
Findings are discussed clearly, including whether monitoring, non-surgical treatment, further investigation or surgery may be appropriate.
Revision surgery is tailored to the cause of the problem
Revision procedures vary considerably. Some involve replacing one component, while others require removal of the full implant, reconstruction of bone loss or the use of specialist implants.
- Diagnosis confirmed before surgery is recommended
- Previous records and implant details reviewed where available
- Specialist implants and reconstruction planned when required
- Risks, limitations and realistic outcomes explained clearly
- Non-surgical options considered where appropriate
- Recovery and rehabilitation planned around the procedure
Arrange a specialist complex or revision joint assessment
A consultation with Mr Dowen provides the opportunity to review your symptoms, previous surgery and investigations and understand which next steps may be appropriate.