Revision arthroplasty in Singapore
Joint replacement surgery is one of the most effective orthopaedic interventions in providing painless functional range of motion to the joints - principally the hip and knee. With newer materials and designs these implants can typically last 15 to 20 years. After this time these implants do run their course and need to be changed out. Most times the implants put in are able to last the patients lifetime. Occasionally, however, the joints need to be changed especially if the patient had them put in early in a previous time. Unlike primary joint replacements which should be in the purview of most orthopaedic surgeons, the experience required for such revision arthroplasties are not common. The patients tend to be older and require specific consideration for more medical problems. The implants used may not be compatible with newer designs and need to be revamped if they cannot be retained and adapted. Bone loss as a result of revision can result in the need for bone transplants in addition to specialised joint replacement implants.
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Figure 1. This patient had a right broken hip and underwent a bipolar hemiarthroplasty some 10 years before in an outside institution. In the intervening period he developed cancer of the prostate requiring surgery and radiation to the pelvis. The hip had worn down and there was poor circulation in the limb. This high risk situation was handled by our very experienced team who had to navigate through all the difficult problems this case posed. Finally a reconstruction was achieved on which the patient could bear weight and walk. In time the bone graft and implant matures and becomes part of the patient.
Most orthopaedic surgeons who have skills in revision arthroplasty would have to be affiliated with a tertiary referal centre, gone on to do fellowships in top centers and then returned to practice in tertiary centers for a number of years. Consequently such a experience skill set is uncommon. Here at Limb Salvage and Revision Arthroplasty Surgery Pte Ltd our surgeons are well skilled in all aspects of revision arthroplasty and are actively involved in research and education on the subject. For more information on other services we provide you can proceed to our central website at www.limbsalvagesurgery.com .
Figure 2. The knee is a very complex joint to replace. Thankfully, in recent times sequential solutions have been developed to replace joints in ever increasing states of bone and functional loss.
Figure 3. Infections in joint replacements are very difficult to eradicate. Single and double stage options are available - the latter being better but more time consuming. In these instances the infected implants (a) are removed and replaced with cement spacers. After a period of time the revision implants are replaced (b,c). These days such antibiotic bearing cement spacers are available in pre-made forms avoiding the need to create them during surgery (d).