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Health Matters: Providence Saint Joseph Medical Center | 7 W hether it's a bad hip, knee or shoulder, replacement surgery can turn an aching, dysfunctional joint into one that operates painlessly and normally. But occasionally an artificial joint goes bad, and what is known as revision surgery is needed to replace the original implant. This procedure can be more challenging and complicated than the original joint replacement. "It requires undoing what was done during the first surgery and then redoing it, and in the process the patient's bone and tissues may become compromised," explains orthopedic surgeon Shahan Yacoubian, MD, Providence regional medical director of the Orthopedic & Sports Medicine Clinical Institute and a specialist at Providence Saint Joseph Medical Center in Burbank. There can also be scar tissue, and removing a joint that is not loose can be tricky. "Most orthopedic surgeons do not perform joint revisions, and if you are having problems with your original implant it's essential to see a specialist in revision surgery who does many of these procedures," says Dr. Yacoubian, who has performed several hundred joint revision operations. WHEN GOOD JOINTS GO BAD There are a few reasons why someone would need joint revision surgery. Sometimes an implant is unsatisfactory from the start. If it was positioned poorly during the original surgery and is unstable, it may need to be removed and replaced soon afterward. In other cases, a replacement joint has functioned well for a decade or longer but has simply worn out or gotten loose. A fall or other injury can damage or loosen an implanted joint, and infection is a very serious complication that requires removal. The good news about joint revision surgery is that when it is performed by an experienced specialist, the outcome is usually highly successful. "Patients who are experiencing pain, swelling, stiffness or loss of function should not hesitate to see an orthopedic surgeon and at least get an X-ray," Dr. Yacoubian says. "If a catastrophic implant failure is allowed to occur, surgery becomes more complicated, recovery is harder and the prognosis is poorer. But sometimes simple things can be done instead so that revision surgery is avoided altogether." In other cases, just replacing a part or parts of the joint can solve the problem. As with the initial surgery, you will need to work with a physical therapist or other rehabilitation specialist afterward to increase the new joint's strength, flexibility and mobility. This process can be more involved and prolonged the second time around, however. Even if you are not experiencing any problems, you should have your artificial joint looked at by a specialist every few years, Dr. Yacoubian says. "Think of it as preventive maintenance like you get for your car." Joint Replacement Redux Not all artificial joints last a lifetime. Specialized revision surgery at Providence Saint Joseph can help restore what was lost. Please visit to find out about upcoming physician lectures for the community.

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