Surgery for Total Joint Implant Complications

If nonsurgical treatment doesn’t resolve a complication of total joint implant surgery, orthopedic surgeons at NYU Langone Orthopedic Hospital may recommend a procedure to alleviate symptoms and restore function in the prosthetic joint.

Surgery for Blood Clots

If a blood clot in the leg or lungs doesn’t respond to anticoagulant medication, doctors may perform a minimally invasive procedure to prevent the clot from causing serious health problems. Our orthopedic surgeons work with vascular surgeons at NYU Langone’s Venous Thromboembolic Center (VTEC) to provide specialized care.

Inferior Vena Cava Filter

Medication is often sufficient to dissolve even large blood clots. But if you can’t take the medication for health reasons, placement of an inferior vena cava filter may be an option. In this procedure, a surgeon implants a filter into the inferior vena cava, the large vein that carries blood from the lower body to the heart.

The filter is designed to catch a blood clot that breaks loose from a vein in the legs and is in transit to the lungs, where it can cause a life-threatening pulmonary embolism. The filter does not treat the blood clot, but it can be critically important to prevent clots from traveling to the lungs.

Using a local anesthetic and needle stick, your doctor places an intravenous (IV) line in the groin and threads a small catheter through it to the inferior vena cava in order to insert the filter. The filter can be removed up to a year later.

Thrombectomy and Embolectomy

If a blood clot in the legs or lungs is very large or is not responding to medical treatment, doctors may need to surgically remove it to prevent serious health problems. For a blood clot in a leg vein, the surgeon performs a thrombectomy; if a blood clot forms in the lungs, he or she performs an embolectomy. Doctors may perform surgery using a catheter that is inserted into a major vein in the groin or by making an incision in the skin above the blood clot and removing the clot with surgical instruments.

Open Reduction for Hip Dislocation

If doctors can’t reconnect a dislocated hip implant by manipulating the leg and thigh from the outside of the body, called closed reduction, surgery may be required to fit the ball-and-socket parts of the joint back into place.

A surgeon performs this procedure using local or general anesthesia. He or she makes an incision over the hip to reach the joint implant, then manipulates the artificial component at the top of the femur—or thigh bone—into the socket-shaped implant in the pelvic bone. The doctor may use X-rays to confirm that the parts of the joint have been placed accurately.

Revision Joint Implant Surgery

If an infection reaches the deep tissues surrounding the site of the joint implant, revision surgery is required to clean the joint and replace the prosthetic parts. Revision surgery is also appropriate if the parts of a joint implant start to lose their bond to the bone. Implant loosening typically occurs 10 to 20 years or more after the initial joint replacement surgery.

Surgery to remove and replace a joint implant can eliminate infection in the joint, provide renewed adhesion between implant and bone, and restore smooth, painless motion. Revision surgery may be performed using local or general anesthesia.

During the procedure, a surgeon reaches the joint by making an incision in the skin above the joint. He or she uses surgical instruments to remove the infected prosthetic parts and thoroughly clean the joint space. If an infection is present, the doctor may also remove any infected or dead tissue surrounding the joint.

After the joint space has been cleaned out and prepared, doctors implant new prosthetic parts. The incision is closed with staples or stitches. You can expect to remain in the hospital for several days for observation as you begin to heal. Doctors may recommend that you stay in the hospital for one or two days longer than the original joint replacement surgery to ensure that an infection doesn’t occur.

What to Expect After Surgery

After surgery, NYU Langone pain management specialists provide medication to help you recover comfortably.

The physical recovery required after surgery to resolve a blood clot is usually minimal, and most people can return home one or two days after surgery. Recovery from pulmonary embolism can vary based on the severity of the condition and the treatment. People treated with open embolectomy often require rehabilitation after surgery.

After you’ve had open reduction to repair a dislocation or revision joint implant surgery, a physiatrist—a doctor who specializes in rehabilitation medicine—or physical therapist assesses your level of function and helps you stand and walk. He or she gives you crutches or a walker so you don’t put any weight on the hip. For the next couple of days, doctors monitor your recovery and help you learn to walk with your new hip.

Most people leave the hospital after a few days. You return a week later to have stitches removed and a follow-up examination. Crutches are required for approximately two weeks, and an over-the-counter or prescription pain medication may help relieve any discomfort.

After you can walk unassisted without pain, physical therapy helps you rebuild muscle and increases the flexibility and range of motion in the hip. Our physiatrists and physical therapists create an exercise routine you can do at home to continue to condition and strengthen your muscles. Physical therapy continues for four to eight weeks, at which time doctors assess your progress before recommending additional treatment.

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