Complex & Revision Joint Replacement

Name: Complex & Revision Joint Replacement
Creator: Dr. Chetan M. Dojode

Not every joint replacement is a straightforward operation, and not every failed replacement is beyond repair. Revision surgery — replacing an implant that has worn, loosened, become infected or was never right — is a distinct discipline requiring different planning, different implants and a different operative approach from primary replacement.

Dr. Chetan M. Dojode completed the Furlong Fellowship in Arthroplasty and Revision Surgery in the United Kingdom, and revision work formed a substantial part of his NHS consultant practice. Complex primary cases — severe deformity, previous fracture or osteotomy, retained metalwork, stiff or ankylosed joints, and patients with significant bone loss — fall within the same area of practice.

Patients frequently arrive having been told that a painful replacement simply has to be lived with. Sometimes that is correct. Often it is not. A replacement that has never felt right deserves proper investigation before that conclusion is accepted: infection must be excluded, component position and rotation assessed, loosening looked for, and causes outside the joint considered, since pain referred from the spine or the hip is a well-recognised source of a ‘failed’ knee.

Equally, honesty matters in this field more than any other. Revision surgery is more demanding than primary replacement, recovery is longer, and results are less predictable. Where revision is unlikely to improve matters, that will be said plainly rather than an operation offered because one is technically possible.

Complex and revision cases assessed

✓Painful, stiff or unstable knee or hip replacement
✓Loosening, wear or implant failure on imaging
✓Suspected infection of a joint replacement
✓Severe deformity, bone loss or previous fracture around a joint
✓Retained metalwork or previous osteotomy
✓Replacement that has never felt right since the original surgery

Why a painful replacement must be investigated, not assumed

A painful joint replacement has a cause, and the cause determines whether surgery will help. Infection, loosening, component malposition or malrotation, instability, wear, and pain referred from the spine or the adjacent joint all present similarly to the patient but require entirely different treatment. Revising an implant for pain without establishing the reason is the most common way revision surgery disappoints. Assessment therefore includes blood inflammatory markers, appropriate imaging and, where infection is a possibility, joint aspiration before any operation is planned.

Practice across two health systems

Dr. Chetan M. Dojode has operated in both the United Kingdom and India. His UK joint replacement practice is recorded on the National Joint Registry (NJR) — the world’s largest independent registry of joint replacement outcomes, which tracks implant survival and revision rates for every procedure submitted. That same registry-audited discipline — implant selection, alignment targets and structured follow-up — is applied to every joint replacement he performs in Bengaluru.

Frequently Asked Questions

Can a painful knee replacement be fixed?

It depends entirely on why it hurts. Infection, loosening, instability and component malposition are all potentially correctable. Pain without an identifiable cause is much less reliably improved by further surgery. Establishing the diagnosis before operating is the single most important step, which is why investigation comes first.

How is infection in a joint replacement diagnosed?

Through a combination of blood inflammatory markers, imaging, and aspiration of fluid from the joint for culture. No single test is definitive, which is why several are used together. Confirming or excluding infection is essential because infected and non-infected revisions are entirely different operations.

Is revision surgery riskier than the first replacement?

Yes. Revision involves removing existing implants, dealing with any bone loss, and often using larger or more constrained components. Operating time is longer, blood loss is greater, and recovery takes longer. Outcomes are generally good but less predictable than primary replacement, and this is discussed frankly before surgery.

I was told to live with my painful replacement. Is that right?

Sometimes it genuinely is, particularly where extensive investigation has found no correctable cause. But it should follow a proper assessment rather than precede one. If infection has not been excluded and component position has not been reviewed, the conclusion has been reached too early.

What is the Furlong Fellowship?

The Furlong Fellowship is a UK subspecialty training fellowship in arthroplasty and revision surgery, undertaken after completion of higher surgical training. It provides dedicated experience in complex primary and revision hip and knee replacement.