Local Surgeon’s is Advanced Joint Revision Surgery Experts

June 15, 2010

First Coast Orthopedics surgeon, Michael Patney, D.O., is one of the few in the region specializing in complex hip and knee revision surgery requiring custom made implants. This type of surgery is done to remove the original joint implant and rebuild damaged joints. 

According to the American Academy of Orthopaedic Surgeons, about 400,000 hip and knee joint replacement surgeries are performed each year in the United States. The implants used to replace damaged surfaces of these joints can be expected to last up to 20 years for the vast majority of patients. However, infection, wear and dislocation can lead to the need for a second, or revision, surgery to replace the first implant.

In some cases infection, bone collapse around the original joint implant or a fracture around the implant will cause significant damage to the joint. In these cases the original implant must be removed along with damaged bone, and the joint must be rebuilt with new implants custom made for the patient.

To do this, Patney starts with CT scans of the patient’s joint taken at Orange Park Medical Center, where Patney performs his surgeries. The CT scans are sent to Patney’s orthopedic instrumentation company. The company creates a custom acrylic model of the patient’s joint as well as a new, custom designed implant. “When the patient needs a revision, you want someone who’s able to recognize the difference between needing an off- the- shelf implant and needing a custom implant and someone who can do the appropriate workup for that custom implant,” Patney says. About 30 percent of his practice is devoted to revision surgery, and he has performed over 300 revision procedures.

Infection is the most common reason why revision surgery becomes necessary.  “Anytime someone comes into my office with a painful implant, the first thing we think of is infection,” Patney says. He orders radiologic and lab studies to rule out infection and will even take tissue samples in surgery before placing a new implant, to make certain the joint is infection-free.

Implants can become infected for a variety of reasons. They can become infected right after surgery, which will usually happen within six weeks of the operation. “Or the joint can become infected from a cold, a urinary tract infection, dental work, a colonoscopy, or any kind of an invasive procedure where  bacteria can get into the blood stream and seat within the implant,” Patney says.

Bone collapse around the primary joint implant due to poor fixation is another reason Dr. Patney will perform a joint reconstruction. “The bone can be very soft, and as soon as the patient starts to push on that implant, that implant is going to give out simply because the bone can’t support it,” Patney explains.

This can happen within several weeks of the original surgery. “Some of the patients I see say they never had pain relief from the surgery,” Patney says. “Then when I see their implants, I know the surgeon put them in to the appropriate position, but the bone collapsed around the implant.”

In such cases, Patney will rebuild the joint by removing portions of weak bone and place the stems of the implanted prosthetic joints into stronger bone that will support the implant.

Another reason Patney will rebuild a patient’s hip or knee is when the patient has fractured the bone around the original implant. In surgery he removes both the original implant and bone around the area that’s broken.

“I like doing revisions because it requires substantially more engineering,” Patney says. Not every revision surgery he does requires a model of the patient’s joint and a custom designed implant, but when it does, Patney will often study the spatial alignment and the patient’s CT scans for up to a week before the reconstruction surgery. “I really enjoy seeing the patient who comes in after a revision and says, ‘Thank you. I don’t have any more pain. I’m close to where I want to be. I’m walking distances. I’m getting back to my normal life.’ That’s huge to me,” Patney says.

In addition to Patney’s extensive revision surgery expertise, he specializes in minimally invasive hip and knee replacements.