Revision Hip Replacement
Introduction
This means that part or all of your previous hip replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone and hence is difficult to describe in full.
Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) with a plastic liner in between to restore joint movement. Getting good, consistent results with revision hip surgery requires a breadth of experience and capability. Through 11 years of experience at a tertiary referral center, Dr. Hungerford has a thorough knowledge of revision surgery backed up with experience in tackling even the toughest cases.
If you are having trouble with a hip replacement, we will be glad to provide you with a careful assessment of the condition and performance of the implant. Should the implant fail, we will develop a detailed treatment plan to correct the problem up to and including revision of the components and complex reconstruction of missing and damaged tissues.
Why does a hip need to be revised?
Pain is the primary reason for revision. Usually the cause is clear but not always. Hips without an obvious cause for pain in general do not do as well after surgery.
Plastic (polyethylene) wear this is one of the easier revisions where only the plastic insert is changed
Dislocation (instability) means the hip is popping out of place.
Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. For this reason, you must have your joint followed up for life as there can be changes on X-ray that indicate that the hip should be revised despite having no symptoms.
Infection usually presents as pain but may present as an acute fever or a general feeling of unwell.
Osteolysis (bone loss) This can occur due to particles being released into the hip joint that result in bone being destroyed
Pain from hardware e.g.. cables or wires causing irritation
Surgical Procedure
Hip Revision will be explained to you prior to surgery includingwhat is likely to be done, but in revision surgery the unexpected can happen and good planning can prevent most potential problems. The surgery is often but not always more extensive than your previous surgery and the complications similar but more frequent than the first operation.
The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.
Post-Operation Course
You will wake up in the recovery room with a number of monitors to record your vitals. (Blood pressure, Pulse, Oxygen saturation, temperature, etc.) You will have a dressing on your hip and drains coming out of your wound.
Post-operative X-rays will be performed in recovery.
Once you are stable and awake you will be taken back to the ward.
You will have one or two IV's in your arm for fluid and pain relief. This will be explained to you by your anesthetist.
On the day following surgery, your drains will usually be removed and you will be allowed to sit out of bed or walk depending on your surgeon's preference.
Pain is normal but if you are in a lot of pain, inform your nurse.
A post-operative visit will be arranged prior to your discharge.
Special Precautions
Remember this is an artificial hip and must be treated with care.
AVOID THE COMBINED MOVEMENT OF BENDING YOUR HIP AND TURNING YOUR FOOT IN. This can cause DISLOCATION. Other precautions to avoid dislocation are
- You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle
- Avoid low chairs
- Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
- Elevated toilet seats are helpful
- You may shower once the wound has healed
- You can apply Vitamin E or moisturizing cream into the wound once the wound has healed
If you have increasing redness or swelling in the wound or temperatures over 100.5 degrees you should call your doctor.
If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan as it may help to restore function to your damaged joints as well as relieve pain.
Revision Total Hip Replacement
Because the causes of hip failure vary widely, a detailed assessment of the hip is essential to an effective surgical plan. When implants fail, they may also result in bone damage, either from loosening of the components or infection of the components. For this reason, revision surgery runs the gamut from very simple worn part replacement to very difficult replacement of all the components with complex bone reconstruction and bone grafting.
Some representative cases are detailed below
Case 1:
Patient had already had 2 revisions of the right hip, but noted increasing pain and shortening of the leg. Xray revealed prosthesis was loose and sinking into the femoral bone.
Hip was reconstructed with osteotomy of the greater trochanter, removal of the loose prosthesis, reconstruction and bone grafting with a taper type revision stem and refixation of the greater trochanter.
Case 2:
Patient with hip problems since childhood. After 5 hip surgeries, patient had almost no bone remaining in pelvis. Patient was treated with extensive bone grafting and implantation of a custom tantalum component.
Case 3:
Patient with increasing thigh pain. Xrays show failure of cement mantle Patient treated with removal of component, removal of cement and placement of cementless femoral prosthesis.
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