Revision Hip Replacement
Revision hip replacement is a complex surgical procedure in which all or part of a previously implanted hip-joint is replaced with a new artificial hip-joint. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities. During total hip replacement, the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. At times, hip replacement implants can wear out for various reasons and may need to be replaced with the help of a surgical procedure known as revision hip replacement surgery.
Indications
Revision hip replacement is advised in patients with the following conditions:
- Increasing pain in the affected hip
- Worn out plastic or polyethylene prosthesis
- Dislocation of previous implants
- Loosening of the femoral or acetabular component of the artificial hip joint
- Infection around the hip prosthesis causing pain and fever
- Weakening of bone around the hip replacement (Osteolysis)
Revision hip replacement surgery is performed under general or regional anesthesia.. Revision surgery may involve simply replacing the hip liner, removal and replacement of one or both components. During the procedure, your surgeon will make an incision over the hip to expose the hip joint. The decision on which surgical approach to use will be variable and may ultimately depend on which approach was utilized for the original hip replacement procedure. Typically, the posterior approach has been favored during revision surgery, however if an anterior approach was used it is reasonable to consider revision through the original anterior incision. Once the incision has been made and the hip joint is exposed, the femur is dislocated from the acetabulum so that the old plastic liner can be removed from the cup.
If the metal cup requires removal, it will be done carefully to avoid excessive bone loss. After removal, the acetabulum is assessed and prepared to accommodate a new metal cup. In the event of significant bone loss, additional bone or metal augments may be used to recreate the acetabulum in order to accommodate a new metal cup. Then the new metal cup is inserted into the socket. Typically screws or special cement may be used to increase the stability of the new cup. A liner made of plastic, ceramic or metal is placed inside the metal socket.
If the femoral component requires replacement, every attempt is made to do so carefully to avoid bone loss. In some cases, depending on the implant or the bone quality, it is necessary to remove part of the bone in order to take the femoral component out. The bone is cleaned of any debris and the new femoral implant is inserted into the femur either by a press fit or using bone cement. If it was necessary to remove part of the bone, those segments are carefully placed back over the new implant and typically secured with surgical cables or wires. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new components are secured in place to form the new hip joint. The muscles and tendons around the new joint are repaired and the incision is closed.
After undergoing revision hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. The specific precautions will vary depending on the extent of the revision procedure and the approach used. Some of the common precautions to be taken include:
- Avoid combined movement of bending your hip and turning your foot inwards because it can cause dislocation
- Keep a pillow between your legs while sleeping for 6 weeks
- Never cross your legs or bend your hips past a right angle (90 degrees)
- Avoid sitting on low chairs
- Avoid bending down to pick up things, instead a grabber can be used to do so
- Use an elevated toilet seat
- In some circumstances, weight bearing may be limited initially after surgery to ensure maximum stability and reduce the risk of implant failure or dislocation
- If there is extensive soft tissue damage or debridement necessary it may be necessary to wear a special brace for a period of time after surgery
Risks
As with any major surgical procedure, there are certain potential risks and complications involved with revision hip replacement surgery. The possible complications after revision hip replacement include:
- Infection
- Dislocation
- Fracture of the femur or pelvis
- Injury to nerves or blood vessels
- Formation of blood clots in the leg veins
- Leg length inequality
- Hip prosthesis may wear out
- Failure to relieve pain
In the event of an emergency dial 911.
In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.
