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. These operations require skill and experience.
Revision hip replacement is advised in patients with the following conditions:
- Increasing pain in the affected hip
- Worn out plastic or polyethylene insert
- Dislocation or instability of the hip replacement
- 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)
- Fractures around the implants
- Breakage of the implants
- Revision hip replacement surgery is performed under anaesthesia
- An incision is made over the hip to expose the hip joint. Anterior, lateral or posterior approaches may be used. Often the site of the old incision and old approach is used
- The components of the old hip prosthesis that are causing a problem are removed together with diseased tissue and cement if present
- Complex techniques to rebuild missing bone and stabilise the new prosthesis are used.e.g. Bone graft, bone substitutes, metal augments, metal cages, oversized implants, custom implants, long stemmed implants, wires or screws are used to rebuild a new stable hip replacement
- The muscles and tendons around the new joint are repaired and the incision is close
- On occasions biological or synthetic material is required to repair soft tissue
Goals and outcome
Revision hip replacements are longer operations with a higher complication rate. The functional outcomes are less predictable than first time hip replacements. The recovery time is usually longer and often, protected weight bearing is required.
Despite these inconveniences, the procedure is reported to relieve pain, restore function, improve movements at work and play, and provide patients with a much-improvedquality of life in 90% of cases.
As part of the preparation for surgery, the better informed and prepared the patient is, the better the likely outcome. Signing an informed consent is a vital part of preparing for surgery. Attending a preadmission clinic is helpful. Many steps and actions are taken to reduce the risks of surgery and to aid in an uneventful full post-operative recovery.
Post-Operative pathway usually include:
- The patient will be monitored regularly
- Pain will be managed in a multi-modal style
- Drugs will be administered to avoid blood clots, prevent infections and prevent bleeding
- Urinary catheters usually stay in 1-2 days
- Patients usually stay 3-5 days in the acute care ward
- Patients will be given specific instructions regarding exercises and activity. Starting on the day of surgery. The physiotherapist will guide mobility
- Leg swelling is common after hip surgery. Ice, and elevation of the leg are recommended to minimize swelling and pain
- Foot or calf pumps, early mobilising and hydration will be utilised to prevent calf and lung clots
- If progress is slow, a referred to in or out patient rehabilitation will be arranged
- Eating a healthy diet and not smoking will promote healing
After undergoing revision total hip replacement, patients must take special care to prevent the new joint from dislocating and ensure proper tissue and bone healing.
Some of the common precautions to be taken (for at least the first 6 weeks) include:
- Avoiding combined movement of bending the hip and rotating the leg excessively.
- Never crossing the legs and bending the hips past a right angle (90°)
- Avoiding sitting on low chairs
- Avoiding bending down to pick up things; instead using a grabber
- Using an elevated toilet seat
- Protected weight bearing with crutches or a walking frame ‘til confident
As with any major surgical procedure, there are certain potential risks and complications involved with revision total hip replacement surgery. These may include but are not limited to:
- Infection (superficial or deep)
- Wound breakdown or drainage
- Formation of blood clots in the leg veins and lungs
- Hip dislocation
- Fracture of the femur or pelvis
- Injury to nerves or blood vessels
- Leg length inequality
- Limping and weakness
- Loosening of the prosthesis
- Wear out of prosthesis and surrounding bone destruction
- Failure to relieve pain
- Scar formation
- Pressure sores
- Bone formation in the soft tissues
The patient is a very important part of the pathway pre and post surgery. Patients need to be responsible for there own health and follow instructions. Informing the doctor or appropriate professional if there is a concern. Early diagnosis and treatment of complications will improve the success of treatment.
Revision Hip Replacement