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Revision Hip Replacement

Introduction

Revision Hip Replacement 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.

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.

Hip Bone

The hipbone is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts, the ilium, ischium, and pubis, which are distinct from each other in the young subject, but are fused in the adult; the union of the three parts takes place in and around a large cup-shaped articular cavity, the acetabulum, which is situated near the middle of the outer surface of the bone.

Why hip revision

  • Pain is the primary reason for revision. Usually the cause is clear but not always. Those 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) which 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. It is for this reason why 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 which result in bone being destroyed
  • Pain from hardware e.g. cables or wires causing irritation

Surgical procedure

  • The surgery is performed under spinal, general or epidural anesthesia. A combination of techniques are used.
    The surgeon makes an incision along the hip exposing the hip joint.
  • The femur (hipbone) is separated from the acetabulum (pelvic socket).
  • The old plastic liner and the metal socket are removed from the acetabulum.
  • The acetabulum may be prepared with extra bone to make up for the socket space. Sometimes wire mesh may also be necessary to hold the socket shape.
  • The new metal shell may be press fit or fitted with screws. Occasionally cement may be used depending on the surgeon’s preference.
  • A plastic liner is fitted to the metal socket.
  • The surgeon then concentrates on the femur. The damaged bone is cut.
  • To remove the femoral component, the bone around the component may be cut.
  • The parts of the bone are cleared of any old cement.
  • The new femoral component is pressed or cemented into place.
  • Wires may be used to hold the bone and femoral component.
  • Then a ball made of metal or ceramic is placed on the femoral component. This ball acts as the hip joints original ball.
  • The ball and socket are fixed in place to form the new hip joint. The muscles and tendons are then approximated.
  • Drains are usually inserted to drain excessive blood

Post-op 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.
  • An elevated toilet seat is helpful.
  • You can 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 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.
  • Your hip replacement may go off in a metal detector at the airport.

Risks and complications

As with any major surgery, there are potential risks involved.

Specific complications include:

Infection

  • Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Dislocation

  • This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. If a dislocation occurs it needs to be put back into place with an anesthetic. Rarely this becomes a recurrent problem needing further surgery.

Fractures (break) of the femur (thigh bone) or pelvis (hipbone)

  • This is also rare but can occur during or after surgery. This may prolong your recovery or require further surgery.

Damage to nerves or blood vessels

  • Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.

Blood clots (Deep Venous Thrombosis)

  • These can form in the calf muscles and can travel to the lung (pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.

Wound irritation

  • Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.

Leg length inequality

  • It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.

Wear

  • All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hips survive 15 years.

Failure to relieve pain

  • Very rare but may occur especially if some pain is coming from other areas such as the spine.

Unsightly or thickened scar

Pressure or bed sores

Limp due to muscle weakness

Find out more about Revision Hip Replacement with the following links.

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