Revision Hip Replacement
Hip replacement is a serious surgery where a damaged bone from the hip is replaced with synthetic materials. This procedure is indicated for patients suffering from persistent hip pain and loss of motion. Typically, this discomfort is as a result of a degenerative condition such as arthritis. By removing and replacing damaged hip bone and tissue, surgeons are able to offer patients a significant improvement in their strength, stability, flexibility and overall quality of life.
However, certain materials utilized in total hip replacement surgery can wear down. This is where making revisions to a previous hip replacement will be needed to support the artificial hip and restore the initial benefits provided by the original replacement hip.
Indications for Revision Hip Replacement
Hip replacement revision is recommended when these disorders are present:
- Progressive pain in the hip
- Damage to old implants
- Displacement of the old prosthesis
- Slack or looseness of critical ligaments supporting the hip joint
- Infection near the hip implant
- Osteolysis: the weakening of bone near the artificial replacement
Revision Hip Replacement Procedure
Revision hip replacement is a complicated procedure always done under general anesthesia. First, the hip joint has to be exposed, and then the femur is separated from the acetabulum, the socket in which the femur fits, to enable the surgeon to access and remove the old liner and socket replacement.
Then the acetabulum is reshaped using a wire mesh and artificial bone before the insertion of the new metal socket. The new socket is fixed with screws or medical cement. Finally, a new liner made of plastic, metal or ceramic, is fixed on the inner surface of the socket as a means to minimize friction.
Afterward, the femur´s head implant is removed by cutting the bone into a few pieces. These are prepared and cleaned before the new femoral prosthesis is implanted through a press or, again, using medical cement, the whole is kept together with wire. Then the metal, or ceramic, implant femoral head is fixed on the femur´s stem. Any other damage to the tendons or muscles is treated and, finally, the incision is stitched and bandaged.
A conservative recovery period should follow a revision hip replacement in order to avoid dislocation of the new implant.
Special precautions are:
- Do not perform excessive bending or rotation until advised from your doctor to avoid dislocation
- Place a pillow between your knees while you sleep for the next 6 weeks
- Do not cross the legs or bend the hip beyond 90 degrees
- Low chairs are not advised as they can place unnecessary pressure on the hip
- Patients will want to consider an elevated toilet seat to avoid pressure while sitting or getting up from a seated position
Despite all precautions taken during the surgery, there are possible unintended consequences and setbacks. In the specific case of revision hip replacement, risks can include:
- Femur or hip dislocation
- Bone fracture
- Damaged nerves or blood vessels
- Generation of blood clots in legs
- Loss of leg total length
- Prosthesis degradation
- Failure to achieve meaningful pain relief
Revision hip replacement is a maintenance surgery performed on an old prosthesis, implanted in a previous total hip replacement surgery, which is removed and replaced for a new one. The purpose of this new operation is the same as the original one, to make the hip stronger and to improve stability, mobility, and flexibility. The most important objective is to return patients to the pain-free and active life that they previously enjoyed.