Why is revision hip surgery needed?
Many hip replacements are successful and last throughout a patient’s lifetime. However, sadly there are situations where revision of the original surgery becomes necessary.
Implants typically fail for one of a few reasons: loosening, infection, dislocation, fracture, or mechanical failure of the implant (wear and loosening).
The commonest reason to revise a hip replacement is loosening following years of function. All hip implants are subject to friction and wear as the joint surfaces rub against each other during motion. As they wear out they may loosen and cause pain. Younger and more active patients have a higher rate of revision due to the increased demands they place on their implants.
An implanted hip may become infected at the time of surgery or many years in the future. If a joint replacement is infected it will require further surgery to eradicate the infection. The type and number of surgeries is dependent on both patient and infection characteristics and will be tailored to suit each person.
Dislocation is another mode of failure. There are many possible causes of dislocation, including wear and loosening, component malposition and patient factors. Where a patient has a dislocating joint replacement revision surgery maybe necessary to restore stability and confidence in the hip joint.
Fracture may occur of the implant or bone surrounding the implant if a patient was to sustain a significant fall or trauma. In these cases the implant will need to be revised to restore mobility.
Some patients have had a metal-on-metal hip replacement. These were used in the hope that the metal bearing would reduce wear and loosening of the implant in the younger more active patient. Sadly a number of people have reacted to these implants. These reactions have caused local tissue damage surrounding the implant and elevated cobalt and chromium ions in the bloodstream. This does not occur in every patient and many people are functioning well and remain happy with their hip replacement. A metal-on-metal hip replacement requires surveillance with x-rays. If there is any concern over the health of the hip, blood tests are performed and a scan of the hip typically MRI or ultrasound is performed.
If you are concerned you have had one of these implants please contact your treating surgeon/hospital who will be able to advise you of what you had implanted.
What does the hip revision involve?
Any revision or re-do of a failed hip replacement requires a tailored and patient focused approached. The causes of failure and patient factors are assessed and a surgical plan is made.
One or all of the hip components may need to be revised.
Your fitness to undertake the procedure will be assessed, prior to surgery. Screening blood tests are performed to help diagnose why the joint may have failed.
Revision hip surgery requires an anaesthetic. Antibiotics will be given prior to surgery to reduce the risk of infection.
During hip revision surgery, the artificial hip joint is removed and replaced with a new one. Surgery for infection often involves removing all the hip replacement with a temporary hip joint made of cement – which can release antibiotics. A second operation is then required to restore the hip joint when the infection has been eradicated.
Each revision is unique and the advantages, disadvantages and the surgical strategy are discussed with each individual patient.
What happens after my hip revision?
After surgery, you will be taken to the recovery room for a period of close observation. The staff will monitor you and will pay special attention to your circulation and sensation in your feet and legs. When you wake up and your condition is confirmed to be stable, you will be transferred to your hospital room.
You will notice that;
- An intravenous drip will continue post-operatively in order to provide adequate fluids and administer antibiotics and other medications.
- A catheter will be inserted into your bladder to allow for monitoring of your urine output and ease of nursing and toileting in the immediate post-operative period.
- A V-shaped wedge pillow will be inserted between your legs to keep your new hip in the best position for the first 24 hours.
After a revision hip replacement the recovery is typically slower than the original hip replacement surgery.
After the operation you will need walking aids, such as walking sticks, for the first four to six weeks. Your weight bearing status will be dictated by the type of operation you have had. Sometimes a period of non-weight or partial weight bearing on the limb will be needed. You will be taught this by our physiotherapy team. Physiotherapy will continue after your discharge from the hospital.
Two weeks after surgery the wound is inspected and paper stitches are removed. This is an easy and painless procedure.
An anticoagulant will be prescribed for 28 days following the surgery to help decrease the risk of a deep vein thrombosis (Blood clot in the leg veins). During the inpatient stay mechanical foot pumps will also be employed to help decrease this risk.
Some patients experience swelling and bruising of the leg after undergoing hip and revision hip replacement surgery. This is normal. If you experience painful or worrying swelling a scan maybe required to rule out a deep vein thrombosis.
It is important for the patient to keep in mind that hip revision surgery will may require many months of recovery time before they will be able to walk without a limp or pain.