Total Hip Replacements are extremely successful procedures and in majority of the cases, enable patients to live an active life without debilitating hip pain for many years. However, with time, a hip replacement can fail for a variety of reasons.
What is Revision Total Hip Replacement?
When a hip replacement fails, your doctor may recommend that you have a second operation to remove some or all the parts of the original operation and replace them with new ones. This procedure is called Revision Total Hip replacement.
Even though the goal of Primary and Revision Total Hip Replacement is the same viz. relieve pain and improve function, thus quality of life, revision surgery is different in that it is complex and takes much longer. To achieve a good result, it requires extensive planning and the use of specialised tool and prosthesis.
The decision to undergo a Revision Total Hip Replacement is a joint one between you, your family, and the Orthopaedic Surgeon.
A revision total hip replacement is usually recommended for the following:
- Implant Wear or Loosening: With time, the plastic from the cup wears out and the prosthesis ‘comes off’ the bone.
- Infection: 0.5-2% of the Hip replacements get infected and may need revision either in 1 or 2 stages
- Recurrent Dislocation
- Fracture: Fracture of the bone around the prosthesis (Periprosthetic fracture) or rarely the prosthesis may itself break
- Reaction to metal ions or Metal allergy
A revision procedure is usually done under a regional anaesthetic (which numbs you from the waist down) or sometimes under a general anaesthetic (which puts you to sleep). The anaesthetic team, with your input will decide the best type of anaesthesia for you.
A revision procedure is more complex and can often take several hours to complete. Your surgeon will make an incision, usually incorporating the original scar, often extending it to remove the old components. During the course, several samples are taken and sent to rule out/confirm the presence of infection. Original implants are then removed very carefully to preserve as much bone as possible. After removal, the pelvic and thigh bones are prepared to accept and implant the appropriate revision implants. If there is significant bone loss, bone graft or metal augments may be needed to make up these deficits. Specialised Revision implants are then inserted after testing the stability with trial implants. A temporary drain may be inserted to collect fluid/blood from the wound.
After surgery, you will be moved to the recovery room where you will be monitored for a few hours. You will then be shifted back to your room where you will commence your rehabilitation. You will remain in the Hospital for 3-7 days. You will be given painkillers such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs). You will be encouraged to start moving as quickly as possible following surgery, to reduce the risks of blood clots.
Following the surgery, your Surgeon and Physiotherapist will visit you daily. You will require a pair of crutches or some walking aid for a few weeks following surgery and you will be given a physical exercise programme to gradually build strength in your joint and muscles, while increasing the walking distance gradually.
The recovery following revision surgery is often slow and needs longer periods of rehabilitation. It is important to have realistic expectations especially so with activity levels. You may require a walking aid for a longer period and occasionally permanently. However, with appropriate guidance from your surgeon and physiotherapist, the outcome will be almost equal to a primary hip replacement.
Like any other procedures, there are risks associated with a Revision Hip Replacement that you must be aware of and accept prior to undergoing the procedure. Because the procedure is longer and more complex, the incidence of complications is higher than a primary procedure.
The possible risks include Infection, Clots, Embolus, Dislocation, Limb Length inequality, Heterotopic Bone (new bone formation where it is not normally present), Persistent pain, Vessel or Nerve damage, Fracture, Re-operation/revision, medical, anaesthetic and mortality risks. As a surgical team, we make every effort to minimise these risks. This will include giving antibiotics before and after surgery, Injection/Tablet and use of surgical stockings to reduce the risk of clots and thorough pre and post-operative assessment and care.