Revision Hip Surgery

Why Would Hip Revision Surgery Be Required?

Usually, the cause is clear, but not always. Hips without an obvious cause for pain generally do not do as well after surgery. Pain is the primary reason for revision, and hip pain can be caused by:

Wear

This can be caused by the plastic (polyethylene) wearing and is one of the easier revisions where only the plastic insert is changed.

Dislocation

This can cause instability and means the hip is popping out of place.

Loosening

Generally, this occurs where the artificial joint has been in place for a considerable time or has been subject to significant amounts of 'wear and tear'. This can be caused by either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. For this reason, you must have your joint followed up for life, as there can be changes on the X-ray that indicate that the hip should be revised despite having no symptoms.

Infection

It usually presents as pain but may present as an acute fever or a general feeling of unwellness.

Bone Loss

Osteolysis can occur due to particles being released into the hip joint, destroying bone.

Fracture

Due to its proximity to the artificial hip components, this is referred to as a 'periprosthetic fracture'. It is generally caused by a fall or other direct trauma.

Preparation Before a Revision Hip Surgery

• Your surgeon will send you for routine blood tests to rule out infection, a CT scan to look closer at the anatomy, and bone scans to help determine if a component is loose.
• X-rays are essential
• Aspiration of the joint is occasionally done to diagnose or rule out infection.
• You will be asked to undertake a general medical check-up with a physician
• You should have any other medical, surgical or dental problems attended to before your surgery
• Make arrangements for help around the house before surgery
• Cease aspirin or anti-inflammatory medications 10 days before surgery as they can cause bleeding
• Cease any naturopathic or herbal medications 10 days before surgery
• Stop smoking as long as possible before surgery

Day of Revision Hip Surgery

• You will be admitted to hospital usually on the day of your surgery
• Further tests may be required on admission
• You will meet the nurses and answer some questions for the hospital records.
• You will meet your anaesthetist, who will ask you a few questions
• You will be given hospital clothes to change into and have a shower before surgery
• The operation site will be shaved and cleaned
• Approximately 30 minutes before surgery, you will be transferred to the operating room.

Revision Hip Surgery Procedure

• Administration of general anaesthesia or sedation and local anaesthesia
• The entire procedure can take 60 minutes to two hours.
• The procedure is performed and sent to the recovery room for observation
• Pain medications are prescribed to help with pain during the recovery phase. 

Revision Hip Surgery Recovery Plan

• Do not consume large amounts of alcohol after surgery,
• Avoid vigorous physical activity or exercise until advised.
• Follow the post-surgery treatment plan proscribed by the surgeon and post-op care specialists.
• Any questions or complications should be communicated directly to the surgeon.

Special 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.
• Elevated toilet seats are helpful
• You may shower once the wound has healed
• You can apply Vitamin E or moisturising cream to the wound once it has healed.

You should call your doctor if you have increasing redness or swelling in the wound or temperatures over 100.5 degrees.

If you have 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.

Revision Hip Surgery Prognosis

The success rate of revision hip surgery is generally good, especially when performed by experienced orthopaedic surgeons. It often successfully addresses the issues that led to the need for revision, such as pain, instability, or component wear.

Many patients experience significant pain relief and improved mobility following revision hip surgery. Restoring proper joint function can lead to a better quality of life.

Modern hip implant materials and surgical techniques can provide long-lasting results, potentially allowing patients to enjoy many years of improved hip function.

Successful rehabilitation plays a crucial role in the prognosis. Following post-operative rehabilitation protocols prescribed by the surgeon and physical therapist is essential for achieving optimal results.

Revision Hip Surgery Risks and Complications

As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages outweigh the potential disadvantages.

You must be informed of these risks before the surgery takes place.

Complications can be Medical (General) or Specific to the Hip

Medical Complications include those of the anaesthetic and your general well-being. Almost any medical condition can occur, so this list is not complete. Complications include:

• Allergic reactions to medications
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attacks, strokes, kidney failure, pneumonia, bladder infections
• Complications from nerve blocks, such as infection or nerve damage
• Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, or rarely death

Specific Complications to the Hip

Infection

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

Blood Clots (Deep Venous Thrombosis)

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

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 anaesthetic. Rarely, this becomes a recurrent problem needing further surgery.

Fractures (Break) of the Femur (Thigh Bone) or Pelvis (Hip Bone)

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

It is 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.

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

Making the leg the same length as the other one is very difficult. Occasionally, the leg is lengthened to stabilise the hip during surgery. There are some occasions when it is simply not possible to match the leg lengths. A simple shoe can treat all leg length inequalities raised 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 hip replacements survive 15 years.

Failure to Relieve Pain

Very rare but may occur, especially if the pain comes from other areas, such as the spine.

Unsightly or Thickened Scar

Pressure or Bedsores

Limp Due to Muscle Weakness

Discuss your concerns thoroughly with your orthopaedic surgeon before surgery.

What if Revision Hip Surgery is Delayed?

Delaying revision surgery can worsen symptoms, increase complications, and reduce quality of life. Therefore, patients must work closely with their medical team to determine the most appropriate timing for their revision surgery based on their unique circumstances and medical conditions.