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If complications from a hip replacement procedure persist, or your implant fails, corrective surgery may be necessary to make the hip stable again. This may include tightening the muscles and ligaments in the area. In some cases it may require replacing the entire device.
Metal-on-metal hip implants are more prone to this than other types of hip replacement. This has led to recalls of some models.
If you are exhibiting symptoms that may be caused by problems with your replacement hip, a series of tests will help determine if the implant is failing for any reason. X-rays are useful for detecting bone loss and implant wear and tear. Comparison to previous X-ray results can often determine whether an implant has failed due to loosening. For this reason, regular follow-up radiography is often recommended after a hip implant procedure, so potential problems can be identified early.
A complete blood count, erythrocyte sedimentation rate (ESR), and a C-reactive protein test (CRP) can all help determine if infection is present. Doctors may remove joint fluid for analysis or perform a variety of imaging tests.
Hip Revision Surgery Procedure
A revision surgery procedure will vary depending on a variety of factors, including what complications the surgery is meant to address, whether the entire implant needs to be replaced, and the condition of the remaining bone. It is more complex than the initial replacement procedure, and has a higher risk of side effects.
Patients undergoing revision surgery will often require blood donation prior to the surgery to account for the more extensive dissection that the procedure requires. The incision may utilize the scar from the initial hip replacement but is generally larger to simplify implant removal and replacement. Scar tissue will often need to be removed as well.
If some parts of the implant are still functioning properly, the surgeon may choose to leave them in place.
During the procedure, the surgeon may use several methods to remove the implant, including specialized cutting tools or surgically splitting the femur to facilitate component removal. The method used depends on a variety of factors. If some parts of the implant are still functioning properly, the surgeon may choose to leave them in place.
In cases involving significant osteolysis, bone reconstruction may be needed before a new implant can be placed. This can be achieved through bone grafts, through the addition of artificial components such as metallic plates, or through a combination of the two.
Implants used for revision surgeries may be larger than those used for a first replacement to compensate for bone loss. In particular, the femoral stem is often longer.
Repetitive Dislocation and Hip Revision Surgery
Patients who dislocate their hip implant are at risk of repetitive dislocations, because the initial dislocation can distort the musculature around the joint. Patients who are very old, or who had their hip replaced after a fracture, are also more prone to this complication.
The surgeon has several options to prevent further dislocations. They may adjust the components of the implant, replace one or more components, or utilize a device known as a constrained socket that helps hold the implant ball in place.
Infection and Hip Revision Surgery
While infection is most likely soon after a hip replacement, it remains a risk throughout the life of the implant. Several options exist for treating infected implants, which involve some combination of revision surgery, surgical cleaning and antibiotics.
A thorough surgical cleaning may be sufficient if the infection is discovered early enough, but if it has advanced, the implant may be replaced. This can be done in a single surgery or through a two-stage procedure. In the two-stage procedure, the infected implant is removed and a temporary spacer placed in the hip. The spacer, made of cement, allows some motion and administers antibiotics to the infected region. After 6 to 8 weeks, a new prosthesis is implanted during a second procedure.
Periprosthetic Fracture and Hip Revision Surgery
Periprosthetic fracture, the fracture of a bone surrounding an orthopedic implant, is one of the most severe, painful complications of hip replacement. It almost always requires surgery to correct. This surgery can either be a revision of the implant itself, open reduction and internal fixation of the fractured bone, or a combination of the two.
Open reduction refers to the surgical repositioning of the broken bone, most frequently the femur. Internal fixation, where the bone is secured to promote the healing process, is then performed. Your surgeon may use bone grafts or mechanical parts, such as screws, cables or metal plates, to fix the bone in place.
Preparing for Hip Revision Surgery
Prior to revision surgery, you can take a number of steps to help ensure a smooth recovery.
Ready your home:
- Tape down electrical cords and remove carpets to eliminate sources of tripping and falling
- Set up a sleeping area on the ground floor
- Stock up on easy-to-prepare food and store items between waist and shoulder level
- Ensure you have a cordless or mobile phone on hand
- Make sure you have a reclining chair or other comfortable place to sit with your legs elevated
Visit the dentist: Cleaning your teeth prior to the surgery decreases the likelihood of a taxing trip to the dentist during your recovery period. Because of the risk of infection, future dental appointments will require antibiotics.
Donate blood: If you wish, you may be able to donate your own blood for the surgery.
Quit smoking: Smokers should make an effort to quit or reduce their smoking, at least temporarily, to minimize as much as possible the risk of an adverse reaction to anesthetic and other complications.
Hip Revision Surgery Recovery
This period of restriction can last for as long as three months, and recovery may last for as long as two years.
Recovery from revision surgery may be more difficult than from the initial implantation, and involve an aggressive program of physical therapy. Patients may be required to use a walker or crutches and restrict weight bearing on the hip for a period of time after the surgery. This period of restriction can last for as long as three months, and recovery may last for as long as two years. Some patients will permanently need a cane to assist with walking.
Alternatives to Hip Revision Surgery
Because of the procedure’s complexity and more difficult recovery, patients may wish to pursue alternative treatments before settling on revision surgery. Nonsurgical alternatives can include pain medication, an assistive device such as a cane, or lifestyle changes to minimize certain activities.
Resection arthroplasty is a surgical alternative that involves the removal of the entire hip. It was more common prior to the invention of artificial hips and is rare today due to its complexity, the decreased mobility that results, and revision surgery’s high rate of success.
Complications of Hip Revision Surgery
Revision surgery is more prone to complications than initial hip replacement surgery, for a variety of reasons. It is a more complex procedure, and patients who need revision surgery may be predisposed to certain side effects. As such, a successful outcome can be difficult to predict.
Malpositioning and loosening of components: Because the bone in the area of the joint is often in poor condition due to osteolysis or other factors, the implant may not fix properly, or may be more prone to loosening. This more often a problem in patients with severe bone loss.
Dislocation: Repetitive dislocations are more common after revision surgery because of the complexity of the procedure and the toll that multiple surgeries takes on surrounding tissue. Surgeons will often stretch the tendons around the hip to help compensate for this, which can result in a lengthening of the leg.
Blood clots: The extensive dissection, physical strain placed on blood vessels, and need for immobility after the procedure makes deep vein thrombosis a more common occurrence after revision surgery.
- Gonzalez Della Valle, A. (2010, June 16). Revision total hip replacement: An overview. Retrieved from Hospital for Special Surgery website, January 6, 2014
- American Academy of Orthopedic Surgeons. (2007). Joint revision surgery: When do I need it?. Retrieved from AAOS website December 31, 2013
- Cleveland Clinic. (n.d.). Hip revision. Retrieved from Cleveland Clinic website January 9, 2014
- Goetz, D. D. et al. (1998). Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. a retrospective analysis of fifty-six cases. [Abstract]. The Journal of Bone & Joint Surgery, 80(4), 502-509. PMID: 9563379