Revision Total Hip Replacement
Although hip replacement surgery is generally a very successful procedure, complications may arise during or after the original surgery that require correction with a secondary procedure (revision total hip replacement) to remove the old implants and replace them with new components. Current hip replacements typically last between 10-20 years; however, as a greater percentage of young patients undergo hip replacement surgery, and as the expected lifespan of the senior population continues to rise, increasing numbers of joint replacement patients will outlast their implants and require revision hip replacement surgery.
There are a number of reasons why a prosthetic hip joint may fail, including:
- Damage or deterioration of the artificial joint
- Osteolysis (bone loss)
- Injury or trauma to the hip region
- Loosening of the implant: may result from friction of the joint surfaces oraseptic loosening, wherein the body attempts to digest the prosthesis
- Younger, more active patients are more likely to require revision hip surgery, as are obese patients, and patients whose primary hip surgery was performed to treat avascular necrosis, inflammatory arthritis, or a previous hip fracture
- Dislocation: refers to the sudden migration of the implant from its normal position, and is typically the result of the prosthesis loosening, inadequate soft tissues, incompatible component position, neurologic factors, or patient noncompliance with activity restrictions
If you have previously undergone hip replacement surgery and are experiencing any of the aforementioned issues, you should consult with an orthopaedic specialist to determine if a subsequent hip surgery will be necessary. Revision total hip replacement surgery is a complex procedure that requires specialized tools and implants, meticulous preoperative planning, and mastery of complex surgical techniques to achieve a successful outcome.
For these reasons, it is critical that you select a surgeon who has extensive experience performing revision total hip replacement procedures.
Procedure and Recovery
When making the surgical incision for your revision total hip replacement surgery, we will either utilize the site of the previous incision, or create a more-extended incision to facilitate implant and scar removal. We will then evaluate your existing bone quality, remove any failed components, and reconstruct the remaining bone and soft tissue structures. Lastly, we will affix the new components to the bone, either through bone growing into small pores in the outer layer of the implant or by cementing the construct into place.
Once the new components are securely in place, we will suture the tissue layers closed and place drains to collect any fluids or blood. The average procedural time for this surgery is approximately 1.5-3 hours for operating time and he will do the best to minimize pain and narcotic usage, as Tylenol and Celebrex generally suffice for pain management.
You may be given a brace or splint to protect your joint during the healing process, and will participate in rehabilitative physical therapies for approximately 3 months to improve muscle strength and help you adapt to your new joint. Weight-bearing activities may be restricted for 6-12 weeks, and you will be advised about precautions regarding sitting, bending, and sleeping positions.
Although assistive devices (i.e. crutches, walker) will be used early in the convalescence period, the ultimate goal is for patients to progress to the use of a cane, or no assistive device at all. Patients adhering to their therapeutic protocols typically observe gradual improvements in strength and limp over 1-2 years.