What is Revision Hip Replacement?
A total hip replacement (also called total hip arthroplasty) is one of the most successful orthopaedic procedures and is highly effective in relieving pain and improving function. It involves replacing the ball and socket bones that make up the hip joint with artificial parts also known as a prosthesis. Whilst the materials and surgical techniques are continuing to improve, hip replacements may however eventually wear out. Furthermore, unfortunately some patients are faced with complications associated with their hip replacement.
In the situation where a hip replacement is causing problems or has worn out, another operation may be performed to insert a new prosthetic hip. This operation is known as a revision hip replacement.
The operation will involve removing the worn out hip implant and replacing it with a new one. If the reason the revision is taking place is due to an infection, the operation may be carried out in two stages. The first stage is to remove the old implant, clean out the joint and insert a spacer that may contain antibiotics. Once the infection has resolved, a new hip implant is inserted. This two step process can take up to a year to complete.
Who is this operation for?
A total hip replacement is usually a very effective operation. Current studies have shown that 80% of people between 55-65 years old and 85-95% of people between 65-75 years old will have a hip replacement that lasts 15 years. The materials and technology of fitting the hip replacement are continuing to improve and with time we may see even longer periods where the replaced joint remains strong and healthy. There may however come a time when the joint replacement begins to wear out. This can lead to the following problems occurring:
- recurrent dislocation: the hip may lose some of its stability and dislocate too easily
- thigh, groin or hip pain: as the joint wears out, there may be more stress on surrounding bones, muscles and ligaments which can lead to pain
- loosening of the prosthesis (artificial joint): either the ball or the socket which have been replaced in a total hip replacement may become loose. This can cause problems with how the hip is moving and also may lead to pain. It can also wear down some of the bone into which the artificial joint has been placed.
- osteolysis (bone loss): as mentioned above, the components of the artificial joint can become loose and start to wear down. This can lead to particles from the artificial joint being released into the surrounding bone which along with the mechanical pressure from the implant can lead to a wearing out of bone known as osteolysis
If any of these scenarios arise, then a revision of total hip replacement may be necessary.
Another situation that may require a total hip revision is if the hip that has been replaced gets infected. Once an infection occurs in an artificial joint, it is very hard to get rid of it with antibiotics alone. A total hip revision is often required in order to clear the infection and allow the area to heal. Orthopaedic surgeons go to great lengths in order to ensure that the risk of infection is minimised but occasionally this may still occur. A revision of total hip replacement in this setting may be carried out in a two stage process. The first stage involves removing the artificial ball and socket and then the joint is washed out. The hip is then left to heal before another joint replacement is performed. This two step process can take up to a year to complete.
Complications
The complications of a revision of total hip replacement are similar to the complications of the original surgery. These include:
- Joint infection
- Osteolysis – bone loss
- Loosening of the artificial joint
- Dislocation
- Uneven legs
- Chronic pain
- Nerve damage
- Further revision surgery
The risk of these complications are slightly higher for a revision of a total hip replacement as compared with the original hip replacement. The most common complication is loosening of the replacement. This is often due to the fact that there has been some bone erosion during the first hip replacement. The next most common complication is infection.
General complications of any surgery include:
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- blood tests
- Xray hip
- Xray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Go see your dentist
Consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.
Get some help from your friends and family
Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended-care facility during your recovery after surgery also may be arranged.
Home Planning
The following is a list of home modifications that will make your return home easier during your recovery:
- Securely fastened safety bars or handrails in your shower or bath
- Secure handrails along all stairways
- A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
- A raised toilet seat
- A stable shower bench or chair for bathing
- A long-handled sponge and shower hose
- A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
- A reacher that will allow you to grab objects without excessive bending of your hips
- Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
- Removal of all loose carpets and electrical cords from the areas where you walk in your home
About the Operation
Admission
Most people are admitted to hospital on the day of surgery.
Anaesthesia
The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.
The different types of anaesthesia include:
- General Anaesthetic: This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
- Spinal Anaesthetic: An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
- Nerve Blocks: This special injection is used to help with your pain after the operation and often used in conjunction with a general anaesthetic.
The Operation
The operation usually takes between 1 to 2 hours, however can occasionally take several hours.
Your surgical team will remove the old artificial joint components and replace them with a new hip replacement.
Your wound is usually between 15 – 30 cms long, depending on your shape and your hip anatomy.
What is the Hip Replacement made of?
Hip replacements are made of surgical grade metal (often chromium cobalt, stainless steel or titanium), highly wear resistant plastic or ceramic.
A hip joint is basically a ball and socket joint, and a hip replacement is designed to replace this normal anatomy.
A hip replacement is composed of a:
- Socket: Medically called the Acetabular Component. It can be made of highly wear resistant plastic, metal or ceramic.
- Liner: The liner fits snugly into the socket to provide an ultra-smooth surface for the hip joint. It can be also be made of plastic, ceramic or metal.
- Ball: The artificial ball component is smaller than your normal hip ball. It is incredibly polished and perfectly round and smooth. It is usually made of metal or ceramic.
- Stem: The stem fits snugly into your thigh bone (femur) to provide a stable structure for the ball. It is made of metal.
There are types of hip replacements available, and your surgeon will decide which one is best for you.
Recovery Room
After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor to. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.
After the operation
Your stay in the hospital
You will usually stay in the hospital for a few days.
To protect your hip during early recovery, a special triangular splint may be placed in-between your legs to keep them apart.
How much will it hurt?
After surgery, you will feel pain in your hip.
If you have been given a spinal injection during your anaesthetic, your legs may be numb for the first 12 hours.
Pain medication, either tablets or injections, will be given to make you as comfortable as possible.
What exercises do I do whilst in hospital?
Breathing – To avoid lung problems after surgery, you will be asked to breathe deeply and cough frequently. This will help avoid pneumonia and lung collapse.
Walking – Walking and light activity are important to your recovery and will begin the day of or the day after your surgery. Most patients who undergo revision of total hip replacement begin standing and walking with the help of a walking support and a physiotherapist the day after surgery.
The physiotherapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.
If the cause for the revision is infection, then in between the two phases of operation, weight bearing may be delayed and will only be possible with the assistance of crutches.
Recovery and Rehabilitation
Wound Care | How do I look after my wound?
It is important to keep your wound as dry as possible.
Most patients are discharged home with a waterproof dressing, which can be left on for showering.
During the first 24 hours, it is normal to have some minor bleeding. After being discharged home, there should be no discharge, redness or bleeding around the wound. If there is redness, discharge or a foul odour, please seek medical attention as soon as possible.
Wound Care | When will my stitches be removed?
There are a number of ways your wounds may be closed.
You may have either have:
- nonabsorbable stitches
- absorbable stitches
- surgical staples
The stitches or staples are usually removed 10-14 days after surgery.
Diet | What should I eat and drink?
There are usually no specific diet or extra vitamins / nutrients needed to recover from a total hip operation.
It is important to have a normal healthy balanced diet and plenty of nonalcoholic fluids.
Activity | What exercises should I do at home?
Physiotherapy and the exercises that you perform at home are extremely important to achieve the best results after a hip replacement.
After returning home, you should gradually be able to do more and more. It is important to look after your new hip and follow your surgeon’s and physiotherapy instructions.
Your program may include exerises that work on your:
- walking
- sitting
- stair climbing
- muscle strength
Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery.
Be careful on stairs. Stairs are a particular hazard until your hip is strong and mobile, and you’ve regained your balance. You should use a walking aid such as cane, crutches, a walker. Use the handrails on your stairs or ask for someone to help you., or handrails or have someone help you.
Special Precautions
One possible complication of hip replacement surgery is dislocation. Dislocation is most common during the first year after surgery, but can occur at any time.
There are certain positions and precautions that must be avoided.
- Do not cross your legs.
- Do not bend your hips more than a right angle (90°).
- Do not turn your feet excessively inward or outward.