Revision Hip Replacement

A revision hip replacement is done to replace a worn-out hip replacement implant. Hip replacement is a traditional procedure performed by orthopedic surgeons and the surgery is incredibly successful and has excellent results in the vast majority of patients. The problem, unfortunately, is that over time replacements wear out completely.

Hip revision surgery by Dr. Divyanshu is performed to repair an artificial hip joint that has been damaged over time due to an infection surrounding the joint or due to normal wear and tear of the prosthetic hip. Revision surgery helps to correct the problem so the hip can function better again.

The use of artificial hip in the patients is extremely effective in improving hip joints that are damaged by some form of arthritis or by injury. Artificial joints, do not last forever but usually, it can last for 10-15 years, depending on the patient’s daily use of the joint. Patients after hip replacement surgery are typically over the age of 55 and have developed severe arthritis in the hip. After a certain period of normal wear and tear of the hip joint, the prosthetic hip does not fit as securely and is not as effective. In these cases, revision hip surgery may be recommended by your orthopedic doctor.

Why Hip Revision Surgery is Recommended

1. Pain

Pain is the principal sign for hip replacement and is reliably relieved as early as one week after hip replacement surgery. Pain from an arthritic hip is located in the groin and buttock. Radiation into the thigh may occur and at times pain might be present in or even below the knee. The pain in the hip often described as a dull ache that is difficult to localize.  Physical exercise aggravates the pain while bed rest relieves it.

2. Impart Wear and Loosening

When an artificial hip is placed in the patients, it is either pressed or cemented into position so that it fits tightly into the thighbone (femur) and pelvis. While it may not move at first, that does not mean it will not move over time. This is typically a slow process that leads to issues with the normal function of prosthetic implants.

There are several factors that may contribute to implant wear and loosening including the patient’s age, sex, weight, and activity levels.

The figure shows the space around the thigh femoris bone indicates that the component has loosened from the underlying patient’s bone.

3. Infection

Infection may occur at any time after total hip replacement surgery. The risk is usually higher during the first six weeks, the risk of ‘late’ infections after that period is lower. Sometimes, infections in the mouth, gums or teeth or in the lungs, urine or skin can cause bacteria to enter the blood cells. This bacteria can then seen and infect a hip replacement, causing hip pain and high fever. In the presence of a prosthetic infection, a joint replacement surgeon will attempt to identify the bacteria that are causing the infection and the vast majority of treatments including hip revision surgery and a course of antibiotics that specifically target the infecting bacteria. By Dr. Divyanshu SN Goyal Revision hip surgery for infection can be done in different ways, to determine which surgical procedure is best for you, he will consider a number of factors including;

• The type of bacteria
• The duration and severity of the infection
• Your preference for a specific treatment

Debridement- Debridement is the medical procedure of removing dead, damaged or infected tissue to improve the healing potential of the remaining healthy tissue. Removal can be done by surgical, mechanical, chemical, autolytic and by maggot therapy. After Debridement hip surgery you will receive antibiotics for several weeks to help cure the infection.

Staged Surgery- This spacer in the hips is treated with antibiotics to help fight the infection and will remain in your hip for several days. During this time, a patient will also receive intravenous antibiotics by surgeons. An antibiotic spacer is placed in the hip joint during the first stage of treatment to prevent joint replacement infection.

When the infection has been cleared, your doctor will perform a second surgery to remove the antibiotic spacer and insert a new prosthesis. In general, removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery.

In some cases, your doctor may be able to remove the implants, wash out the hip, and place a new prosthesis all in the same operation. This procedure, which is called a one-stage exchange, may be appropriate in limited situations.

4. Recurrent Dislocation

Dislocation is one of the most common causes of hip revision surgery after loosening and infection. The patient who develops recurrent dislocation of a total hip arthroplasty presents a challenging problem for the orthopedic surgeon. If you experience recurrent dislocation, we recommend hip revision surgery to better align your hip joint or to insert a special artificial implant designed to prevent dislocations.

The left figure shows dislocation after primary hip replacement. The right figure shows that the revision implant is designed with a ring mechanism that locks the femoral head into the socket to prevent further dislocation of the hip joints.

 

5. Fracture

A periprosthetic fracture is a broken or cracked bone that occurs all over the components of a total hip replacement. Although, it’s a serious complication of hip revision surgery that should be treated as soon as possible. Many fractures occur after a patient has been living with a hip replacement for several years. Treating periprosthetic fractures (broken implants) can be challenging because patients tend to be older. They are more likely to have weaker bones and other medical conditions.

In the left patient has a periprosthetic fracture of the thighbone. In the right, the same fracture treated after revision surgery.

5. Metal Hypersensitivity Reactions to Hip Implants

Total hip replacement surgery using metal alloy devices is common. Type IV allergic reactions to these prosthetic implants may occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected patient. In some patients, this reaction can result in damage to the bone and soft tissues around the hip and lead to the need for hip revision surgery.

If you face any of these problems, you may require hip revision surgery for better health. Contact best orthopedic surgeon- Dr. Divyanshu at SNG Hospital, Indore for hip-related issues.