Revision surgery (redo) of the hip is needed when there is a problem with the existing hip replacement. These operations are often complex, involve greater operating time and have a slightly higher risk of complications. The reasons which may ncessitate revision surgery include -
1. Aseptic loosening – loss of fixation of the implant in the pelvis or thigh bone. This is a long term complication and usually presents many years after primary hip surgery. With modern techniques, and implant systems, the survival of implants is often beyond 15 to 20 years.
- X ray of the pelvis showing migration of the acetabular component, signifying gross loosening X ray of the pelvis showing migration of the acetabular component, signifying gross loosening
- X ray showing a new socket has been placed in place of the loose component X ray showing a new socket has been placed in place of the loose component
2. Infection in a primary hip joint will require its removal and insertion of a new implant. Established deep infection in artificial joints is unlikely to respond to administration of antibiotics alone. Infection risk is very low generally, and in my patients, the rate of infection in hip replacements is zero percent.
Some patients may develop a late infection - months or years after a primay hip replacement. This usually happens due to spread of bugs through the bloodstream from a source somewhere else in the body.
- infection of right hip replacement infection of right hip replacement
- Single stage revision using a cemented prosthesis Single stage revision using a cemented prosthesis
3. Recurrent dislocation - The hip is a ball and socket joint and in a small percentage of people, the ball may come out of the socket (dislocate). In a third of patients with hip dislocation, it may go on to become a recurrent problem. This implies a problem with the hip joint and revision surgery may be needed to address this.
- dislocated hip joint despite the use of a constraining ring dislocated hip joint despite the use of a constraining ring
- Revision of the socket to correct positioning and achieve stability Revision of the socket to correct positioning and achieve stability
4. Periprosthetic fracture – is fracture of the bone adjacent to the hip, commonly due to a fall or a significant injury. Usually, these are fractures involving the thigh bone, and rarely the pelvis bone. The presence of an artificial joint makes conventional fracture fixation techniques unsuitable in these situations. These fractures require changing the hip prosthesis.
- Fracture of the femur around a cemented hip replacement Fracture of the femur around a cemented hip replacement
- Revision of the stem using a uncemented long stem and a cable plate Revision of the stem using a uncemented long stem and a cable plate
5. Osteolysis – is a long term problem of joint replacements whereby the wear particles generated by joint movement initiate a bone dissolving process. The dissolution of bone around the hip joint results in loss of fixation and in these situations, the hip joint has to be changed and the bone deficient areas addressed.
Most of the discussion relating to primary hip replacement is applicable to revision hip surgery. As mentioned above, the notable difference is that revision hip surgery is more extensive, takes longer to perform, has a higher risk of complications and a longer recovery period. The type of implant (prosthesis) used is different to primary hip surgery.
Most patients following revision hip surgery do well, although, statistically, the outcome of primary hip replacement is generally superior to revision hip surgery.
If you have further questions, please contact us about your query, and I will be delighted to respond to any comments, questions or concerns