Revision of Total Hip Replacement – Overview

There are two hip bones in the body, and they are on each side of the pelvis. Your hip has a complex ball and socket joint that performs many functions. The hip joint supports the body’s weight while standing, running, walking, or performing other activities. It also connects the pelvic girdle to the lower limb and is responsible for the diverse movement of the upper leg. That is why you cannot perform some of these activities when you suffer damage to the hip joint. Therefore, giving hip revision a chance isn’t a bad idea.

The hip joint can get faulty due to hip fracture, osteoarthritis, bursitis, tumor, osteonecrosis, rheumatoid arthritis, etc. Damaged hip joints can cause pain and discomfort and limit your mobility. Therefore, you may require artificial replacement in severe cases. Your doctor will remove your damaged hip joint and replace it with artificial implants during hip replacement surgery. However, the artificial hip joint might become faulty after a long period due to infections or wear and tear, hence the need for hip revision surgery.

What is a Revision of the Total Hip Replacement?

Hip revision surgery is a procedure you undergo to repair or replace an artificial hip replacement implant that has worn out or overused. The natural hip joint can lose its functionality if it is damaged by osteoarthritis, fractures, and other conditions. Hip replacement surgery enables the hip to function correctly again using artificial implants. This surgical procedure is standard and records a high success rate. However, the correction does not last forever, and the hip may need replacement again.

While it may take long before an artificial hip joint wears out, it can also become damaged due to an infection in the surrounding tissues. In the absence of disease, artificial hip joints can last for about 10-20 years, depending on the patient’s lifestyle habits. While hip revision surgeries are complicated, they ensure that your hip becomes functional again.

Why do you need a Revision of the Total Hip Replacement?

Hip damage limits your motion and the ability of your hip to function correctly, and it also causes severe pain and discomfort. The following are signs of hip damage that require hip replacement surgery;

• Severe pain in your hip area that does not subside despite medication use.
• Stiffness in your hip.
• Pain in your thigh or knee when performing different activities.
• You may limp while walking.
• Inability to perform your everyday actions without discomfort.

The following are the reasons for hip revision surgery:

• Aseptic loosening: Occurs when the hip joint implants loosen within the bone. It might cause pain and limit your range of motion; therefore, hip revision surgery is needed.
• Allergy to metals in the artificial implant: Some people might be allergic to metals in their artificial hip joint implant. It can cause itching, skin rashes, and discoloration of the area around the artificial implant.
• Infections: An infection in the tissues surrounding the artificial implant causes damage and weakness in the ligaments and tendons of the hip joint. Also, some bacteria might attack the prosthetic itself, making it hard to get rid of them, thereby requiring hip revision surgery.
• Recurring dislocation; The hip joint is a complex ball and socket joint. In cases where the artificial hip joint becomes dislocated often, the prosthetic might need to be replaced through hip revision surgery.
• Bad surgical technique: A poorly done hip replacement surgery can cause severe pain, discomfort, and infections that might require hip revision surgery to correct.

Furthermore, factors that cause faster implant wear include the material type of implant used, obesity, engaging in sporting activities and strenuous physical activities, diseases such as osteoporosis which causes the bones to become weak and brittle, etc. Generally, younger people who undergo hip replacement surgery usually need hip revision later because of their active lifestyle.

Preparations for Hip Revision Surgery

Before undergoing hip revision surgery, you might need to take blood tests, EKG, X-rays, CT scans, synovial fluid analysis, MRIs, etc. Their results will determine if revision surgery is necessary. After you have been declared eligible to undergo hip revision surgery, you can ask the surgeon questions about the procedure. To make your recovery process after the surgery faster and easier, you can also make some changes around your house.

See your doctor and dentist before the surgery to treat existing conditions that can interfere with your recovery process after surgery. You may inform your surgeon of your medical history and medications to avoid complications during the surgery. Finally, make sure you have someone to drive you home after the surgery.

Procedure

Generally, this surgical procedure takes several hours. However, it only takes a day. It involves opening up the hip area and removing, replacing, or reconstructing the old artificial implant. Generally, this may depend on the severity of the damage done.

Before beginning this procedure, your doctor will administer anesthesia to numb the area they want to work on. To open up the hip area, the surgeon makes an incision along the line of the initial hip replacement. Then, the hip’s old prosthetic and infected parts are cut away and removed. After removing the old implant, your surgeon will insert the new hip replacement and test its motion quality.

Hip revision surgeries are complex, and complications might arise during this surgical procedure; however, a total replacement of your hip joint is not always necessary. There are different types of hip revision surgery, and the process depends on the patient and the reason for the revision.

When your hip ball slips out of the socket part of the artificial hip joint frequently (recurring dislocation), the surgeon may insert new additional components to support the joint and prevent dislocations. In addition, the patient might have to wear a brace until the implant is stable. In case of infections around the tissues surrounding the implant or the prosthetic itself, the following is a common treatment method a surgeon might use before replacing the entire prosthetic:

• Debridement (Surgical cleaning): If detected early, the surgeon can clean the joint implant manually without removing it. On the other hand, your surgeon will remove the infected tissues, and you will use some antibiotics for a long time.

Recovery

Immediately after hip revision surgery, the patient is placed under observation and monitored while recovering from the influence of anesthesia. When the patient regains consciousness, the surgeon gives the necessary instructions. It might take a while before you can resume your normal activities after hip revision surgery. Also, you might experience difficulties while performing simple tasks such as walking. However, it is important to exercise your legs to prevent them from swelling and aid in faster recovery.

If you experience severe pain, swelling, redness, and any other unusual symptom, you should contact your surgeon. The following are tips to avoid complications after surgery and aid a faster recovery:

• Eat a healthy and balanced diet to maintain a healthy weight.
• Avoid strenuous physical activities for a few months after surgery.
• Take all prescribed medications as and when due.
• Report any unusual event to your surgeon regardless of appointment dates.
• Always undergo regular checkups with your dentist to track your healing process.

Possible Complications after Hip Revision Surgery

The following are the risks associated with hip revision surgery:

• Infections: You might develop an infection at the incision site, surrounding tissues, and the prosthetic hip joint.
• Clotting of blood: Blood clots might form in the veins of the leg, thereby cutting off the supply of blood to the lungs, heart, or even the brain.
• Unequal leg lengths: At the end of hip revision surgery, the size of your legs might be unequal as a result of contractions around the hip.
• Dislocation: Carrying out extreme physical activity after hip revision surgery can cause the ball of your hip joint implant to come out of its socket.
• Nerve damage: Sometimes, the nerves around the hip joint implant might be mistakenly damaged during surgery.
• Fractures: Some healthy parts of the hip joint might become fractured during the surgical procedure.
• Heterotopic ossification occurs when you experience new bone growth in the hips in the wrong places.

Benefits of Hip Revision Surgery

The following are the benefits of undergoing a hip revision surgery:

• Pain relief: This is the primary benefit of undergoing hip revision surgery. A failed hip replacement surgery causes severe pain or discomfort. However, revision surgery alleviates that pain and helps you return to your everyday life.
• Improved movement: Hip revision surgery restores your range of motion and helps you move around without having to endure excruciating pain.
• Undergoing hip revision surgery can help to reduce your risk of developing chronic health conditions such as diabetes, depression, and heart failure.
• Improvement of one’s quality of life: Hip pain can hinder you from participating in your favorite activities. However, after a successful hip revision surgery and recovery, you can again partake in your favorite activities.
• Before a hip revision, you may limp while walking, and there might be noticeable differences between your legs. However, hip revision surgery can improve the appearance of your hips and legs.

The recovery period from a hip revision surgery differs depending on the individual. Although, you should be able to return to most of your everyday activities in three months. Hip revision surgery might be the solution to the pain, discomfort, and limitations you have been experiencing since your hip replacement surgery.