Everything about Revision Hip Surgery

Revision Hip surgery

What Is Revision Hip surgery?

Revision hip surgery, also known as revision total hip arthroplasty (THA), is a surgical procedure performed to replace or repair a previously implanted hip prosthesis (artificial hip joint) that has become problematic or has failed. This type of surgery is necessary when the original hip replacement, whether it was a total hip replacement or partial hip replacement, is no longer functioning properly due to various issues. The primary goal of revision hip surgery is to address and correct the problems with the existing hip implant to improve the patient's pain, mobility, and overall quality of life.

Common reasons for revision hip surgery include:

• Implant Wear and Tear: Over time, the components of a hip prosthesis can wear out, leading to pain and reduced function. This can be due to the friction between the metal or plastic parts or wear of the bearing surfaces.

• Implant Loosening: The artificial components may become loose from the surrounding bone. This can be caused by the gradual breakdown of the bone-cement interface or the bone-implant interface.

• Infection: In some cases, infections can develop around the hip implant, which may necessitate the removal of the infected components and the placement of new ones.

• Component Malposition: Incorrect positioning of the hip implant components during the initial surgery can lead to issues such as instability, impingement, or discomfort.

• Fracture: A fracture in the bone around the hip implant may require revision surgery to stabilise the fracture and replace damaged components.

• Instability: Patients may experience recurrent dislocations or instability of the hip joint due to problems with the implant or soft tissues around the joint.

• Component Breakage or Failure: In rare cases, the artificial hip components themselves can break or fail, requiring their replacement.

• Periprosthetic Osteolysis: The body's response to particles released from the implant can lead to bone loss around the prosthesis, which may require correction.

How should a patient prepare for hip revision surgery?

Preparing for hip revision surgery is important to ensure a successful outcome and a smooth recovery. Hip revision surgery is typically more complex than primary hip replacement surgery, as it involves replacing or repairing a previously implanted hip prosthesis. Here are some steps to help you prepare:

• Consult with Your Surgeon:

Schedule a consultation with your orthopaedic surgeon to discuss the need for hip revision surgery and to understand the specific reasons for the revision. Ask any questions you may have about the procedure, expected outcomes, and potential risks.

• Medical Evaluation:

Undergo a thorough medical evaluation to assess your overall health and identify any underlying medical conditions that may affect the surgery or recovery.

• Medication Review:

Inform your surgeon about all medications, supplements, and herbal remedies you are taking, as some may need to be adjusted or temporarily stopped before surgery.

• Lifestyle Adjustments:

Make necessary lifestyle adjustments, such as losing weight if you are overweight, quitting smoking, and managing chronic health conditions like diabetes or high blood pressure.

• Physical Therapy:

If recommended by your surgeon, engage in physical therapy exercises to improve your hip's strength and range of motion before surgery. This can help with your post-operative recovery.

• Pre-operative Tests:

Complete any pre-operative tests or imaging studies required by your surgeon, such as X-rays, MRI, or blood tests.

• Dental Checkup:

Consult with your dentist and address any dental issues or infections, as they can increase the risk of infection after surgery.

• Medications:

Your surgeon may prescribe antibiotics or other medications to take before surgery to reduce the risk of infection.

• Prepare Your Home:

Make necessary modifications to your home to accommodate your post-surgery needs. This may include installing handrails, securing loose rugs, and arranging for assistance with daily tasks.

• Arrange for Help:

Plan for someone to assist you at home during your recovery, especially during the initial weeks when mobility may be limited.

• Stock Up on Supplies:

Purchase any necessary supplies, such as a walker or crutches, raised toilet seats, and comfortable clothing that is easy to put on and take off.

• Plan for Transportation:

Arrange for transportation to and from the hospital on the day of surgery, as you will not be able to drive yourself.

• Understand the Recovery Process:

Have a clear understanding of what to expect during the recovery process, including restrictions on weight-bearing and physical activity.

• Emotional Preparation:

Mentally prepare for the surgery by discussing your concerns and fears with your healthcare team or a mental health professional if necessary.

• Follow Pre-operative Instructions:

Adhere to any specific pre-operative instructions provided by your surgeon, such as fasting before surgery.

What happens during hip revision surgery?

Hip revision surgery is a complex procedure that is performed to replace or repair a previously implanted hip prosthesis, which may have become damaged, worn out, or infected. The specific details of the surgery can vary depending on the individual case and the reason for the revision. However, here is a general overview of what typically happens during hip revision surgery:

1. Anaesthesia: You will be given either general anaesthesia, which puts you to sleep during the procedure, or regional anaesthesia, which numbs the lower half of your body while you remain awake. The choice of anaesthesia depends on your health and the surgeon's preference.

2. Incision: The surgeon makes an incision over the hip joint, usually along the same scar from the previous hip replacement surgery. The length and location of the incision can vary.

3. Removal of the Old Prosthesis:

• If the old prosthesis is a total hip replacement, the surgeon will first remove the components of the existing hip implant. This may involve cutting and removing the cement or bone cement that holds the implant in place.

• If the existing implant is a partial hip replacement or a hip resurfacing, only the damaged or problematic components may be removed, and the remaining parts may be retained if they are still functioning well.

4. Evaluation of the Hip:

• The surgeon assesses the condition of the bone, soft tissues, and any remaining components to determine the best course of action.

• Bone grafts or bone cement may be used to fill in any defects or gaps in the bone.

5. Implantation of the New Prosthesis:

• The surgeon implants the new hip prosthesis, which may consist of a combination of components such as a femoral stem, acetabular cup, and a ceramic, metal, or plastic liner.

• The components are carefully positioned and secured to ensure proper alignment and stability.

6. Closure: The surgeon closes the incision with sutures or staples and may place a drain to remove excess fluid from the surgical site.

7. Dressing and Bandage: A sterile dressing is applied over the incision, and a bandage is placed to protect the wound.

8. Post-operative Imaging: X-rays or other imaging studies may be performed to confirm the proper placement of the new hip prosthesis.

9. Recovery Room: After surgery, you will be moved to a recovery room, where healthcare professionals will monitor your vital signs and manage your pain.

10. Post-operative Care: Once you are stable, you will be transferred to a hospital room or a designated recovery area. Physical therapy and rehabilitation will begin as soon as possible to help you regain mobility and strength.

It's important to note that hip revision surgery can be more challenging than primary hip replacement due to factors like scar tissue, bone loss, and the need for specialized implants. The specific surgical approach and techniques used will depend on the individual's condition and the surgeon's expertise.

Recovery from hip revision surgery can take several weeks to months, and it involves a comprehensive rehabilitation program to restore function and mobility to the hip joint. The success of the surgery depends on factors like the patient's overall health, the surgeon's skill, and the type of prosthesis used. Patients should follow their surgeon's post-operative instructions carefully to maximise their chances of a successful outcome.

What is the recovery period for hip revision surgery?

The recovery time for hip revision surgery can vary widely depending on several factors, including the complexity of the surgery, the patient's overall health, and the specific reasons for the revision. In general, hip revision surgery involves a longer recovery period compared to primary hip replacement surgery. Here is a rough timeline of what to expect during the recovery process:

1. Hospital Stay: Most patients will spend several days (typically 3 to 7 days) in the hospital after hip revision surgery. During this time, healthcare providers will monitor your condition, manage pain, and begin early rehabilitation.

2. Early Post-operative Period (Weeks 1-6):

• During the first few weeks after surgery, you will need assistance with daily activities, and mobility will be limited.

• You may be instructed to use crutches, a walker, or a cane to avoid putting too much weight on the operated hip.

• Physical therapy will begin in the hospital to help you regain range of motion and strength in your hip and leg.

• You will gradually increase your weight-bearing activity as instructed by your surgeon and physical therapist.

3. Mid-term Recovery (Weeks 6-12):

• By the 6th to 12th week post-surgery, you should experience improved mobility and less pain.

• Physical therapy and exercises will continue, focusing on strengthening the hip and improving walking patterns.

• You may be able to resume some light activities and return to work, depending on the nature of your job.

4. Long-term Recovery (Months 3-6+):

• Full recovery can take several months or more.

• Physical therapy and exercise programs will continue to progress, aiming to restore normal hip function and strength.

• You can expect ongoing improvement in your hip's range of motion and reduction in pain.

• High-impact activities or sports may be limited or discouraged to protect the hip prosthesis.

It's important to note that recovery is highly individualised, and the timeline can vary significantly from one person to another. Some factors that can influence the recovery time include:

• The patient's age and overall health.

• The complexity of the revision surgery.

• The condition of the bone and soft tissues in the hip area.

• Compliance with post-operative instructions and physical therapy.

• Any complications that may arise during the recovery period.

Your orthopaedic surgeon and physical therapist will provide you with a personalised rehabilitation plan and recovery timeline. It's crucial to follow their guidance and attend all recommended follow-up appointments to monitor your progress. Be patient with the recovery process, as it can take time to regain full function and mobility in the hip joint after hip revision surgery.