Revision Hip Replacement
“Revision hip replacement” refers to a procedure that is performed when your previous hip replacement needs to be revised. The operation can vary from a minor adjustment made to the original surgery, to a full second hip replacment surgery, where the objective is to replace a significant amount of bone. This surgery is more difficult to describe fully, since that objective varies depending on the result of your original surgery.
Another type of hip surgery, Total hip replacement, or THR, involves the replacement of your hip joint (all of it or just part of it) with an artificial device, or prosthesis. This prosthesis has a plastic liner designed to restore movement to your joint.
Reasons for a hip revision
The main reason patients usually need a hip revision is because they are in pain. Sometimes, depending on your individual case, the cause is clear. However, if the cause of your pain is not immediately obvious, your hip may not do as well after your surgery.
Polyethylene (or Plastic) Wear
This revision is often easier than other types of revisions and involves only replacing the plastic insert in the prosthesis.
Dislocation, or Hip Instability
Hip instability, or dislocation, means that your hip is dislodging, or having trouble staying in place.
Femoral or Acetabular Component Loosening
The main symptom of femoral component loosening is usually pain, but depending on your case, you may not have any symptoms. That’s why it is important that you maintain follow-up care after your replacement surgery for the rest of your life. Regular X-rays can show changes that develop in time, indicating that your hip should be revised.
Hip Replcement Infection Symptoms
Symptoms of infection can include pain but may also manifest as a fever or just feeling unwell.
Osteolysis, or Bone Loss
Bone loss can occur when particles, or “wear debris,” exist in the hip joint. This debris can cause inflammation and break down of bone.
Pain from Hardware
The prosthesis used in hip replacement contains hardware like screws, wires and non-organic materials. Sometimes, these materials can cause inflammation or irritation.
Before Your Surgery
There are several things that your surgeon will have you do before your revision hip replacement, including:
- Routine blood tests, to make sure you are infection-free
- CT scan, to determine whether any of your hip components are lose
- X-rays, so that your doctor can have a clear picture of what needs to be done during surgery
- Aspiration of the joint to make sure you are free of infection
- A check-up with your regular physician, to make sure you are healthy before surgery
- Attend to any other physical issues before your revision hip replacement, such as medical, dental or surgical issues
- Arrange for home help during your recovery time
- Ten days before surgery, stop taking any anti-inflammatories or aspirin, since they can cause or worsen bleeding
- Ten days before surgery, stop taking any herbal or naturopathic medications
- Quit smoking as long before your surgery as you can
On Surgery Day
- You will arrive at the hospital and be admitted, usually on the same day as your surgery
- Any last-minute tests may be performed before your surgery
- You will be asked questions by the nursing staff, who will make sure your hospital records are up-to-date
- You will meet your anesthesiologist, who will ask you further questions
- You will change into a hospital gown and shower before your surgery
- The site of your operation will be cleaned and shaved
- You will be moved to the operating room about 30 minutes before your surgery begins
The Surgical Procedure
Your doctor and the nursing staff will explain what will happen during your revised hip replacement surgery, but often, the exact extent of what will need to be done will only be clear to the doctor during the process. Hip revision surgery can be more extensive and while there are not always complications, they may be similar or more frequent than with your first operation.
Hip revision surgery can vary from a simple liner replacement to substituting new components for those already in place. If you have experienced bone loss, the doctor may need to use extra bone (cadaver bone) to repair the joint.
When you wake in the recovery room, your vitals, such as blood pressure, oxygen saturation, temperature and pulse, will be monitored. There will be a dressing at the site of your surgery, and drains coming out of the wound site.
- Hospital staff will perform post-operative X-rays.
- You will be taken back to your room after you wake up and the nurses verify that your vital signs are stable.
- You will have IV-administered pain relief and fluids.
- Usually, one day post-surgery, your drains will be removed. You may then be encouraged to sit in a chair or walk, depending on your doctor’s orders.
- Some amount of pain is normal after surgery, but if your pain feels extreme, be sure to inform the nursing staff.
- Your hip can hold your weight at this point, and a physical therapist will assist you with post-operative exercises designed to strengthen the muscles around it.
- If you have adequate help at home post-surgery, you may be discharged in five to seven days. If not, you will be discharged to a hospital for rehabilitation.
- Your sutures will likely dissolve on their own, but if dissolvable stitches are not used, regular stitches will be removed in around 10 days.
- Your doctor will schedule a post-operative visit before you leave the hospital.
- You will need to walk with crutches for at least two weeks after your surgery and will need a cane in the four weeks following.
Precautions After a Revised Hip Replacement Surgery
You must be sure to treat your artificial hip carefully. DO NOT BEND YOUR HIP AND TURN YOUR FOOT INWARD AT THE SAME TIME. This can cause your hip to dislocate. Other ways you can prevent hip dislocation include:
- Sleep with a pillow between your legs for at least six weeks.
- Try not to cross your legs and bend your hip beyond a right angle.
- Avoid using low chairs.
- Try not to bend over to pick up items from the floor. Instead, wear slip-on shoes or use shoe horns. Grabbers are effective for retrieving dropped items.
- Use an elevated toilet seat for greater ease of up and down movement.
- Avoid showering until after your wound has healed.
- After your wound has healed, you may apply moisturizing cream or Vitamin E to the area.
Be alert for signs of infection. For example, if your wound increasingly looks red or swollen, or you have a temperature over 100.5 degrees, you should contact your doctor.
Because of the risk of infection after surgery, you should take an antibiotic before and after any dental work or additional surgeries. Your doctor will be able to prescribe those for you.
Be aware that when traveling, your hip replacement may set off a metal detector at an airport.
Possible Risks or Complications
As with any major surgery, there is always a possibility of risk or complication. While the benefits of hip revision surgery outweigh these possibilities, it is important to be informed of any risks before your surgery.
Surgery complications can be general (medical), or specific to your hip.
Medical complications may be related to anesthesia or your overall well-being, and may include almost any type of condition, so the list below is not complete. However, complications may include:
- An allergic reaction to a medication
- Loss of blood, requiring a transfusion (which carries a low risk of disease transmission)
- A heart attack, stroke, pneumonia, failure of the kidneys, or bladder infection
- Nerve block complications, which can include nerve damage or infection
- Possibly life-threatening medical conditions that may lead to ongoing health issues, a longer hospital stay, or in rare cases, death
Complications specific to your hip may include:
Hip Replacement Infection
Hip replacement infection is a risk that occurs after any type of operation. When located in the hip, an infection can be either superficial or deep. Rates of infections for this type of surgery can vary. Antibiotics can sometimes be used to treat infection, but you may require further surgery to resolve the infection. Removing the hip eliminates any infection.
Blood Clots, or Deep Vein Thrombosis
Blood clots can form in the calf muscles and move to the lung, resulting in a pulmonary embolism. Pulmonary embolisms can be serious or life-threatening. If you experience pain in your calf or shortness of breath at any point, notify your surgeon, doctor or nursing staff immediately.
A dislocation involves the hip coming out of its socket. With a new hip, you will need to take precautions against this for the rest of your life. A dislocated hip requires you to have it put back into place by a doctor while you are under an anesthetic. Rarely, this can become a recurring problem that requires further surgery.
Fracture (Breaking) of the Thigh Bone or Hip Bone
Fractures of the thigh bone (femur) or hip bone (pelvis) are rare but occur sometimes during or after hip revision surgery. In some cases, this can prolong your recovery or create the need for additional surgery.
Nerve or Blood Vessel Damage
Damage to the nerves or blood vessels is also rare but may lead to loss of sensation or a feeling of weakness in part of your leg. This damage may require further surgery if bleeding is ongoing.
Irritation of the Wound
You may experience some sensitivity or numbness around your scar. This numbness or sensitivity usually decreases in time and does not cause any problems with your new hip.
Unequal Leg length
Matching the length of both legs during surgery is very difficult. Sometimes, the surgeon will deliberately lengthen your leg to make your hip more stable, and sometimes, it just isn’t possible to match the lengths. However, a simple shoe lift on one side can treat this inequality.
Joints will all eventually experience wear. If you are an active person, this wear can occur more quickly. The typical survival of a hip replacement is 15 years, in 80-90 percent of cases.
Pain Relief Failure
This is a rare complication, but sometimes a hip revision will not relieve your pain if the origin of the pain resides in a different area of the body, like the spine.
Thick or Unsightly Scar
Bedsores or Pressure Sores
Limp Caused by Muscle Weakness
If you have concerns before your surgery, discuss them thoroughly with your Orthopedic surgeon.
While surgery is a last choice for most people, if you have arthritis, surgery could mean the difference between you living with debilitating suffering or enjoying a normal, active life. Surgery can often help to relieve your pain and bring back function to your damaged joints.
Hip Replacement Case Studies
- Case Study 1 – Painful Hardware
- Case Study 2 – Total Hip Arthroplasty
- Case Study 3 – Infected Hip Arthroplasty
Why choose Dr. Kakare?
As a top joint replacement specialist in New York City, Dr. Karkare has extensive experience in revision hip replacements, ensuring that patients have the broadest array of safe and effective treatment options to relieve hip pain and other symptoms.
He performs an in-depth evaluation of each patient to determine if an anterior approach could be a good choice or if another approach might be preferred before any procedure is performed,
This enables every patient to make an informed, educated decision so they can feel confident in their care every step of the way.
To schedule your evaluation, call (212)951-0182 or use our online contact form to learn more.