Revision Hip Replacement
What is revision hip replacement surgery?
A revision hip replacement operation is any surgery in which parts of a previously performed total hip replacement are re-done or replaced. This can range from a relatively minor change of the ball or plastic liner, to a major operation involving replacing the entire prosthesis and managing defects in the surrounding bone.
Why is a revision total hip replacement performed?
There are many reasons why a revision hip replacement could be required. The most common of these are loosening or wear of the old implants, infection, recurrent dislocation, fracture or adverse reaction to metal debris. Click this link to learn more about the reasons for revision hip replacement.
How is the surgery done?
As with primary hip replacement surgery, most revision operations are performed under spinal anaesthetic. This involves a small injection in your back that makes the lower half of your body completely numb for around four hours. If you prefer to be asleep for your surgery you will be given medication via a drip in your arm to make you sleep. Revision hip replacement is more complex and takes longer to perform than a first time hip replacement. The operation can take anything from 90 minutes to four hours or more.
After an incision is made in your upper thigh, the worn or problematic old implants are removed. Any implants which are still in good condition are left undisturbed. Often the previous implants or old bone cement can be stuck firmly to your bone. These need to be removed very carefully to preserve as much bone as possible. Once the old implants are removed, the bone is cleaned thoroughly and made ready to accept the new implants. The implants used for revision surgery are specially designed to accomodate for bone loss, and are often much larger and more complex to insert than the original prosthesis. Multiple screws may be required to make the implants stable. Sometimes additional metal implants called augments, or donated bone graft are required to build up areas in which there has been significant bone loss. The final construct is tested, and the skin is closed with dissolving stitches. Dressings are put on, including paper stitches (steri-strips) and a waterproof dressing. You will be taken to the recovery area to wake up and an x-ray will be taken of your new hip joint while you are there.
WHAT IS THE RECOVERY AFTER SURGERY?
Much of the inital recovery after revision hip surgery is the same as for primary (first time) hip replacement. After surgery is complete, you will be taken to a ward in another part of the hospital. If you have had a spinal anaesthetic your legs will stay numb for another 2-3 hours. You can eat and drink normally as soon as you feel ready. Your nurse will monitor your pulse, blood pressure and oxygen levels and provide you with pain relief and anti-nausea medication as required. It is better to keep on top of pain instead of trying to be tough. You will have foot pumps on your feet to help keep your circulation moving and prevent blood clots in your legs. Moving your feet regularly yourself also helps to prevent clots.
As revision surgery is often longer and more complex than your first hip replacement the recovery may take longer. Even considering this, most patients are able to get out of bed and even walk a few steps on the day after surgery. You will need to stay in hospital for 2-7 nights after surgery, depending on your recovery. Mr Gormack will come and check on you each day while you are in hospital. A physiotherapist will also see you daily; they will teach you how to walk with a frame or crutches, and give you exercises to do yourself. If there is major bone loss, there may be restrictions on the amount of weight you are allowed to take on your leg. Once you are confident and safe to walk around and do your daily activities independently, you will be able to go home. Before you go home you will also be taught ‘‘hip precautions”; these are ways to avoid a hip dislocation.
Full recovery from surgery may take several months. You will be able to gradually increase walking distance and duration over this time. You should keep using crutches for the first six weeks after surgery, unless otherwise instructed. You will need to have your wound checked 10 – 14 days after surgery. For convenience, you can choose to have this done at Mr Gormack’s clinic or by your own GP. Pain levels will steadily decrease. You will be given prescriptions for any pain relief you need by your anaesthetist. You will have an appointment booked to see Mr Gormack six weeks post surgery. If there are any concerns earlier, please call or email the clinic.
What are the results of revision hip replacement?
The majority of patients who undergo revision surgery experience favorable long-term outcomes, including relief from pain and better function. Problems such as infection or dislocation can be solved in around 90% of cases. Due to the more extensive surgery involved, a revision hip replacement is often never quite as good as the initial hip replacement. Complete pain relief and restoration of function are not always achievable; some patients may still experience some pain or dysfunction.
what are the risks of surgery?
As with any surgical procedure, there are risks associated with revision total hip replacement. Because the procedure is longer and more complex than primary total hip replacement, the risk of complications is higher. Before your surgery, Mr Gormack will discuss each of the risks with you and will take specific measures to help avoid potential complications.
The possible risks and complications of revision surgery include:
Infection
Bleeding
Nerve damage
Blood clots in the legs or lungs (DVT / PE)
Dislocation
Fracture
Leg length difference
Medical events after surgery such as heart attack, kidney injury, stroke, pneumonia.
When can i drive and when can i return to work?
Revision hip replacement is more variable than primary hip replacement. Therefore any recommendation regarding returning to activities will require an individual assessment of your circumstances, and is based on what was discovered during your surgery. As a rough guide, returning to driving and working will take at least six weeks, and may be significantly longer.