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Revision hip replacement surgery is a procedure to replace a worn out hip replacement implant. Hip replacements are among the most common procedures performed by orthopedic surgeons. This surgery is incredibly successful, and have excellent results in the vast majority of patients. The problem, unfortunately, is that over time hip replacements wear out.
The problem of revision hip replacement
Revision hip replacements are more complicated surgeries and the outcomes are not as good as the first hip replacement. Technical problems include the quality of the bone and the ability to adequately secure the revision hip replacements into position. Furthermore, removing the old hip replacement can necessitate more extensive surgery. Together, these problems often require the revision hip replacement to be much more complex. Careful planning by your orthopedic surgeon is needed to ensure he or she will be able to construct a hip that will allow you to adequately recover.
Another problem with revision hip replacement is that the surgery itself can be more complicated. Patients tend to be older, and less tolerant of long surgical procedures. The procedure is technically more difficult that primary hip replacements, and the effects on the patient are more significant (longer surgery, more blood loss). Because of this, revision hip replacement must be carefully considered and planned. Involvement of general medical doctors, anesthesiologists, and the orthopedic surgeon are all important.
revision hip replacement involves longer operating time and increased blood loss, and may require an increase in the length of the hospital stay. A mini-incision operation is not possible for revision surgery, even though some revision cases are relatively straightforward. Much depends on how difficult it is to remove the prosthesis, and on the quality and quantity of bone left behind after the implant has been removed.
The trochanter bone may need to be cut to remove the implant. Wires may be needed to hold the parts together until the bone has healed. Bone grafts from your pelvis and/or from a bone bank may be needed if defects need to be filled with bone. With bank bone, infections can be transmitted in the same way as with blood transfusions (see Disease Transmission Through Blood Transfusion).
The approaches are the same as when performing primary hip replacements but the surgical approach can be extended for increased exposure for what is a more complex procedure.
Advantages
Relief of pain and restoration of hip function
Return to a full and active life style
Disadvantages
Failure of the hip implant over time
In several cases, bone grafts are needed. This involves addition of bone material to reconstruct the acetabulum (hip socket) from where bone was removed to fix the prosthesis. It can be an auto-graft (bone taken from other parts of one's own body- e.g. pelvis) if the requirement is very small. If more bone is needed, the hip surgeon will use an allograft (donor bone). Due to concerns like contracting HIV or hepatitis, the bone tissue needs to be screened thoroughly for infectious agents and proper processing.
Inherent risks of surgery
After grafting, you are advised to avoid putting weight on the operated hip for three months or so. This time is needed for the graft to grow into solid bone. This can be a lot of hard work and you will need crutches for some time. Patients for revision surgery are typically older and less able to cope with long procedures and blood loss.
As more primary arthroplasties are performed particularly in young patients to try and attain an improved quality of life the risk of revision surgery increases. The problem with revision surgery is that removal of the hip prosthesis and replacement with a second, third and even fourth artificial joint requires increased technical skills, an array of specialist equipment and bone grafting facilities. These complex operations have a longer operation time, a longer rehabilitation and a higher complication rate. Unfortunately it is not the same as replacing a mechanical part where once the new part is in place the machine continues to perform as if it were new.
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