Revision Total Hip Replacement

What is a Revision Hip Replacement?

A Revision Hip Replacement is replacement of your artificial hip and is performed because of the failure of your previous hip replacement.

What does Revision Hip Replacement involve?

Revision Hip Replacements are technically more demanding than Primary Replacements and because of their complexity are associated with a higher risk of complications and longer recovery times. Surgeons will often refer to a colleague who performs these procedures on a more frequent basis. Dr. Thornton-Bott is a sub-specialist in Revision Hip Surgery and is regularly referred to, to perform Revision Hip Replacements.

Revision Hip Replacement can involve the removal of the full initial implant or just some components of it and the replacement of those parts. Revision Hip Replacement procedures are highly variable, as the operation depends on the problem causing failure of the original implant. Artificial bone graft or donor bone may be used in this type of surgery.

General precautions

The hip replacement that you have had is an artificial joint and will have been far more challenging to remove than the implanting of the first. It is important that you take necessary precautions to prevent complications. Listed below are some of the precautions to be taken particularly in the first 6-8 weeks. Your physiotherapist will discuss these and others with you in greater detail prior to your discharge from hospital as well as during your follow up visits post surgery.

Contact your doctor if you notice any redness, leaking fluid or have an increased pain in the operated area
Do not bend the hip more than a right angle as this could cause the hip to dislocate or pop out of the joint.
Do not force the hip to bend to reach your toes such as to clip your toe nails or put on your stockings.
Do not cross your legs.
Do not bend down to the floor to pick up objects.
Avoid low chairs and toilet seats.
Do not twist the hip.
Do not lie on your side for the first 6 weeks.
In the longer term, you need to avoid the small risk of the spread of infection to the hip should you have an infection anywhere else in the body. If you are undergoing an operation, internal examination or even dental work, remember to inform your doctor/dentist, so that they can consider putting you on antibiotics as preventative a measure.

What are the success rates if I choose Total Hip Replacement surgery?

Hip replacement surgery is a very successful operation and over 95% of patients are expected to achieve an excellent outcome. This means pain free, good range of motion (ROM) and the ability to get back to both normal activities as well as active sports and recreational activities. Dr. Thornton-Bott aims to provide you with a ‘Forgotten Joint’. i.e. you forget that you have had a hip replacement performed. The ability to achieve this comes with surgical skill and experience.

Risks of Revision Hip Surgery

Thrombosis - As revision surgery is more prolonged and the condition of the soft tissues and bone often not as good as when first time surgery is carried out, patients undergoing revision surgery are at a higher risk of thrombosis. Patients undergoing this type of surgery may not be as mobile as patients having first time surgery. This may contribute to the higher risk of blood clot formation.
Infection - This is definitely one of the more serious complications. In order to reduce the risk of infection, patients are given antibiotics routinely just prior to the surgery and for two doses after.
Change in the length of the leg - Revision surgery can result in changes to your leg length. Often the quality of the soft tissues and the bone available to work with is not the same as it is at the point of the primary surgery. Usually the discrepancy is small and a shoe raise on the shorter side is all that is required.
Dislocation - The risk of dislocation after revision surgery is higher than after primary surgery, the risk is about five in a hundred. The risk is highest in the first few weeks after the surgery, this is why we ask patients not to lie on their side, to not bend their hip more than a right angle such as when sitting in a low chair or attempting to bend to the floor or reach for their toes. Also simple actions like crossing your legs or twisting of your hip could cause a dislocation and should be avoided.
Nerve injury – In rare cases the sciatic nerve may get injured. No surgeon wants this injury to occur, and will do everything to avoid the area of the nerve, however anatomical variations can sometimes conspire. In the unfortunate situation when the injury does occur, it usually involves only a portion of the sciatic nerve and is reversible. In other words, a substantial recovery takes place over time in the majority of patients. It is a slow process.
Fracture of the thigh bone - A fracture of the thigh bone is a risk during a revision operation and certainly more so that at the time of primary surgery. This is again due to the soft tissue and bone quality. The tissue can be quite hard, inflexible and stuck down and the bone quality in terms of strength is often poor.
Loosening of the artificial hip - As with primary hip replacement surgery, there is no guarantee that the revised hip will last a lifetime. Revision hips can loosen in just the same way as the primary ones. As with primary surgery, it is important for patients to have regular check ups after the operation to pick up any signs of failure so that the problem can be dealt promptly. This is because a loose hip replacement can be causing damage to the bones without producing pain or other symptoms. This progressive damage can remain unknown to the patient and may be discovered only during a chance x-ray for an unrelated reason or only after the bone cracks and becomes painful and the operation becomes even more complex. Occasionally a revision operation is undertaken based upon the X-rays alone even though the patient may not be experiencing any symptoms.

Please talk to Dr. Thornton-Bott before your operation if you have concerns about possible risks. We hope the information provided has been useful to you. Before moving forward with a revision hip replacement, I will discuss the whole procedure with you in detail.