Introduction
This means that part or all of your previous hip replacement needs to be revised. This operation varies from very minor adjustments to long operations where all implants need to be replaced.
Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) with a plastic liner in between to restore joint movement
Why do hip replacements occasionally need to be revised?
Plastic (polyethylene) wear. This may require a simple procedure to change the polyethylene insert or may require a more extensive revision
Hip instability causing dislocations
Loosening of either the femoral or acetabular component.This usually presents as pain due to motion or micro-motion between the implant and the host bone.
Infection
Osteolysis (bone loss)This can occur due to particles being released into the hip joint that results in erosion of bone
Pain from hardware e.g. cables or wires causing irritation of overlying soft tissues
Pre-operation
- Blood tests, X-Rays and relevant scans will be organised
- You may be asked to undertake a general medical check-up with a physician
- You should have any other medical, surgical or dental problems attended to prior to your surgery
- Make arrangements for help around the house prior to surgery
- Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
- Cease any naturopathic or herbal medications 10 days before surgery
- Stop smoking as long as possible prior to surgery
Day of your surgery
- You will be admitted to hospital usually on the day of your surgery
- Further tests may be required on admission
- You will meet the nurses and answer some questions for the hospital records
- You will meet your anesthetist, who will ask you a few questions
- You will be given hospital clothes to change into and have a shower prior to surgery
- The operation site will be shaved and cleaned
- Approximately 30 minutes prior to surgery, you will be transferred to the operating room
Surgical Procedure
The surgery varies from a simple liner exchange to changing one or all of the components. Donor bone from the NSW Bone Bank may be required to make up for any bone loss.
Post-Operation Course
You will wake up in the recovery room with a number of monitors to record your vitals. (Blood pressure, pulse, Oxygen saturation, temperature, etc.) You will have a dressing on your hip.
Post-operative X-rays will be performed in recovery.
Once you are stable and awake you will be taken back to the ward.
You will have one or two IV’s in your arm for fluid and pain relief. This will be explained to you by your anesthetist.
On the day following surgery you will be allowed to sit out of bed or walk with a frame under the supervision of the hospital physiotherapist.
You will be able to put all your weight on your hip and your physical therapist will help you with the post-op hip exercises.
You will be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your pain and help at home.
The sterile waterproof dressing is left intact for 14 days. It is safe to shower and enter the hydrotherapy pool.
Dissloving sutures are used.
You will progress from the walking frame to crutches and then to a stick in your own time, assisted by the physio staff.
Special Precautions
- You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle
- Avoid low chairs
- Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
- Elevated toilet seats are helpful
- You can apply Vitamin E or moisturizing cream into the wound once the wound has healed
If you have increasing redness or swelling in the wound or temperatures over 38 degrees you should call your doctor.
If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.
Your hip replacement may go off in a metal detector at the airport.
Risks and Complications
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to the Hip
Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission. Medications are given to minimise blood loss during and after surgery.
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns and prolonged hospitalization.
Specific complications to the hip include
Infection
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates vary but in my units is very rare. If it occurs it can be treated with antibiotics but may require further surgery. Very rarely the hip may need to be temporarily removed to eradicate infection. Antibiotics are routinely given to prevent infection.
Blood Clots (Deep Venous Thrombosis)
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify the medical team. Medications are routinely given to prevent blood clots.
Dislocation
This means the hip comes out of its socket. Precautions need to be taken with your new hip. If a dislocation occurs it needs to be put back into place with an anesthetic. Rarely this becomes a recurrent problem needing further surgery.
Fractures of the femur or pelvis
This is also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery.
Damage to Nerves or Blood Vessels
Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery.
Wound Irritation
Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.
Leg length inequality
Hip stability is more important than leg length. In some cases it may be necessary to slightly increase the leg length to ensure hip stability. Leg length inequalities can be treated by a simple shoe raise on the shorter side.
Wear
Modern hip replacements wear rates are very low. Most patients undergoing a modern hip replacement will never require revision surgery.
Failure to relieve pain
Very rare but may occur especially if some pain is coming from other areas such as the spine.
Unsightly or thickened scar
Pressure or bedsores
Limp due to muscle weakness
Please feel free to discuss any concerns with me or my team your prior to surgery.
Summary
Revision hip replacement is complex surgery but is usually very effective in achieving its aim of providing a stable, durable, painless, functional hip joint.
