Total hip joint replacement - revision
Hip revision surgery; Revision total hip replacement; Revision hip arthroplastyHip joint replacement is surgery to replace all or part of the hip joint with a man-made joint. The artificial joint is called a prosthesis. Over time some or all parts of a prosthesis may wear out due to several reasons. The prosthesis may also loosen up with trauma or infection. When this happens, another surgery is needed to replace or repair the artificial hip joint. This is called total hip joint replacement revision.
Hip joint replacement
Hip joint replacement is surgery to replace all or part of the hip joint with a man-made joint. The artificial joint is called a prosthesis....
Read Article Now Book Mark ArticleProsthesis
A prosthesis is a device designed to replace a missing part of the body or to make a part of the body work better. Diseased or missing eyes, arms, h...
Read Article Now Book Mark ArticleDescription
The results of hip replacement surgery are often excellent. Most artificial hip joints last 15 to 20 years before they loosen and need to be replaced again. Revision of hip joint replacement may either require replacement of the whole prosthesis or some of its parts.
You will not feel any pain during the surgery. You will have one of the following types of anesthesia:
- General anesthesia -- This means you will be asleep and unable to feel pain.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark Article - Regional (spinal or epidural) anesthesia -- Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy. And you may get medicine that will make you forget about the procedure, even though you will not be fully asleep.
Spinal or epidural
Spinal and epidural anesthesia are procedures that deliver medicines that numb parts of your body to block pain. They are given through shots in or ...
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After you receive anesthesia, your surgeon will:
- Make an incision following the same line used for the primary (initial) hip replacement surgery.
- Assess the soft tissues for any infection.
- Examine all the parts of the prosthesis to check if any part is worn, loose, or dislocated.
- Remove the existing implant, if required.
- Remove cement, if it was used in the primary surgery.
- Remove the metal stem from the thigh bone (femur), if required.
- Prepare the bone surfaces in the pelvis and femur for the revision implant.
- Use metal parts (augments) or a bone graft for bone reconstruction, if there is significant bone loss.
Bone graft
A bone graft is surgery to place new bone or bone substitutes into spaces around a broken bone or bone defects.
Read Article Now Book Mark Article - Fix specialized implants, specially designed to make up for the damage to the soft tissue and bone.
- Place a temporary drain to collect extra blood or fluid.
Total hip replacement revision surgery takes longer to perform than primary total hip joint replacement. It usually lasts for several hours. In complex cases, it may take even longer.
Why the Procedure Is Performed
Disabling pain is the most common reason for revision surgery. Depending upon the part of the prosthesis that is affected, pain may occur in the hip region, groin, thigh, or knee.
Pain may occur due to:
- Implant wear
- Infection
- Mechanical or septic implant loosening
- Implant failure or breakage
- Repetitive hip dislocation
- Bone degeneration (osteolysis)
- Bone fracture around the artificial hip joint (periprosthetic fracture)
Even if you don't have disabling pain, you still may need revision surgery if your surgeon thinks that the joint will continue to wear out and loosen and make the surgery difficult at a later time.
Revision surgery is not recommended for certain functional problems, such as limb lengthening or painless loss of motion.
These problems are unlikely to get resolved with revision and may even cause greater problems such as recurrent dislocation.
Risks
People at a higher risk of needing revision surgery include:
- Younger, more active people. They may put extra stress on the artificial hip, causing it to wear out earlier and not last as long. Part of or the whole prosthesis may need to be replaced again if that happens.
- People who have had an artificial hip joint for 15 years or longer. Most artificial hip joints last 15 to 20 years. After that, the joint may loosen and need to be replaced again.
Before the Procedure
You will have a complete physical examination several weeks before the revision surgery. This is to check if you are healthy enough for the surgery. If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see your health care provider who treats you for these conditions to see if it is safe for you to have the surgery.
You will have imaging tests to check the condition of your hip and the extent of bone loss around the implant:
- X-rays
X-rays
This test is an x-ray of a knee, shoulder, hip, wrist, ankle, or other joint.
Read Article Now Book Mark Article - CT scan
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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Imaging tests help to determine if there is loosening or other mechanical problems of the prosthesis or its parts.
Your surgeon may order blood tests to determine if you have an infection. Aspiration of hip joint fluid may need to be done to check for infection.
Aspiration
Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (for example, sucking food into the air...
Read Article Now Book Mark ArticleYou may need to make some changes before the surgery.
Tell your surgeon or nurse if:
- You are taking any medicines, including drugs, supplements, or herbs you bought without a prescription.
- You have been drinking a lot of alcohol, more than 1 or 2 drinks per day.
If you smoke you need to stop. Ask your providers for help. Smoking will slow down wound and bone healing. Your recovery may not be as good if you keep smoking.
You need to stop
There are many ways to quit smoking. There are also resources to help you. Family members, friends, and co-workers may be supportive. But to be su...
Read Article Now Book Mark ArticleWound and bone healing
Quitting smoking and other nicotine products, including e-cigarettes, before surgery can improve your recovery and outcome after surgery. Most people...
Read Article Now Book Mark ArticleDuring the 2 weeks before your surgery:
- Prepare your home ahead of time.
Prepare your home ahead of time
Before you go to the hospital for surgery, set up your home to make your recovery and life easier when you come back. Plan and do this well in advan...
Read Article Now Book Mark Article - You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
- You may also need to stop taking medicines that can make your body more likely to get an infection. These include methotrexate, etanercept (Enbrel), or other medicines that suppress your immune system. Make sure you ask your surgeon when it is safe to resume taking these medicines.
- Ask your surgeon which medicines you should still take on the day of your surgery.
- Always let your surgeon know about any cold, flu, fever, herpes breakout, or other illness you have before your surgery.
- You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using a walker or crutches.
- Ask your provider whether you need to go to a nursing home or rehabilitation facility after surgery. If you do, you should check out these places ahead of time and note your preference.
Practice using a cane, walker, crutches, or a wheelchair correctly to:
Cane
It is important to start walking soon after surgery for a leg injury. But you will need support while your leg is healing. A cane can be used for s...
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It is important to start walking soon after a leg injury or surgery. But you will need support while your leg is healing. A walker can give you sup...
Read Article Now Book Mark ArticleCrutches
It is important to start walking as soon as you can after your surgery. But you will need support for walking while your leg heals. Crutches may be...
Read Article Now Book Mark Article- Get in and out of the shower
- Go up and down stairs
- Sit down to use the toilet and stand up after using the toilet
- Use the shower chair
On the day of your surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
After the revision surgery, you will stay in the hospital for several days. The type of care you will receive can be similar to the care you received after primary hip replacement surgery. However, it is important to check with your surgeon as you may need to follow more precautions after a revision surgery.
Stay in the hospital
You will stay in the hospital for 1 to 3 days after having hip or knee joint replacement surgery. During that time, you will recover from your anest...
Read Article Now Book Mark ArticlePhysical therapy will be started as soon as the first day after surgery and will continue for up to 3 months. You will require a walker, cane, or crutches during the recovery phase. As your condition improves, you may use a cane or walk without any aid.
Recovery after revision surgery takes longer than recovery after primary hip replacement surgery. Complete recovery will take 6 months to a year.
Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehab center, you will learn how to safely do your daily activities on your own. Home health services are also available.
Daily activities on your own
After you have hip replacement surgery, you will need to be careful how you move your hip. This article tells you what you need to know to care for ...
Read Article Now Book Mark ArticleOutlook (Prognosis)
Total hip joint replacement revision is a complex surgery. Certain complications are more common after revision surgery than the primary surgery, such as:
- Infection
- Dislocation
- Thromboembolism
Thromboembolism
Deep vein thrombosis (DVT) is a condition that occurs when a blood clot forms in a vein deep inside a part of the body. DVT mainly affects the large...
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- Thigh (femur) bone fracture
- Leg-length inequality
- Blood clots
Revision surgery will help relieve your pain and improve your hip stability and function. However, because it is the second replacement, you may still have some pain or instability following revision surgery.
References
Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 3.
Rizzo TD. Total hip replacement. In: Frontera WR, Silve JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 61.
Review Date: 6/24/2024
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.