Revision Total Hip Replacement

Revision total hip replacements at The Runnymede

What is revision hip surgery?

Unfortunately not all hip replacements last forever. Very few hip replacements run into early problems. Most replacements wear out at a later date, requiring a revision of the hip replacement.

Revision surgery is more complicated than a primary hip replacement and the nature of surgery required is different in every case.

Occasionally an isolated socket or femoral stem can be replaced but in the majority of cases both components need to be revised.

The duration of surgery, the length of the hospital stay and the post-operative recovery may be more prolonged.

As part of the surgery bone graft may be required. This is often obtained from a bone bank.

Sometimes in order to remove the femoral component an extended trochanteric osteotomy has to be performed (a bony window at the top of the femur).

This is repaired using cables and requires 6 weeks to 3 months to heal in most cases.

During post-operative mobilisation restricted weight bearing may be required for a period of 4-6 weeks and sometimes three months with the help of crutches or a walking frame.

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This 42 year old patient with rheumatoid arthritis had fractured around the stem of his total hip replacement. This was repaired using a long stem with distal locking screws. Unfortunately the bone did not heal, his leg was slightly short and the hip was dislocating. A revision hip replacement was performed using a long uncemented stem, strut bone graft and a captured liner was placed. At 6 months he is essentially pain free, his bone graft is incorporating and he has had no further dislocations.

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Why may a revision operation be required?

The three most common reasons for requiring a revision total hip replacement is aseptic loosening, infection and recurrent dislocation.

Aseptic loosening

A common cause of failure of the prosthesis is the wearing out of the bearing (junction between femoral head and socket). The wear particles produced by everyday use of the hip may cause a process known as “osteolysis”. Osteolysis is the resorption of bone around the hip replacement which will ultimately cause the implant to fail.

Infection

The chance of infection following total hip replacement is 1-2%. If the infection is caught early (3-6 weeks post surgery) it may sometimes be successfully treated by debridement (clearing away of non viable tissue) and exchange of some of the modular parts of the hip replacement.

If infection can not be cured by this method a two stage revision may be required. At the first stage the implant, cement (if present) and all non-viable tissue will be removed. An antibiotic loaded spacer will be placed which will allow the patient to function reasonably well. Intra-venous antibiotics will be administered for 6 weeks.

Provided that blood tests and clinical examination show that the infection has been cured, the patient may proceed to second stage at about three months. At that stage the definite revision total hip replacement can be carried out.

Dislocation

Recurrent dislocation of a primary or a revision hip replacement is fortunately quite rare. In the majority of patients a cause can be identified why the hip dislocates and in certain cases corrective surgery can be performed. In a select number of patients this may involve a captured liner which enclosed the femoral head and considerably reduces the chance of further dislocation.

   
Sometimes a dual mobility cup (Picture left) or a constrained liner (Picture right) reduces the chance of hip dislocation.
 

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What are the possible complications following revision hip replacement?

The complications for revision total hip replacement are the same as for primary total hip replacement however the chance of them happening is higher.

  • The infection is slightly higher in revision hip surgery (3-5%).
  • There is a higher risk of dislocation for 12 weeks after revision hip surgery.
  • There is a chance that your leg may be shorter or longer than it was before the operation.
  • The femur bone can be fractured during surgery, requiring extra repair procedures.
  • The range of motion of your new hip may be less than after first-time hip replacements.

Patients who have revision operations are frequently advised to use a walking stick, full-time, in order to protect the replacement from re-loosening.

This 63 year old gentleman presents with a failed total hip replacement. There is extensive osteolysis (bone loss) in the acetabulum (socket) of the hip. The socket was reconstructed using bone graft, mesh and a reconstruction cage. At 6 months he is pain free and is planning his retirement activities.
 

Please remove this case of the 63-year-old gentleman with the two cases below.

This 51 year old gentleman has a ceramic on ceramic hip for 23 years which had suffered aseptic loosening. The technique of impaction bone grafting was used to reconstitute the bone stock and a new hip placed. The increased bone stock will be an advantage if a further revision hip procedure will be required in the future.

This 78 year old gentleman had a 27 year old hip that had loosened. He had his hip revised with a titanium long femoral stem and a cup-cage construct to rebuild the socket of the hip.

Information on revision total hip replacement