A traditional hip replacement surgery is one in which a mechanical device is implanted into a patient as a means of restoring movement of the hip. As is the case with any mechanical device or surgical procedure, initial hip replacement surgery can be subject to mechanical or biological failure. In either of these cases, a hip replacement revision surgery may be required. A revision surgery is a subsequent operation used to address the reasons behind the hip replacement failure and correct them.
Reasons for Hip Replacement Revision Surgery
Since 2010, in the United States, there are approximately 18 hip revisions for every 100 hip replacement surgeries. Reasons for hip replacement revision surgery can vary but are typical because of repeated dislocation of the device, mechanical failure, or infection.
Recurrent Hip Dislocation
Hip replacements include a mechanical structure that resembles a natural hip joint by having a ball and socket joint. Dislocation occurs when the ball portion of the device is removed from the socket. The ball is typically kept inside the socket because hip replacements are manufactured to have a large range of motion. Dislocation can occur due to trauma or a hip position that forces the ball out of the socket.
Patients can sometimes be prone to dislocations, such as the elderly, or those patients that have undergone several hip surgeries. Once a patient has had a dislocation of their hip replacement implant, further dislocations are likely. Those who have suffered frequent dislocations are possible candidates for hip replacement revision surgery.
It is normal for the various parts of the hip replacement device to rub against one another once they have been implanted. This chafing can cause wear and tear over time. Patients who are younger and more active tend to experience this mechanical failure much sooner than older patients. Hip replacement implants can consist of plastic, cement, metal, or ceramic parts.
Depending on the material, wear and tear can occur more frequently. Certain materials such as plastic and metal can even begin to break apart, distributing debris into surrounding tissues. This debris is often detected by the body as foreign matter and can lead to an allergic reaction.
Infections stemming from a hip replacement surgery are more likely to occur in the first six weeks following surgery. In order to correct the problem, the surgeon must first determine what type of bacteria is causing the infection. Treatments typically involve hip replacement revision surgery, as well as a course of antibiotics.
Infection-based hip replacement revision surgeries typically involve a complete exchange of the hip replacement implant. Revision surgery, in this case, is either done in two stages approximately eight weeks apart or as a single operation.
Hip Replacement Revision Surgery Procedure
Hip replacement revision surgery is considered to be more challenging than the initial hip replacement. Prior to a hip replacement revision surgery, the physician may utilize imaging scans to determine proper positioning of the replacement hip implant.
During the revision surgery, one or more parts may need to be repositioned. Sometimes a completely new hip replacement device is required. The proper healing of the soft tissues surrounding the new implant is imperative for the success of a revised hip replacement. Surgeons will typically advise that their patients wear a brace or even limit certain physical activities following the revision surgery.
Hip replacement revision surgery due to mechanical failure involves removal and replacement of the worn or broken components. Surgeons at this time will also assess the amount of bone loss (if any). Should bone loss be determined, not only will the device be replaced but a bone graft may also be required. Bone loss is more likely to occur if some of the components are metallic. During revision surgery musculature surrounding the hip could also be lost, affecting the patient’s motion and hip function after the procedure.
Results of hip replacement revision surgery are not always predictable and depend heavily on the particular patient and cause of the revision surgery. Each subsequent revision surgery will include a loss of muscular mass and bone. Hip replacement revision surgery it typically a longer process than the initial procedure and complications can be higher. Patients are advised to adhere to any postoperative warnings and medical advice issued by their surgeon, including limited activity.