Hip Revision
Introduction
Revision Hip Replacement means that part or all of your previous hip replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone.
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.
Hip Bone
The hipbone is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts, the ilium, ischium, and pubis, which are distinct from each other in the young subject, but are fused in the adult; the union of the three parts takes place in and around a large cup-shaped articular cavity, the acetabulum, which is situated near the middle of the outer surface of the bone.
Why (Reasons) Hip revision
Pain is the primary reason for revision. Usually the cause is clear but not always. Those hips without an obvious cause for pain, in general, do not do as well after surgery.
Dislocation (instability) which means the hip is popping out of place.
Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. It is for this reason why you must have your joint followed up for life as there can be changes on X-ray that indicate that the hip should be revised despite having no symptoms.
Infection-usually presents as pain but may present as an acute fever or a general feeling of unwell.
Osteolysis (bone loss). This can occur due to particles being released into the hip joint which result in bone being destroyed.
Pain from hardware e.g. cables or wires causing irritation.
Hip Revision Surgical Procedure
The surgery is performed under spinal, general or epidural anesthesia. A combination of techniques are used.
The surgeon makes an incision along the hip exposing the hip joint.
The femur (hipbone) is separated from the acetabulum (pelvic socket).
The old plastic liner and the metal socket are removed from the acetabulum.
The acetabulum may be prepared with extra bone to make up for the socket space. Sometimes wire mesh may also be necessary to hold the socket shape.
The new metal shell may be press fit or fitted with screws. Occasionally cement may be used depending on the surgeon’s preference.
A plastic liner is fitted to the metal socket.
The surgeon then concentrates on the femur. The damaged bone is cut.
To remove the femoral component, the bone around the component may be cut.
The parts of the bone are cleared of any old cement.
The new femoral component is pressed or cemented into place.
Wires may be used to hold the bone and femoral component.
Then a ball made of metal or ceramic is placed on the femoral component. This ball acts as the hip joints original ball.
The ball and socket are fixed in place to form the new hip joint. The muscles and tendons are then approximated.
Drains are usually inserted to drain excessive blood.
Remember this is an artificial hip and must be treated with care.
AVOID THE COMBINED MOVEMENT OF BENDING YOUR HIP AND TURNING YOUR FOOT IN. This can cause DISLOCATION. Other precautions to avoid dislocation are:
Do's
You should sleep with a pillow between your legs for 6 weeks
An elevated toilet seat should be used
Don'ts
Avoid the combined movement of bending your hip and turning in your foot
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
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.