Although hip replacement surgery is generally a very successful procedure, complications may arise during or after the original surgery that require correction with a secondary procedure (revision total hip replacement) to remove the old implants and replace them with new components. Current hip replacements may last as long as 20 years; however, as a greater percentage of young patients undergo hip replacement surgery, and as the expected lifespan of the senior population continues to rise, increasing numbers of joint replacement patients will outlast their implants and require revision hip replacement surgery.
There are a number of reasons why a prosthetic hip joint may fail, including:
- Damage or deterioration of the artificial joint – implants are made from metal and plastic that are subject to wear over time
Osteolysis (bone loss)
- Injury or trauma to the hip region resulting in fracture or implant failure
- Loosening of the implant – may result from friction of the joint surfaces causing wear or aseptic loosening, wherein the body attempts to reject the prosthesis
- Infection – there are multiple factors that increase the risk for infection including obesity, renal failure, rheumatoid arthritis, avascular necrosis, previous surgery and many other conditions that affect the normal immune function of the body (i.e. cancer)
- Dislocation: refers to the sudden migration of the implant from its normal position, and is typically the result of the prosthesis loosening, inadequate soft tissues, incompatible component position, neurologic factors, or patient noncompliance with activity restrictions
Younger, more active patients are more likely to require revision hip surgery, as are obese patients, and patients whose primary hip surgery was performed to treat avascular necrosis, inflammatory arthritis, or a previous hip fracture.
If you have previously undergone hip replacement surgery and are experiencing any of the aforementioned issues, you should consult with an orthopaedic specialist to determine if a subsequent hip surgery will be necessary.
Revision total hip replacement surgery is a complex procedure that requires specialized tools and implants, meticulous preoperative planning, and mastery of complex surgical techniques to achieve a successful outcome. For these reasons, it is critical that you select a surgeon who has extensive experience performing revision total hip replacement procedures. Dr. Lige Kaplan is a talented orthopaedic surgeon with extensive training and experience in revision surgery. He will work with you to understand the benefits and risk of revision surgery, and whether it is right for you. He will address any concerns you might have and work hand-in-hand with you to ensure that you are completely comfortable with your customized treatment plan.
Procedure and Recovery
When making the surgical incision for your revision total hip replacement surgery, Dr. Kaplan will either utilize the previous incision, or create a more-extended incision to facilitate exposure. He will then evaluate your existing bone quality, remove any failed components, and reconstruct the remaining bone and soft tissue structures. Lastly, he will affix the new components to the bone, either through bone growing into small pores in the outer layer of the implant or by cementing the construct into place. Once the new components are securely in place, Dr. Kaplan will suture the tissue layers closed. In some cases, a surgical drain may be placed to collect any excess fluids or blood from the hip joint and surrounding tissue. The average procedural time for this surgery is approximately 1.5-3 hours for operating time and he will do the best to minimize pain and narcotic usage postoperatively.
You may be given a brace or splint to protect your joint during the healing process, and may participate in physical therapy for approximately 3 months to improve muscle strength and help you adapt to your new joint. Weight-bearing activities may be restricted for 6-12 weeks, and you will be advised about precautions regarding sitting, bending, and sleeping positions. Although assistive devices (i.e. crutches, walker) will be used early in the convalescence period, the ultimate goal is for patients to progress to the use of a cane, or no assistive device at all. Patients adhering to their therapeutic protocols typically observe gradual improvements in strength and limp over 1-2 years.
The rehabilitative process after revision surgery is longer, slower and more unpredictable than primary or first-time joint replacement surgery. Recovery and ultimate outcome varies widely and will depend on patient factors (age, comorbidities, weight, compliance), amount of bone loss and magnitude of surgery.
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