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Revision Total Hip Replacement

Dr. Lingaraju A P - Consultant Orthopaedic & Joint Replacement

What is Revision Hip Replacement Surgery?

Although Total Hip Replacements is the most successful procedures in all of medicine, problems can develop over time. These problems may require a revision procedure to replace the original components. Revision Hip Replacement is a surgical procedure that involves the replacement of prosthetic implants with a new implant in a person who previously had a total hip replacement.

When do you require Revision Hip Replacement Surgery?

If you are suffering from severe hip pain while standing, walking and stair climbing, instability in the hip and discharging pus from the hip joint in a previous total hip replacement. You will require Revision Hip Replacement surgery.

Revision Hip Replacement
What are the common conditions requiring Revision Total Hip Replacement surgery?
  1. Implant Loosening and Wear: The common causes of implant loosening are high-impact activities, excessive body weight, and wear of the plastic liner between the ball and the metal cup.

Patients who are younger when they undergo the initial hip replacement may “outlive” the life expectancy of their artificial hip beyond 20years.

  1. Infection: Infection is a potential complication in any surgical procedure. Infection may occur immediately after your primary total hip replacement or some years later. You will start noticing fever, pain, swelling, stiffness and pus drainage from the operated hip.
  1. Recurrent dislocation of Hip: A hip replacement has a ball-and-socket structure like that of a natural hip. For a hip replacement to work well, the ball must remain inside the socket. Trauma or certain hip positions can sometimes cause the ball to become dislodged from the socket. This is called a “hip dislocation.” If you experience recurrent hip dislocations, you may need revision surgery to better align your hip joint or to insert a special implant designed to prevent dislocations.
  1. Fracture: Fractures around the components of a total hip replacement can happen due to fall. These are called per prosthetic fractures of hip. These per prosthetic hip fractures require Revision Hip Replacement surgery.
Any age limit to undergo Revision Total Hip Replacement surgery?

No age bar to undergo this surgery. Your physical fitness and medical conditions are important. We have done revision hip surgeries even at the age of 90 years.

How the Revision Total Hip Replacement surgery done?

To begin with, the hip joint will be opened through the line of the incision made during your primary total hip replacement. All the original implants along with cement are removed by preserving as much bone as possible. The bone surfaces for the revision implant are prepared. All bony defects assessed. New implants with added extra-long rods and augments are re-fixed to the bone with cement.  An ultra-high molecular weight polyethylene cup is inserted between the metal components to create a smooth gliding surface. Now your hip joint moves in a normal way.

How the Revision Total Hip Replacement surgery is done in presence of Infection: Revision Total Hip Replacement surgery for infection can be done in one of two ways, depending on the type of bacteria, how long the infection has been present, the degree of infection, and patient preferences.

Debridement: In early and mild infections, the bacteria can be washed out, the plastic cup can be exchanged, and the metal implants can be left in place.

Staged surgery: In severe long-standing infections revision surgery is performed through two separate surgeries. In the first surgery, all the implants will be removed along with cement and a temporary antibiotic spacer will be inserted to control the infection. This spacer will remain in the hip for several weeks. During this time, you will also receive intravenous antibiotics. When the infection has been cleared, a second surgery is done to remove the antibiotic spacer and new implants with added extra-long rods and augments are re-fixed to the bone with cement.  An ultra-high molecular weight polyethylene cup is inserted between the metal components to create a smooth gliding surface. Now your hip joint moves in a normal way.

 

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