Revision Total Hip Replacement Surgery

Total Hip Replacements are an extremely successful procedure and allows many people to continue living an active lifestyle. However, on rare occasion a total hip replacement may fail for several reasons. Should your total hip fail, your physician may recommend that you have another operation to remove and exchange some or all of the components. While the goal of a revision total hip replacement is to improve function and pain, a revision surgery is can be significantly different than a primary total hip replacement as it is often a longer, more complex procedure.

It may require extensive planning and the use of specialized equipment.

Reaction to Metal Ions

With long-term use, the metals in implants can break down and cause inflammatory reactions in the soft tissue. This is often exacerbated in metal-on-metal hip replacements. Should there be significant damage to the bone and soft-tissue a revision surgery may be needed.

Heterotopic Ossification

Frequently after a total hip replacement, there are areas within the muscle that can calcify, which is referred to as 'heterotopic ossification'.

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Heterotopic ossification is usually benign. In rare cases it can limit motion to the point where a surgery may be required to remove the excess calcium deposits.

Fracture

A broken bone can occur around the components of the implant. This broken bone, also known as a fracture often requires surgery. Evaluation of a fracture involves analyzing the amount of remaining bone, loosening of the implant, and the location of the break.

Implant Wear and Loosening

The cause of loosening is not always clear.

Repetitive high-impact activities, high bodyweight and wear of the plastic liner between he ball and metal cup may be contributing factors. Patients who undergo the hip replacement at a young age may outlive the life expectancy of a total hip. Sometimes tiny particles generated by wear of the plastic liner are attacked by the body's immune system. The immune system may attack healthy bone around the implant, leading to a condition called 'osteolysis'.

Infection

Infection occurs when bacteria attached in and around the surface of the prosthesis. Infection may occur while in the hospital, after you return home, or years later. Your risk for infection depends on any underlying medical conditions you may have and risks from exposure. An infected total hip may cause pain, instability, and drainage. Options for a infected total hips include explant, revision, debridement, or antibiotic suppression. Multiple surgeries are often required to treat an infected total joint.

Recurrent Dislocation

The hip joint is a ball-and-socket joint. An artificial hip is at a higher risk for a dislocation than a native hip. Trauma and certain hip positions may cause the ball to dislodge from the socket. If you have multiple dislocations you may need a surgery to realign your hip socket or insert a specially designed implant to prevent hip dislocations.

Preparing for Surgery

A revision total hip may require more extensive preparation. Your previous medical charts will need to be reviewed. You will need to obtain an x-ray. Occasionally more advanced imaging such as a CT or MRI may be required. Often laboratory tests will need to be obtained to determine if there is an infection or a reaction to metal components in your hip.

Risks

Many of the risks of a revision total hip are similar to the original operation. Some of your risks may be higher due to your medical complication or the nature of your surgery.

Risks include:

Blood clots

Blood loss

Infection

Implant loosening

Fracture

Dislocation

Leg length inequality

Heterotopic ossification

Nerve or blood vessel damage

Your surgeon will take great care to minimize the risk of complications. If you have any questions, your surgeon will be happy to answer them.