Revision Hip Replacement Surgery

Revision Hip Replacement Surgery

A revision (redo) total hip replacement can be a scary and complex issue for a patient. There are many reasons for a revision total hip replacement to be required.  It will be important to identify the exact issue requiring a revision prior to surgery to ensure a positive outcome. This can require an extensive workup, as well as a significant amount of time discussing with the surgeon the reasons for it as well as the problems that can arise because of it. It is important to know that a revision surgery is still a very successful surgery, and the outcomes are generally very good.

Common Reasons for Revision Hip Replacement Surgery

Loosening:

Loosening is when one of the parts of the total hip replacement debonds from the bone itself.  It is an important thing for a total hip replacement to be connected to the bone itself, should it loosen or break free, we will have to replace that, as it can become a painful scenario.  Oftentimes, we can replace only one of the parts, however we will check every part of the hip if we were to do surgery.

Fracture:

While it is very difficult to break the components of a hip replacement, the bone around it is still susceptible to breakage.  If you fall and break the bone around your hip replacement, it may require a surgical intervention.  Sometimes, we can simply fix the bone and not involve the hip replacement itself, sometimes we have to take out one or both of the components and replace it with a more advanced implant, so that you can recover faster and more reliably.

Infection:

Rarely, infections do occur after a total hip replacement.  This can require surgery to clear the infection.  If it is a deep infection, one that involves the joint itself, this will require a surgery to wash the area out, to decrease the amount of bacteria in the area.  If we are unable to clear an infection with this particular type of surgery, there is a chance that we have to do a surgery to remove the implants that are in, and clear the infection, this may require 2-3 surgeries to remove the infection and the implant, and then to ultimately replace the hip with a definitive revision arthroplasty.  These are difficult issues to navigate, and we require multiple types of physicians in the team, including infectious disease specialist, to ensure that you have a positive outcome.

Hardware Breakage:

Because these components are not able to heal themselves after injury, occasionally, these can break.  Should they break, we do have the ability to replace only the broken piece.  Occasionally, we will have to redo the entire hip replacement to ensure that you have a fully functioning hip after surgery.

Instability:

Dislocation, where the ball levers out of the socket, is a difficult problem for a surgeon to resolve.  The reason that it is difficult, is that there are many causes for this.  Occasionally, it is simply an odd position, and it can be resolved with simple restrictions of certain motions.  Occasionally, this can become an issue that arises several times.  This may require a revision surgery.  The revision that would be performed, would be directed at the reason for the instability.  Sometimes, the components can be in a less than ideal position, and they may need to be reoriented.  Sometimes, the ligaments of the hip itself are too loose to hold the hip in place, and they can be tightened, usually by adjusting one of the components of the primary hip replacement.  Sometimes, there is an injury or dysfunction of the muscles, and these can be adjusted as well.   Unfortunately, instability can be a persistent problem, even after a revision surgery.  It will be important to have a discussion between you and your surgeon regarding the surgery to be done, the postoperative rehabilitation, and the expectations at the end of your recovery.

Leg Length Differences:

Dislocation, where the ball levers out of the socket, is a difficult problem for a surgeon to resolve.  The reason that it is difficult, is that there are many causes for this.  Occasionally, it is simply an odd position, and it can be resolved with simple restrictions of certain motions.  Occasionally, this can become an issue that arises several times.  This may require a revision surgery.  The revision that would be performed, would be directed at the reason for the instability.  Sometimes, the components can be in a less than ideal position, and they may need to be reoriented.  Sometimes, the ligaments of the hip itself are too loose to hold the hip in place, and they can be tightened, usually by adjusting one of the components of the primary hip replacement.  Sometimes, there is an injury or dysfunction of the muscles, and these can be adjusted as well.   Unfortunately, instability can be a persistent problem, even after a revision surgery.  It will be important to have a discussion between you and your surgeon regarding the surgery to be done, the postoperative rehabilitation, and the expectations at the end of your recovery.

 

Dr. Budny will review non-surgical treatment options for hip pain with you and only recommend surgery if absolutely needed.