"It is one of the most difficult areas of orthopedic surgery. With the experience of the surgeon and the help of implants (platinum), good results can be obtained even in the most difficult cases."
Why consider a hip revision?
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
Preoperative investigations of patients who will undergo revision surgery are more extensive than those for patients who will undergo a primary surgery. Often times, special radiographic (X-ray) projections, CT scan, or MRI imaging of the hip may be necessary to determine position and fixation of the replacement parts (components), and to determine precisely the extent of bone loss around a failed implant.
Reasons for hip revision Hip revision operations are performed relatively infrequently. In the United States, there are approximately 18 revision hip replacements performed for every 100 hip replacements. The most common reasons for revision are: a. Repetitive (recurrent) dislocation of a hip replacement b. Mechanical failure (implant wear and tear – loosening or breakage) c. Infection
Preventing the need for revision hip surgery
It is vital for a hip replacement patient to be aware of the risks of infection and implant failure, and to monitor themselves postsurgery. Some of the above-mentioned forms of failure can be prevented.
Dislocations can be prevented by following the surgeon’s instructions. Some forms of hip infection can be prevented by prompt treatment of other bodily infections and by taking antibiotics before certain dental and other procedures.
The natural wear and tear of a prosthesis generally causes no pain or discomfort. Therefore, it is very important for the patient to have his or her hip replacement regularly checked. A simple physical examination and radiographs (X-rays) are necessary at intervals designated by the surgeon. If excessive wear and/or bone loss is detected at any time, close monitoring is necessary to determine the best possible time (if any) to have the hip replacement revised.
During revision surgery, the surgeon may need to remove or exchange one or more parts of the hip replacement. The parts that are not attached to the bone can be safely exchanged with minimal to no removal of the patient’s bone. However, if the metallic parts in contact with the bone need to be changed, some bone loss generally occurs. In addition, some of the musculature around the hip will be lost, thus affecting the strength of the hip and the patient’s function after surgery. The results of revision surgery are not as predictable as those of the primary surgery. Complications are more frequent.
A revision of a hip replacement is generally more challenging than the initial operation. It should not be regarded as or compared to "changing the tires on a car." The results of surgery and the durability of the revised hip replacement are less predictable than those of the primary operation. With every revision surgery, there is some loss of muscular mass, bone, or both. The duration of surgery is generally longer and the likelihood of complications higher than during the primary surgery.
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