Revision Hip Replacement

What is Revision Hip Replacement?

During total hip replacement, the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. At times, hip replacement implants can wear out for various reasons and may need to be replaced with the help of a surgical procedure known as revision hip replacement surgery.

Revision hip replacement is a complex surgical procedure in which all or part of a previously implanted hip joint is replaced with a new artificial hip joint.

Indications for Revision Hip Replacement

Revision hip replacement is advised for the following conditions:

• Increasing pain in the affected hip 
• Worn out plastic or polyethylene prosthesis
• Dislocation of previous implants
• Loosening of the femoral or acetabular component of the artificial hip joint 
• Infection around the hip prosthesis, causing pain and fever
• Weakening of bone around the hip replacement (osteolysis)
• Fracture around the hip replacement

Procedure of Revision Hip Replacement

• Revision hip replacement surgery is performed under regional (spinal) or general anaesthesia.
• During the procedure, Mr Sakis Pollalis will make an incision over the hip to expose the joint. Then, the femur is dislocated from the acetabulum so that the old plastic liner and metal socket can be removed from the acetabulum.
• After removal, the acetabulum is prepared using extra bone and wire mesh if required to make up for the socket space and shape. Then, the new metal shell is inserted into the socket using screws or special cement. A liner made of plastic, ceramic or metal is placed inside the metal socket.
• To prepare the femoral component, the old implant needs to be removed. Occasionally the femur bone needs to be split to remove the old implant. The segments of bone are cleaned and the new femoral implant is inserted into the femur either by a press fit or using bone cement. The segments of the femur and the femoral component are held together with surgical wires.
• Your hip is tested to check the stability, leg length, soft tissue tension, and range of movement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new components are secured in place to form the new hip joint.
• The muscles and tendons around the new joint are repaired. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed with absorbable sutures and a sterile dressing is placed over the incision. Drains are generally avoided to enable early mobilisation and discharge

Post-procedure Care for Revision Hip Replacement

After undergoing revision hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. Some of the common precautions to be taken include:

• Do not do resistive exercise on the bike, treadmill or gym equipment for six weeks after surgery.
• Avoid the combined movement of bending your hip and turning your foot inwards.
• Avoid pillows behind your knees or recliners for six weeks after surgery as they encourage your hips to heal in a bent position.
• Sleeping on your back is the best position for your hips. It keeps them straight during the healing process. If you are going to sleep on your side, be sure to use a pillow between your knees to maintain your hip precautions.
• When choosing a chair, be sure that your hips are higher than your knees (so your hip is bending to fewer than 90 degrees) when you sit.
• Do not cross your unoperated leg under your operated leg — this breaks a hip precaution! A leg lifter strap may help you to get in an out of bed without crossing your legs.
• Use an elevated toilet seat.
• Avoid bending down to pick up things; instead, a grabber can be used to do so.
• Do not be afraid to walk. Walking is a great source of exercise. It strengthens your muscles, increases your flexibility, and improves your endurance.

Risks of Revision Hip Replacement

As with any major surgical procedure, there are certain potential risks and complications involved with revision hip replacement surgery. The possible complications after revision hip replacement include:

• Infection
• Blood clots in the leg or lung
• Hip pain, stiffness, or limited mobility
• Dislocation
• Leg length inequality
• Fracture of the femur or pelvis
• Nerve or Blood Vessel Injury
• Bleeding and Hematoma
• Prosthesis Failure or Loosening
• Requirement of additional surgery
• Cardiovascular risks, also leading to life-threatening complications
• Allergic reaction
• Anaesthetic risks

If you would like to have additional information on treatments of hip conditions or would like to learn more about revision hip replacement, please contact Mr Sakis Pollalis, serving the communities of Buckinghamshire and Berkshire.