Hip replacement surgery allows patients to get back to the physical activities they love by stopping the pain caused by hip arthritis. A hip replacement is made up of mechanical parts that resemble a ball (femoral head) and socket (acetabular component), and will restore movement for the patient as long as the prosthetic parts remain durable.
The majority of patients who have a hip replacement will not encounter problems with the new joint within their lifetime. The materials and technologies used to perform this type of surgery have majorly advanced over the years, which have made implants longer-lasting. A lot of total hip replacement surgeries are done on older patients who place less stress on their joints, and won’t wear down the implant as fast. According to the American Association of Hip and Knee Surgeons, a total hip replacement can last between 15-20 years.
But for those who have the procedure done at a younger age, and have a fairly physical lifestyle, a hip revision procedure may be needed for the initial implant. This can be due to loosening of the prosthesis (implant), dislocation, infection or just failure altogether with the joint replacement.
Revision surgery is most commonly needed for the hip because of loosening of the prosthesis. The parts of the initial implant that are mobile will wear and tear over the course of the replacement. When younger patients have a replacement, especially ones that are extremely active, the wear will happen more quickly. As friction builds, small particles from the hip implant material begin to wear off, which can be made of plastic, metal and other materials. This can cause a strong reaction within the body that causes bone destruction in the hip. Components of the artificial hip may become loose and intensify bone loss, which could result in a fracture. Factors such as obesity and performing strenuous activities can contribute to the loosening of the implant as well.
Hip replacements are more likely to come out of place than a knee replacement. A hip replacement has an implant that resembles a ball and socket. The ball must be in the socket at all times for the hip to function correctly. Depending on how the ball and socket were placed during the initial surgery, or the forces exerted by the muscles surrounding the hip, the ball could slip out of the socket and dislocate the hip.
The risk for infection is highest during the first six weeks post surgery. The implantation of various metals and plastics into the body can act as a site for bacteria to grow. This can lead to infection and swelling, and must be controlled before performing a revision surgery on the failed joint. An infection in the mouth, lungs or skin allows bacteria into the blood stream, which could spread and also infect the hip replacement. Depending on the type of bacteria and extremity, antibiotics can be used for minor complications in the hip. Revision surgery is necessary in the case of severe infection to remove the implant and affected surrounding tissue.
Some of the main symptoms of a failed hip replacement are pain when placing weight on the hip and loss of mobility. When both the femoral and acetabular components have been damaged or become loose, the patient may feel pain in the hip as well as the thigh. Some patients may experience no pain from a compromised prosthesis. To determine exactly what the internal issue is, I will have x-rays taken.
What should I expect during surgery?
The first step in this type of surgery is to remove the old implant. The device attached to the acetabulum is removed initially so that the hip socket can be cleaned and filled with morselized bone. The morselized bone will aid in the induction of joint ossification, artificial bone growth, which will create less pain for the patient. The new acetabular component and liner are then put into place.
To remove an implant that was initially held in place by cement, I will have to cut through the top of the femur in a process called osteotomy. If the patient has endured extensive bone loss, bone grafts can be used along with plates, cables and custom implants to gain a stable joint. After the old device is removed, I will clean the canal and then insert the new femoral component with cement or pressure. Once both parts of the prosthesis are intact correctly, I will place the head of the femoral component into the acetabular component.
What happens during recovery?
The recovery process for a revised hip is similar to the initial hip replacement. In the initial recovery stages, a walker or crutches may be used, which will slowly progress to walking without an aid. Patients will go through a physical therapy routine combined with pain medication to restore mobility. An anti-coagulant will be prescribed to prevent blood clots as well.
What are the risks of revision surgery?
A hip revision surgery is much more complicated than the initial total hip replacement. The possibilities of complications are higher and recovery can take longer. There are several risks associated with hip revision:
• Leg length- One of the patient’s legs may be shorter than the other after a hip revision procedure. This can be adjusted with a shoe lift on the shortened side.
• Dislocation- This is more common post revision because of the weakened state of the tissue and bone that were affected during surgery.
• Deep Vein Thrombosis- Veins can be damaged during a revision procedure which increases the chance for blood clots and pulmonary embolism. As mentioned before, a blood thinning medication will be prescribed to patients to decrease the chance of DVT.
• Infection- The chance of infection is two times greater than that of the initial hip replacement.
John D. Burrow, DO is a Fellowship-Trained, Board Certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, VA. His areas of practice specialty include Adult Joint Replacement and Revision and General Orthopaedics.
If you have had a total hip replacement and have experienced some of the symptoms discussed or suspect an issue, please contact us at (757) 596-1900 to schedule an appointment Dr. Burrow.