Revision Hip Replacement
With advances in hip replacement surgery over the past few decades, the total hip replacement procedure has never been more effective or safer than it is today. However, as with any major surgical procedure, there is the possibility, no matter how small, of failure. In the case of a hip replacement, a second procedure to correct the failure of the original procedure is known as a revision.
Common Reasons for Hip Replacement Revision
Wear and Tear – Over time, implants can wear down, just like the natural joint, and begin to loosen. If this happens, dysfunction and pain may return to the hip area. During the primary hip replacement surgery, the implant is either cemented or pressed into place to allow the bone to grow around it. Sometimes, the bone does not react as expected and does not grow as it should. Alternately, with time, and especially if high impact activities are continued or excess body weight is maintained, the implant can wear down. Lastly, even implants have a lifespan limit, no matter how well cared for. Therefore, younger hip replacement patients may require a revision when they get older.
Osteolysis – A relatively rare cause of revision may also be due to osteolysis. This occurs as the replacement parts, that serves to replace the joint, begin to wear down and the body’s immune system mistakes it for an invading organism. This immune overreaction can also attack healthy bone and cause the implant to become unstable. Modern medical devices and improvements in plastic composition have reduced the incidence of osteolysis.
Infection – As with any surgery, there is the possibility of infection. Infection can begin at the hospital or several days after surgery when the patient has returned home. Infection can also cause the implant to loosen from the bone. Unfortunately, when infection takes hold, it is hard to eliminate with antibiotics alone, therefore a revision is often necessary. Revision procedures due to infection are usually performed in two phases. The first implants a spacer treated with antibiotics to stop the infection. After several weeks, a new implant will be placed.
Dislocation – A ball and socket joint, whether natural or fabricated can dislocate. This occurs when the ball pops out of the socket. If this occurs regularly after surgery, a revision procedure may be performed to secure the joint.
Trauma – Just as with the natural hip joint, a fall or other trauma can cause a fracture within the hip. Fractured bone around the implant will require revision surgery to correct. On occasion the implant itself can also fracture, but this is relatively rare
The Prognosis for Hip Replacement Revision
There are a number of factors that alter the prognosis for those undergoing a hip replacement revision. Some of these factors include the nature of the failure of the primary operation, the patient’s lifestyle, the patient’s general health and the health and structure of the bone in and around the hip area. However, while there are greater risks in any revisional procedure, most patients experience excellent results after a revision. Most importantly, patients must modify their lifestyle and activity level to ensure that the revision succeeds. There will almost invariably be a longer recovery period, so it is imperative to understand what is needed after surgery to ensure the very best outcomes.