Revision Hip Replacement - Procedure, Benefits and Recovery

Total hip replacement surgery is considered one of the most effective measures in restoring mobility in people suffering from debilitating hip pain. During primary total hip replacement surgery, the damaged or worn-out hip joints of the patient are replaced with an artificial joint made up of plastic, metal, or ceramic to regain the function of the hip. Revision hip replacement surgery is an effective surgery performed to repair or replace the worn parts of the artificial hip joint placed during the hip replacement surgery. In some cases, the whole artificial hip joint needs to be removed or replaced with a new one. This surgery helps to rectify any problems the patient might have been having with the original implant (artificial hip joint) and re-establish its function. One of the issues requiring the revision hip replacement surgery is the failure of the artificial implant to attach securely to the joint due to an infection or due to extensive use of the joint over the period of 10 – 15 years.

 

Some of the benefits of revision hip replacement surgery are:

1. Provides relief from pain
2. Improves mobility, strength, and coordination of leg and torso
3. Improves the appearance of leg and hip
4. Allows the patient to return to day-to-day activities without any pain

Revision hip replacement surgery may be recommended for people who have:

1. Wearing or loosening of the implant
2. Experienced hip fracture or dislocation 
3. Developed an allergy to metal
4. Developed an infection on their replaced hip joint
5. Abnormal motion that causes pain

If the revision hip replacement surgery is delayed:

1. The muscle, tendon, and ligament around the hip may be damaged.
2. The damage will weaken the hip joint and damage the hip bone.

The revision hip replacement surgery caused due to the wear and tear of the artificial implant consists of the following steps:

1. Primarily, the surgeon will cut the sides of your hip.
2. Next, they will remove the old artificial implant along with any cement present.
3. After that, they will place a new hip replacement which is slightly larger than the previous one.
4. Finally, this new implant will be fixed to the bone using acrylic cement or a special coating that will bond directly to the bone.

Some patients with hip replacement may require a revision hip replacement surgery due to an infection. The steps followed for the procedure are as follows:

1. You will need surgery to remove the old, infected implants and the scar tissue first.
2. Following that, you will be treated with antibiotics for the infection.
3. Once the hip infection is resolved, your doctor will conduct an operation to insert a new set of implants.

You can expect the following before the surgery:

1. Your doctor will explain the whole procedure briefly to you. 
2. Your appointments may start at least one month before the surgery.
3. During your doctor’s visits prior to the surgery, your doctor will discuss the following with you:
   1. Any medications that you have been taking, both over-the-counter and prescription.
   2. Any dental problems 
   3. A blood transfusion may be required. They will seek your opinion if you would like to donate your blood for future use.
4. Your doctor may inform you that the most preferred anaesthesia for hip replacement surgery is spinal or regional anaesthesia. In the case of spinal anaesthesia, the anaesthetic is injected into the fluid surrounding the spinal cord. Regional anaesthesia makes a specific part of your body numb. 

On the day of the surgery:

1. You will be given a consent form to read and sign before the procedure.
2. You will be asked to read the admission letter carefully and follow the directions mentioned there carefully.

You may expect the following during the surgery:

1. You will be taken to the operation theatre and positioned for the surgery, depending on the severity of your condition.
2. The most preferred position is the supine position (lying horizontally on your back) for the surgeon to access the pelvis and assess the limb length.
3. However, recently most of the total hip replacement surgeries have been performed in the lateral decubitus position.

Positioning after the surgery:

1. Avoid bending forward more than 90 degrees. 
2. Avoid lifting your knee higher than the hip on the concerned side. 
3. Avoid crossing or rotating your leg outwards.
4. While sitting, make sure to use a chair with a straight back and armrests. Avoid sitting on chairs or sofas lower than your height. Avoid sitting on low sofas or stools.
5. When using the toilet, you may have to use a toilet seat extension.

Positioning while resting or sleeping:

1. You may have to lie on your non-operated side while resting or sleeping for four to six weeks after the surgery. Lying down on the operated side is not recommended immediately after the surgery.
2. While lying down, keep a pillow between your legs and a second one to support the foot and ankle. 
3. If you lie on your back, keep a pillow between your legs.

Positioning while dressing up:

1. While wearing pants, make sure you put the operated leg in the pants first.
2. If you wear tie shoes, use the ones with elastic ties to prevent having to tie the shoelaces every time.
3. You may be given a dressing stick to help you avoid lifting your knees higher than your hip while dressing up.  
4. You may be given a shoe horn to help you take off your shoes.

Positioning while using stairs:

1. Make sure to use the good leg first, followed by crutches and the operated leg while climbing the stairs.
2. You may use the crutches first, followed by surgery and good leg while going down the stairs.

Positioning while bathing: 

1. Avoid using a bathtub to avoid having to bend excessively. 
2. Avoid using an overhead shower.
3. Avoid using a walk-in type shower or taking a sponge bath up to 11 days post-surgery.

Some of the things you may expect after the surgery are:

1. Your doctor will prescribe you pain and anticoagulant (to prevent blood clots) medications.
2. You may be given a special type of stocking to wear and asked to do ankle pumps for two to three days following the surgery.
3. If necessary, you may be given pain medications with an injection for about one or two days following the surgery.
4. You may have to spend an average of four to five days in the hospital, post which you will be discharged with a set of instructions like:
   1. Follow the physical therapy regime regularly and elevate your legs above the level of your heart to reduce the swelling.
   2. Use a walker.
   3. Reduce the use of stairs or climbing activities until you recover completely.

1. After revision hip replacement surgery, you will be asked to visit the doctor for a follow-up appointment after a period of one month. Your doctor will advise X-ray examination to assess the healing process.
2. After the first follow-up appointment as per the recommended time period by your surgeon, which is usually four to six weeks, additional visits are recommended after:
   1. Three to six months from the date of surgery
   2. One year from the date of surgery
   3. Once every year on the date of the surgery

When to Consult the Doctor?

Please consult your doctor immediately if any of the following complications or side effects arise after the revision hip replacement surgery.

Possible side effects which normally occur after any surgery:  

Like any surgery, there is a possibility of after-effects of anaesthesia. Like after you wake up, you may feel:

1. Cold
2. Confused
3. Weak
4. Unable to pass urine after being given anaesthesia

Risks/complications of surgery:

Some people may develop some complications associated with anaesthesia like:

1. Respiratory malfunction
2. Cardiac malfunction

Some people may develop other complications like: 

Pulmonary embolism 

1. Leg length inequality 
2. Dislocation of the joint replacement
3. Damage to nerves or blood vessels 
4. Heterotopic ossification (formation of bone in tissues where bones did not exist) 
5. Loosening of the implant 
6. Failure of the metal implant to attach to the bone

Post-surgery after discharge, please consult your doctor immediately if you experience any of the following symptoms:

1. Swelling or increased redness at the hip joint
2. Elevated pain in the hip joint 
3. Leaking wound at the site of operation
4. Bumps or pimples at the hip joint

Sequelae of infection/complications if not treated in time:

Please consult your doctor immediately if you experience any of the following signs or symptoms of infection to prevent any complications resulting from post-surgery infection.

1. Pain in the hip
2. Hip fracture
3. Weakness in the hip joint
4. Stiffness or instability of the joint.