What is a revision hip replacement?
This means that part, or all, of your previous hip replacement needs to be taken out and replaced with a new part. This operation varies from very minor adjustments to massive operations, replacing significant amounts of bone and hence is difficult to describe in full.
A hip replacement consists of a femoral component with a ball placed onto it, an acetabular component attached to the pelvis and an insert in between.
Why does a hip need to be revised?
- Pain is the primary reason for revision. Usually, the source of the pain is clear, but not always. In general, the more obvious the source of pain, the more effective the surgery will be.
- Plastic (polyethylene) wear. This is an easier revision, where only the plastic insert is changed.
- Dislocation (instability), which means the hip is popping out of place.
- Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. It is for this reason why you must have your joint followed up for life as there can be changes on x-ray that indicate that the hip should be revised despite having no symptoms.
- Infection is usually presented through pain but may present as swelling or an acute fever.
- Osteolysis (bone loss). This can occur due to particles being released into the hip joint which results in bone being destroyed.
- Pain from hardware e.g. cables or wires causing irritation.
- X-rays are essential and should be of good quality
- Sometimes a CT scan may be ordered to look closely at the anatomy
- Routine blood tests, especially to rule out infection
- Bone scans can help to determine if a component is loose
- Aspiration of the joint is occasionally done to diagnose or rule out infection
What is involved?
It will be explained to you prior to surgery what is likely to be done but in revision surgery the unexpected can happen and good planning can prevent most potential problems. The surgery is often, but not always, more extensive than your previous surgery. The surgery presents similar complications but at a higher rate than the first operation (see complications section in total hip replacement).
The surgery can vary from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.
Again, this is similar but often a bit slower than the first hip replacement. The amount of weight you can put on it and the recovery period really does depend on what was done and is hard to generalise.