Introduction
A revision hip replacement is a procedure to correct issues that have arisen with a previous hip replacement procedure.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g.: water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts/tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
A complex revision hip procedure shares some similarities with a standard hip replacement procedure, but is more complex and is normally completed in three stages:
Removal of components of original hip replacement
This stage involves a careful removal process to avoid any damage to bone and surrounding soft tissue. As well as the artificial components themselves, any bone cement used in the original procedure must be removed at the same time (this is often done using an ultrasonic device that dissolves the cement).
Preparation of surfaces
During a revision procedure there will be less bone to work with, as some will have been removed during the original procedure. Bone grafts or 'augments' may be needed to replace this lost bone material – these can be taken either from another bone in the patient's body or from a 'bone bank' of donor bones, or in other cases sections of metal called 'augments' can be used instead.
Artificial components fitted
Once the augments or grafts have been fixed in place, new artificial hip joint components are fitted into place in the thigh bone and the socket in the hip.
As with other types of joint replacement revision surgery, if there is infection present the procedure may be performed in two completely separate stages – the first stage involving the removal of the original components, clearing any infected tissue and then placing a temporary antibiotic spacer to deal with any remaining infection. The second stage, generally performed 4-6 weeks after the first stage, involves the fitting of the new components (once the spacer has been removed).
Other differences between a standard hip replacement and a revision are that a revision hip replacement involves a slightly larger incision and the procedure takes a little longer – 2-3 hours and sometimes longer.
Postoperative Instructions
After the procedure the patient will need to stay in hospital for a few days, with the hip largely immobilised in a splint. Standing up and walking a short distance on the day after surgery is strongly encouraged and a rehabilitation exercise program is put together to aid in recovery (more details on this rehabilitation program are given to all patients after surgery).
During the 6-week postoperative period extra care must be taken to always lie down on the opposite side of the body to the new hip, to avoid squatting beyond 90 degrees (such as when sitting in a deep chair) and to avoid crossing the legs.
Day-to-day activity can normally be resumed 3-6 weeks after hip replacement surgery. The replacement hip will allow the resumption of low impact sports (e.g.: walking, bowls, golf) and some versions of more physical sports – doubles tennis for example but not singles, and 'gentle' skiing are OK. Contact sports and any sports involving running are not recommended after a hip replacement.
Risks
As with any surgery, with complex revision hip replacement surgery there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
- Damage to nerves / blood vessels.
Specific risks of all hip replacement procedures include:
- Artificial components of the hip may wear out or become loose over time (due to 'wear and tear' or in some cases a condition known as osteolysis).
- Hip dislocation.
- Leg length discrepancy (some leg length discrepancy – around 1cm – helps to avoid dislocation).
After a complex revision hip replacement some patients have the sensation that their legs are different lengths – this can be caused by normal muscle contraction which goes away over time as the muscles become accustomed to the new joint.