What does Revision Total Hip Replacement involve?
What does Revision Total Hip Replacement involve?
The most common reason for requiring revision of a hip replacement is gradual loosening of the grip between the bone and the prosthetic implants. This is a condition known as ‘Aseptic Loosening’. Aseptic loosening usually occurs slowly over many years, with the artificial hip joint becoming increasingly painful over time. Typically the bone adjacent to the implant will have erosions due to the effect of wear debris. As hip replacement technology is constantly improving, with more durable bearing materials and better fixation methods, aseptic loosening is becoming less common and occurring much later stage after the original operation.
Other reasons for requiring a revision hip replacement include:
- Infection
- Dislocation
- Periprosthetic Fracture
- Polyethylene Wear and Osteolysis
- Adverse Local Tissue Reactions to some Metal-on-Metal implants
- Ceramic Bearing Fracture
Identifying the underlying cause for the failure of an implant can be challenging. Associate Professor Harvie has a multidisciplinary team of colleagues including from other specialties Infectious Diseases. Musculoskeletal Radiology, Perioperative Medicine, Physiotherapy and occasional Plastic Surgery who work together in order to provide the best outcome for patients.
Revision Total Hip Replacement requires specific techniques to address the surgical issues encountered in this surgery. It is important therefore that your surgeons is suitably trained. Associate Professor Harvie is a specialist in Revision Hip and Knee Replacement Surgery.
What does Revision Total Hip Replacement involve?
Revision hip replacement procedures are very variable, as the nature of the operation depends on the problem causing failure of the original implant. In general, revision hip replacements are technically more demanding than ‘first time’ replacements and are associated with an higher risk of complications and longer recovery times. Revision hip replacement often involves the removal of failed implant(s) and insertion of new prosthetic components. Not all implants necessarily require removal – some portions may be retained if the strength of bone contact is maintained and no wearing of the retained components is observed. In addition, as a result of the gradual loosening process over time, bone quality may be compromised and bone grafting may be required. Typically an artificial bone graft or donor bone is obtained for use in these situations. For infection of a hip replacement, a ‘two-stage’ revision may be recommended. This is where the old implants are removed and the final implants are inserted in a second procedure only after the infection has been definitively eradicated.
As revision hip replacements are technically demanding, not all surgeons perform these procedures. In these situations, surgeons will often refer for ongoing care by colleague who has the specialist training to performs these procedures. If you have been asked to see Associate Professor Harvie for this reason, it does not indicate that your original surgeon is uninterested in your care – in fact quite the opposite. Before undertaking revision hip replacement, I will discuss the recommended procedure with you in detail.
What are the Risks and Complications?
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the Knee. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.