Revision Total Hip Artroplasty

Revision total hip arthroplasty is a complex procedure performed in individuals who already had hip replacement surgery but had certain complications that led to failure of the previous surgery. Total hip replacement is recommended in certain disease conditions of hip joint and hip arthritis is one of those common conditions. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities. Some replacement will last longer, while other hip replacement implants can fail due to various reasons and may need to be replaced. When implant failure occurs another surgery may be needed to replace the failed implant, known as revision hip replacement surgery.

Indications

Revision total hip arthroplasty is recommended in patients with:

• Increasing pain in the affected hip is one of the first indications that revision surgery is necessary.
• Plastic (polyethylene) wear in which the plastic implant is changed
• Dislocation of previous implants
• Loosening of the hip joint prostheses
• Infection of the hip replacement
• Weakening of bone around the hip replacement (osteolysis)

Procedure

In revision total hip arthroplasty, your surgeon removes the old plastic liner and the metal socket from the acetabulum. The acetabulum is prepared using wire mesh to make up for the socket space. Then the new metal shell is inserted into the socket using screws or special cement. A liner made of plastic, ceramic or metal is placed inside the metal socket. To prepare the femoral component, the top of the femur is cut into several pieces to remove the implant. The segments of bone are cleaned and the new femoral implant is inserted into the femur either by a press fit or using bone cement. The segments of the femur are held in place with surgical wire. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new parts are secured in place to form the new hip joint. The muscles and tendons around the new joint are repaired and the incision is closed.
After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing.

Post-op Precautions

Remember this is an artificial hip and must be treated with care.
 Avoid the combined movement of bending your hip and turning your foot in. this can cause dislocation. Other precautions to avoid dislocation are

• You should sleep with a pillow between your legs for 6 weeks.
• Avoid crossing your legs and bending your hip past a right angle.
• Avoid low chairs.
• Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes.
• An elevated toilet seat is helpful.
• You can shower once the wound has healed.
• You can apply Vitamin E or moisturizing cream into the wound once the wound has healed.
• If you have increasing redness or swelling in the wound or temperatures over 100.5° you should call your doctor.

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. Some of the complications associated with revision total hip arthroplasty include infection, dislocation, injury to blood vessels, blood clots, limb length inequality, failure to relieve pain, unsightly or thickened scar, pressure or bed sores and limp due to muscle weakness.
    
Rehabilitation

Post-surgery rehabilitation is essential to avoid further complications such as reduction in the range of motion, muscle weakness and recurrence. Physical therapy may be initiated immediately after surgery and may be continued for up to three months. Physical therapy includes uses of crutches or walker along with strengthening and mobilization exercises to regain the strength and mobility of the joint.