Revision Hip Replacement

When a replacement joint wears out, loosens, or develops a problem, it can be resurfaced or replaced in a joint revision operation. Using regular X-ray examinations, the orthopedic surgeon can detect and monitor any changes in component position, and plan for revision surgery before a major problem develops.

The revision total hip replacement is a more complex procedure because there is a reduced amount of bone to place the new total hip into. Extra bone may be required and this is usually received from a bone bank. Bone bank (allograft bone) is safe and has been treated to eliminate any chance of disease transmission. There are also artificial bone substitutes that may be used.

Revision total hip replacement takes longer than primary total hip replacements and there is a slightly higher complication rate. The prosthesis may also not last as long as a primary hip replacement. Surgery is usually performed through the same incision but may need some extension of this to provide adequate exposure. Some revisions can be performed with a minimally invasive technique.

What are some of the situations that require hip revision surgery?

Component failure

While your hip implant may shift slightly after surgery leading to unbalanced weight distribution and premature implant failure, the most common reason for hip implant failure is the wearing down of the plastic insert in the hip socket.

In the years following your first hip replacement surgery, the metal portion of your implant slowly wears down this plastic portion. In fact, your regular daily activities may produce as many as 2 million cycles per year on these parts.

Depending on the amount of wear to this plastic piece, Dr. Matthys may be able to replace only the plastic piece alone. In other cases, though, you may have worn through it and damaged the metal components as well. In this case the entire implant will need to be replaced.

Osteolysis

The wearing down of the plastic component has an unfortunate side effect. The tiny plastic/metal particles that wear off are attacked by your body’s immune system and this immune response also attacks the healthy bone around your implant. This leads to a condition called osteolysis, a condition in which the bone around the joint implant softens as it is absorbed by the body. This in turn makes your implant unstable and in need of revision. Dr. Matthys will be able to detect osteolysis on your standard X-rays.

Dislocation

Some patients do experience dislocation of the implant after surgery. The nationwide dislocation rate after a primary hip replacement is about 5%. In approximately half of these cases, the hip can be put back into the correct place without the need for surgery. However, if Dr. Matthys determines the implant was damaged or poorly positioned, certain components may need to be replaced in a revision surgical procedure.

Fracture

If the bone next to your primary implant is fractured in an accident, revision surgery may be required in order to provide a safe, stable joint. In this case, the original implant may need to be removed, the fracture addressed, and a revision joint implanted. If the implant is stable, then the fracture is treated with a combination of plates, screws, cables and possibly bone graft. A fracture around an implant is called a periprosthetic fracture.

Infection

In a low percentage of cases, your hip may become infected after surgery. Although it may be successfully treated with antibiotics, there are severe cases where a follow-up revision surgery may be required. In this surgery, the primary implants will be removed and a temporary, antibiotic-laced “spacer” is implanted. These spacers allow for joint function and are intended to give your body time to heal before the new revision prostheses are surgically implanted. Most likely, you will be put on a six-week course of antibiotics in order to eliminate the infection. At a follow-up evaluation, Dr. Matthys will determine if your body is ready for the revision procedure.