Revision Hip | Hip Replacement Procedure

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Introduction

Revision Hip Replacement means that part or all of your previous hip replacement needs to be revised. This operation varies from very minor adjustments to massive operations replacing significant amounts of bone.

Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) with a plastic liner in between to restore joint movement.

Hip Bone

The hipbone is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts, the ilium, ischium, and pubis, which are distinct from each other in the young subject, but are fused in the adult; the union of the three parts takes place in and around a large cup-shaped articular cavity, the acetabulum, which is situated near the middle of the outer surface of the bone.

Why (Reasons) Hip revision

Why hip revision

Hip Bone

Total Hip Replacement (THR) procedure replaces all or part of the hip joint with an artificial device (prosthesis) with a plastic liner in between to restore joint movement.

Introduction

Pain is the primary reason for revision. Usually the cause is clear but not always. Those hips without an obvious cause for pain, in general, do not do as well after surgery.
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-usually presents as pain but may present as an acute fever or a general feeling of unwell.
Osteolysis (bone loss). This can occur due to particles being released into the hip joint which result in bone being destroyed.
Pain from hardware e.g. cables or wires causing irritation.

Hip Revision Surgical Procedure

The surgery is performed under spinal, general or epidural anesthesia. A combination of techniques are used.
The surgeon makes an incision along the hip exposing the hip joint.
The femur (hipbone) is separated from the acetabulum (pelvic socket).
The old plastic liner and the metal socket are removed from the acetabulum.
The acetabulum may be prepared with extra bone to make up for the socket space. Sometimes wire mesh may also be necessary to hold the socket shape.
The new metal shell may be press fit or fitted with screws. Occasionally cement may be used depending on the surgeon’s preference.
A plastic liner is fitted to the metal socket.
The surgeon then concentrates on the femur. The damaged bone is cut.
To remove the femoral component, the bone around the component may be cut.
The parts of the bone are cleared of any old cement.
The new femoral component is pressed or cemented into place.
Wires may be used to hold the bone and femoral component.
Then a ball made of metal or ceramic is placed on the femoral component. This ball acts as the hip joints original ball.
The ball and socket are fixed in place to form the new hip joint. The muscles and tendons are then approximated.
Drains are usually inserted to drain excessive blood.

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:

Do's

You should sleep with a pillow between your legs for 6 weeks
You should sleep with a pillow between your legs for 6 weeks
An elevated toilet seat should be used
An elevated toilet seat should be used

Don'ts

Avoid the combined movement of bending your hip and turning in your foot
Avoid the combined movement of bending your hip and turning in your foot
Avoid crossing your legs and bending your hip past a right angle
Avoid crossing your legs and bending your hip past a right angle
Avoid low chairs
Avoid low chairs
Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes

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.

See all risks and complications with hip surgery here

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

Risks and complications

American Academy of Orthopaedic Surgeons

The American Board of Orthopaedic Surgery

A total hip replacement is one of the most successful operations that orthopedic surgeons perform. A hip replacement is an elective surgery, which means patients decide if and when to have their hip replaced. As a physician, I never tell patients they have to have a hip replacement surgery, but many times surgery may offer the only possibility for pain relief. Although the surgery is elective, it is covered by most insurance companies; however, depending on your policy you maybe required to make a small co-payment. My philosophy is to give my patients as much information as they need to make informed decisions regarding their health and hip pain and then treat their hip pain according to their wishes.

A hip joint is basically a ball and socket joint. A hip replacement involves removing the ball (femoral head) and replacing it with a metal prosthetic ball. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. The new metal ball and new metal socket form the new hip joint and allow the same and often times more motion than the native hip joint. The femoral and acetabular prosthesis are attached to your bones by creating a space in the bone that is slightly smaller than the metal prosthesis and then pressing the metal prosthesis into this tight space. Occasionally, the metal prosthesis is attached to the bone with bone cement. The parts are made of stainless steel, titanium, ceramic and/or polyethylene. I typically make an incision about 3-4 inches long for a hip replacement.

The purpose of this web page is to educate patients about the major aspects of hip replacement surgery. Many studies have shown that an informed patient will have less surprises and more satisfaction with their surgery. I do not intend to scare people away from getting their hip pain treated. Although the following information is a reasonable overview of what I consider the major aspects of hip surgery, it is not a substitute for a clinical consultation where I can directly answer your questions. If you would like more information, please schedule an appointment to see me.

After surgery your surgeon will give you guidelines to follow. It is important that you follow your surgeons’ instructions for a safe and successful outcome.

Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to prevent dislocating the new joint. Hip precautions are very restrictive and usually include the following:

Post Operative Care

Anterior Hip Replacement</strong> is performed in a hospital operating room under general or regional anesthetic depending on you and your surgeon’s preference. You will be placed supine, on your back, on a special operating table that enables the surgeon to perform your hip replacement anteriorly. Flouroscopic imaging is used during the surgery to ensure accuracy of component positioning and to minimize leg length inequality.

The surgeon makes one incision to the front of the hip, about 4 inches long. The surgeon then pushes the muscles aside to access the hip joint to begin the replacement. At no time during the surgery are any muscles cut.

The femur (thigh bone) is separated from the acetabulum (hipbone socket).The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented.

A liner, which can be made of plastic, metal or ceramic material, is then placed inside the acetabular component. The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments to exactly fit the new metal femoral component.

The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference. The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The artificial components are fixed in place.

The surgeon withdraws the instruments and sutures the incision closed. The incision is then covered with a sterile dressing.

Surgical Procedure

Potential benefits of direct anterior hip replacement compared to the traditional hip replacement surgery, may include the following:

Direct Anterior Hip Replacement is a minimally invasive, muscle sparing surgery using an alternative approach to traditional hip replacement surgery. Traditionally, the surgeon makes the hip incision laterally, on the side of the hip, or posteriorly, at the back of the hip. Both approaches involve cutting major muscles to access the hip joint. With the anterior approach, the incision is made in front of the hip enabling the surgeon to access the hip joint without cutting any muscles. A special operating table is used that facilitates various anatomical positions enabling the surgeon to replace the hip joint anteriorly.

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

Post-op Precautions

The surgery is performed under spinal, general or epidural anesthesia. A combination of techniques are used.
The surgeon makes an incision along the hip exposing the hip joint
The femur (hipbone) is separated from the acetabulum (pelvic socket)
The old plastic liner and the metal socket are removed from the acetabulum
The acetabulum may be prepared with extra bone to make up for the socket space. Sometimes wire mesh may also be necessary to hold the socket shape
The new metal shell may be press fit or fitted with screws. Occasionally cement may be used depending on the surgeon’s preference
A plastic liner is fitted to the metal socket
The surgeon then concentrates on the femur. The damaged bone is cut
To remove the femoral component, the bone around the component may be cut
The parts of the bone are cleared of any old cement
The new femoral component is pressed or cemented into place
Wires may be used to hold the bone and femoral component
Then a ball made of metal or ceramic is placed on the femoral component. This ball acts as the hip joints original ball
The ball and socket are fixed in place to form the new hip joint. The muscles and tendons are then approximated.
Drains are usually inserted to drain excessive blood

Pain from hardware e.g. cables or wires causing irritation