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Hip Replacement Revision Surgery

What Is Hip Revision Surgery?

Hip replacement surgery is a procedure where an artificial hip is inserted in place of a damaged or diseased hip.  The goal of this surgery is to relieve pain experienced in daily activities or higher levels of function. In most cases this artificial joint will last your lifetime. 

Sometimes, this artificial hip will become damaged, like your own hip did, and the artificial parts will need to be replaced. This is called hip replacement revision surgery.

Common Reasons for Hip Revision Surgery

You may need hip replacement revision surgery if you had a hip replacement in the past and have:

  • Pain in your hip
  • Worn-out, loose or broken parts in your replacement joint
  • Weak bones or bone loss surrounding your implant
  • An implant that repeatedly becomes dislocated
  • Infection at the site of the implant
  • Reaction to the metal implant components

How It Differs from Hip Replacement Surgery

In total hip replacement surgery, a doctor replaces a diseased or damaged hip joint with a prosthesis. They may have used either a front-of-the-hip (anterior) or back-of-the-hip (posterior) approach.

In hip replacement revision surgery, some or all of the components of that prosthesis need to be replaced. There may be damage to your bone and to the surrounding tissue near your original implant. So, doctors usually need to use specialized tools and implants during revision surgery. Your doctor will determine whether an anterior or posterior approach is better for your revision surgery.

How to Prepare for Surgery

A few weeks before your surgery, you’ll have a physical exam to make sure you don’t have any conditions that would affect your success with surgery or recovery. If you have any chronic conditions, such as heart disease, you may need to see those specialists as well.

Typically, this procedure is more complex than your first. You may need more time to recover and more help after surgery while you recover. Depending on your condition, you may need to stay at a nursing home or rehabilitation center after surgery. And you will want to make arrangements to have someone help you at home with cooking, shopping, bathing and household tasks while you recover. 

Pre-Surgery Tests

Your doctor will likely recommend imaging tests to evaluate your hip joint. Those could include X-rays, nuclear medicine bone scans, MRIs and/or CT scans. Blood tests can identify infections or reactions to the metal in your hip. And if your doctor suspects an infection, they may remove some fluid from your hip joint so it can be analyzed.

Based on your surgeon's evaluation of these tests they will tell you which components will likely need replacing. However, the final decision on all components replaced is made during surgery.

What the Surgical Procedure Is Like

Hip revision surgery is a more complex and longer procedure than hip replacement surgery. You’ll have general anesthesia for the procedure.

Your surgeon will make an incision over your hip to expose the joint. This incision might be longer or in a different location than your original incision. The surgeon will separate the femur (thigh bone) from the hip socket and remove the initial hip replacement. They will check for signs of infection and reactions to metal components and assess the stability of the components. At this point in the surgery, your surgeon will determine if some or all of the components need to be removed. 

Your surgeon will then use specialized tools to remove the socket or stem, or both. The revision components are usually longer, or bigger, and sometimes require bone cement and screws for added fixation or stability.

Once the new joint’s components are in place and attached, the surgeon will repair the muscles and tendons in the hip area. They may also place a drain to collect fluid and blood before they close the incision.

After that, you’ll move to the recovery room for several hours. There, your team will monitor you as you recover from the anesthesia. When you’re ready, you’ll transfer to a hospital room. You’ll probably stay in the hospital for several days, since recovery usually takes longer than with the original hip replacement.

In the hospital, you’ll take medication to relieve pain, and you’ll begin to perform physical therapy exercises. Your doctor will recommend therapies to help prevent blood clots and infection. The duration of these medications may mean you continue taking them once you are discharged from the hospital.

Possible Complications

All major surgical procedures have risks, including hip replacement revision surgery. These risks are typically the same ones you talked about with your surgeon with your first surgery. However, due to the complexity of the procedure these risks are slightly higher.  Possible complications include:

  • Dislocation
  • Infection
  • Pain
  • Fracture
  • Nerve or blood vessel injury
  • Blood clots in the legs or lungs
  • Unequal leg length
  • Failure of the revision joint

Recovery at Home

Your doctor will give you instructions about caring for your new hip joint. You may need to use a walker, cane or crutches.

Your health care team will let you know how to care for and bandage your wound. Avoid soaking your wound in water until it has healed. Your stitches or staples will probably be removed a few weeks after your surgery.

You will continue physical therapy exercises at home and with your physical therapist. These exercises are essential for building your strength and mobility so you can return to your everyday activities.

As you recover, it’s essential to prevent dislocating your new joint. You will need to:

  • Keep your hips bent at a 90-degree angle or larger
  • Avoid crossing your legs
  • Sit on higher chairs
  • Use an elevated toilet seat
  • Avoid turning your foot inward when you bend your hip
  • Use a grabber to pick things up off the ground

Long-Term Outcomes

With revision surgery, your doctor may need to remove some bone and/or muscle, which can change the way your hip functions. Some people may still have some pain and loss of strength after they’ve recovered from surgery, but most people have good outcomes after hip replacement revision surgery. They have less pain and more joint stability and can function better.