Revision Total Hip Replacement
Although first time (or primary) total hip replacements are very successful operations, re-operation or revision of the primary hip replacement may be required years after the operation, or occasionally sooner. The most common causes are wear of the implants and loosening of the cement used to fix the artificial socket into the hip bone. As the socket loosens progressively, it starts to rub on or abrade the bone into which it had been fixed, and may result in increasing bone loss around the socket (acetabulun) over a period of time. Revision surgery may also be required for hip infection, recurrent dislocation or fracture
Revision hip surgery is typically more complicated than a primary (first time) hip replacement operation. It is technically more difficult, takes longer to perform and associated with a higher level of risk. Patients generally take longer to recover from revision surgery. The magnitude of a revision hip procedure varies from patient to patient, and depends on a variety of factors, including the amount of bone loss, patient fitness and underlying diagnosis.
Infection occuring deep within the hip joint and in and around the implants may occasionally be a cause of hip replacement failure requiring revision surgery. This is a particularly difficult problem to deal with both from the point of view of the surgeon as well as from the perspective of the patient. The hip components may be securely fixed but may have to be removed to clear up the infection.
Repeated hip dislocation may necessitate a revision operation. A single dislocation particularly in the first few weeks after the primary hip replacement is not necessarily a problem and often remedies itself after the hip is put back providing of course that there are no recurrences.
The hip may be unstable because there is not enough tension or tightness in the muscles and ligaments around the artificial replacement. This lack of tissue tension can make it easy for the hip to pop out.
Development of bone defects or patches of bone loss even though the components are securely fixed shows up on a routine X-Ray years after a total hip replacement. (Osteolysis). In situations such as this, early surgical intervention may help preserve the patient’s bone stock and make the redo operation technically easier.