Hip revision surgery

Overview

Hip revision surgery involves repairing or replacing an artificial hip joint. This procedure becomes necessary if the prosthetic becomes infected or damaged after the initial hip replacement surgery. The primary goal of hip revision surgery is to enhance the functionality of your artificial hip, ensuring improved performance. You can prepare for this procedure in a manner similar to how you readied yourself for your first hip replacement surgery.

Hip revision surgery might involve the repair or replacement of an artificial hip joint. This procedure could become necessary subsequent to hip replacement surgery, addressing any damage that your artificial hip might have incurred due to:

• Infection
• Wearing and tearing of the implant
• Implant that has loosen from the bone
• Popping out or dislocation
• Problems with alignment
• Fracture of bones surrounding the artificial hip joint

Pain and discomfort could be symptoms of damage to your artificial hip joint. It’s possible that you won’t be able to make full use of your hip. The purpose of hip revision surgery is to enhance hip functionality.

Reason for undergoing the procedure

You might find it puzzling that you require an additional procedure after undergoing a hip replacement. In your initial surgery, the orthopaedic surgeon replaced your hip with artificial implants, which have a limited time of use. Typically, an artificial hip joint lasts for around 10 to 20 years, depending on your joint’s usage.

Think of the implant in your artificial hip like a vehicle. Over time, your car needs maintenance to remain functional. Due to consistent use, your car is subject to regular wear and tear. To get your car back on the road, you may need to repair it or invest in a newer model. Similarly, hip revision surgery serves as the maintenance or repair that your artificial hip joint requires to keep functioning optimally.

After undergoing hip replacement surgery, your everyday movements gradually contribute to the wear and tear of your prosthetic joint. This wear and tear can lead to issues such as loosening, dislocation, or improper fit of the prosthetic, resulting in compromised functionality. Often, discomfort in the vicinity of your artificial hip is an indicator that this surgery might be necessary. Opting for revision surgery can alleviate or eliminate this pain and restore the proper function of your replacement hip.

Another circumstance that might require hip revision surgery is infection. An infection around your artificial hip joint not only weakens and damages your muscles, tendons, ligaments, and hip bone, but it also leads to significant pain. In cases of infection, your medical professional might recommend hip revision surgery to rectify the damage caused.

Before the procedure

Roughly a month prior to your hip revision surgery, you will have a consultation with your healthcare team to discuss the upcoming procedure and potential risks. During this appointment, they will perform a physical examination, review your complete medical history, and evaluate any current prescription medications or dietary supplements you are taking. You will also need to undergo a series of tests, which might encompass: 

• Laboratory examination.
• Urine analysis.
• Electrocardiogram (EKG).
• X–rays.

As you schedule your hip revision surgery, it’s advisable to coordinate appointments with a physical therapist. Your surgeon will provide detailed guidelines, including information about medication usage before the procedure, in order to prepare you effectively for the surgery. It’s important to note that you should never discontinue any prescribed medications unless your doctor explicitly advises it.

To facilitate a speedier recovery from hip revision surgery, you can take proactive steps at home by following these measures:

• Requesting assistance at home during the initial weeks following surgery.
• If you smoke, attempting to quit or reduce your smoking before your surgery.
• Eliminating tripping hazards from your home, such as loose rugs or electrical cords.
• Placing frequently used household products, snacks, and beverages at waist or shoulder level on a shelf or counter.
• Setting up your sleeping quarters on the ground floor to prevent climbing stairs.
• Using specialized tools around your house to assist you in carrying out your regular tasks. You can use an elevated toilet or shower seat or a gripping aid to assist you put on your socks and shoes.

Dental preparation

Prior to undergoing hip revision surgery, your surgeon might recommend a dental visit for teeth cleaning and addressing any cavities. This precaution is taken to mitigate the risk of introducing germs into your bloodstream via your mouth after the surgery. In the healing phase, your hip requires increased blood flow, rendering you more susceptible to infections.

Following surgery, your surgeon may suggest delaying non–emergency dental visits for about three months. However, if a dental emergency arises, it might necessitate a visit. To prevent infections, it’s essential to take antibiotics after surgery before undergoing any dental procedures.

During the procedure

During hip revision surgery, your surgeon will replace either the entire artificial hip joint or a portion of it with a new one.

In cases where more serious infections are present, hip revision surgery might occur in two distinct stages. In the initial operation, the artificial joint is removed, and antibiotics are administered to address the infection. Once the infection has been successfully treated, a second procedure is performed to implant the new hip joint.

The duration of a hip revision procedure typically lasts around two hours. Your surgeon will provide you with an estimated timeframe before the surgery takes place.

After the procedure

After undergoing hip revision surgery, you will be required to remain in the hospital for several days in order for your medical team to monitor your recuperation progress. Once discharged, you will continue your recovery at home.

Upon leaving the hospital, your surgeon will provide you with a set of care instructions, which could encompass:

• Taking drugs as prescribed to treat pain and lower the risk of developing a blood clot.
• Showing up on time for physical therapy and follow–up visits.
• Elevating both legs for the first four to six weeks after surgery, either using a pillow or a reclining chair.
• Using a walker or cane to assist you in walking until you can support your entire weight on your hip.
• Using the handrails when climbing or descending steps. After surgery, avoid utilizing the stairs.

Risks

Risks could result from any surgical operation. Following a hip revision procedure, the following problems may occur:

• Infection
• Blood clots
• Blood vessel or nerve damage
• Scars after the surgery
• Join instability and weakness
• The requirement for future revision procedures.
• Anesthesia complications which affect the heart and lungs

The potential hazards of your surgery will be discussed with you by your doctor prior to the operation.

Outcome

The process of recuperation after a hip revision surgery spans approximately six months. Following the surgery, there is an initial period of adaptation as tasks like entering a car or climbing stairs might pose challenges. The discomfort and walking difficulties that you encounter should subside within six months, marking the completion of your full recovery.

You can shorten the time it takes you to recuperate from surgery by:

• Following instructions to exercise your legs to lessen edema.
• Placing your feet on a pillow to raise your legs above your heart when you’re sleeping.
• Walking with a cane following surgery. You can convert to a cane whenever you’re comfortable, as long as you abide by your doctor’s recommendations.

Around one month after your surgery, your doctor will conduct X–rays of your leg to monitor the progress of the healing process. If you encounter intense pain or swelling following the surgery, it’s advisable to reach out to your surgeon for guidance.

Physical therapy after hip revision surgery

Immediately after the surgery, you will initiate physical therapy and rehabilitation. Your physical therapist will evaluate factors such as the strength and flexibility of your hip and leg, as well as your range of motion while standing and sitting.

Both during your hospital stay and after returning home, your physical therapy sessions will persist. The course of physical therapy will extend for approximately a year. Your physical therapist will provide guidance on exercises to be performed at home between appointments. They will also provide clarity on when you can reintegrate your regular routine and what exercises and activities are suitable following the surgery.