REVISION HIP REPLACEMENT MELBOURNE

What is revision hip replacement surgery?

Revision hip replacement surgery – This 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 and hence is difficult to describe in full.

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.

David LoveDr. David Love – Help centre:

Why would you need hip revision surgery?


Hip pain
– Pain is the primary reason for hip revision surgery. The cause may not always be clear. Hips without an obvious cause for pain in general do not do as well after surgery.

Wear and tear on the plastic prosthesis – Wear and tear is natural in your prosthetic hip. This is one of the easier revisions where only the plastic insert is changed.

Hip dislocation – Instability or dislocation means the hip is popping out of place and needs to be repaired.

Loosening of either the femoral or acetabular component – This usually presents as pain but may be asymptomatic. For this reason, 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 – Infection usually presents as pain but may present as an acute fever or a general feeling of being unwell.

Osteolysis (bone loss) – This can occur due to particles being released into the hip joint that result in bone being destroyed.

Pain from hardware – The cables or wires in your hip may be causing irritation.

Before your hip revision surgery

Your surgeon will send you for:

  • Routine blood tests to rule out infection
  • CT scan to look closer at the anatomy and,
  • Bone scans to help to determine if a component is loose
  • X-rays are essential
  • Aspiration of the joint is occasionally done to diagnose or rule out infection
  • You will be asked to undertake a general medical check-up with a physician
  • You should have any other medical, surgical or dental problems attended to prior to your surgery
  • Make arrangements for help around the house prior to surgery
  • Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
  • Cease any naturopathic or herbal medications 10 days before surgery
  • Stop smoking as long as possible prior to your surgery

What happens on the day of your surgery

You will be admitted to hospital usually on the day of your surgery and:

  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your anesthetist, who will ask you a few questions
  • You will be given hospital clothes to change into and have a shower prior to surgery
  • The operation site will be shaved and cleaned
  • Approximately 30 minutes prior to surgery, you will be transferred to the operating room

What happens during hip revision surgery?

Hip Revision will be explained to you prior to surgery including what is likely to be done, but in revision surgery the unexpected can happen and good planning can prevent most potential problems. The surgery is often but not always more extensive than your previous surgery and the complications similar but more frequent than the first operation.

The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.

What happens after your operation?

You will wake up in the recovery room with a number of monitors to record your vitals including:

  • Blood pressure, pulse, oxygen saturation and temperature
  • You will have a dressing on your hip and drains coming out of your wound
  • Post-operative X-rays will be performed in recovery
  • Once you are stable and awake you will be taken back to the ward
  • You will have one or two IV’s in your arm for fluid and pain relief (his will be explained to you by your anesthetist)

 

On the day following surgery, your drains will usually be removed and you will be allowed to sit out of bed or walk depending on your surgeon’s preference.

Pain is normal but if you are in a lot of pain, inform your nurse.

You will be able to put all your weight on your hip and your physical therapist will help you with the post-operation hip exercises.

You will be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your pain and help at home. A post-operative visit will be arranged prior to your discharge. Your stitches are usually dissolvable but if not are removed at about 10 days.

You will be instructed to walk with crutches for two weeks following surgery and cane from then on until 6 weeks post-op.

Special precautions

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:

  • You should sleep with a pillow between your legs for 6 weeks.
  • Avoid crossing your legs and bending your hip past a right angle
  • Avoid low chairs
  • Avoid bending over to pick things up – Grabbers are helpful as are shoe horns or slip on shoes
  • Elevated toilet seats are helpful
  • You may shower once the wound has healed
  • You can apply Vitamin E or moisturising cream into the wound once the wound has healed

If you have increasing redness or swelling in the wound or have a temperature, call your doctor.

If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.

Your hip replacement may go off in a metal detector at the airport.

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.

It is important that you are informed of these risks before the surgery takes place.

Complications can be Medical (general) or specific to the Hip. Medical Complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications may include:

  • Allergic reactions to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, or rarely death.

 

Specific complications to the hip may include but not limited to:

Infection – Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates vary.  If it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Blood Clots (Deep Venous Thrombosis) – These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.

Dislocation – This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. If a dislocation occurs it needs to be put back into place with an anesthetic. Rarely this becomes a recurrent problem needing further surgery.

Fractures (break) of the femur (thigh bone) or pelvis (hipbone) – This is also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery.

Damage to Nerves or Blood Vessels – Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.

Wound Irritation – Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.

Leg length inequality – It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.

Wear – All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements survive 15years.

Failure to relieve pain – Very rare but may occur especially if some pain is coming from other areas such as the spine.

Unsightly or thickened scar

Pressure or bedsores

Limp due to muscle weakness – Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan as it may help to restore function to your damaged joints as well as relieve pain.

Discussing any surgical option can be stressful. So if you have any any questions please do not hesitate to email me.
I will get back to you as soon as possible – Dr. David Love.

DL

CONTACT & CONSULTING INFORMATION

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REVISION HIP REPLACEMENT MELBOURNE – DR DAVID LOVE

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