If all or part of your existing hip replacement has failed, worn out, loosened, or is infected or causing pain, you will need to undergo complex revision surgery.
Revision hip replacement surgery can vary greatly in scope and magnitude depending on the amount of damage that needs to be repaired, however in general it is a little more complex than a primary replacement as there is less existing bone to work with.
In some cases, minor revision surgery can be performed arthroscopically (keyhole surgery), but in many cases a full incision is required, along with what is essentially a total repeat of your initial hip replacement procedure.
When is surgery necessary?
The primary reason for complex revision surgery is to alleviate pain caused by the damaged replacement site. Being artificial, the existing prosthesis is unable to heal, and more severe complications can arise if the problem area is left untreated.
About the procedure
What it involves
Complex revision surgery is generally more demanding than initial hip replacement surgery as bone quality around the prosthesis can be lower. This means that operations tend to take longer, as they can involve the need to remove existing implants and/or applying bone grafts.
- You will be given either general anaesthesia (put to sleep), spinal (waist down) or local (only one area) based on the anaesthetist’s recommendation.
- An incision is made over your existing scar on the hip, buttock or thigh area.
- Muscles and ligaments are separated or temporarily detached to expose the existing hip replacement site.
- The failed implant (ball or socket) is removed.
- The area where the implant was attached is re-prepared for a new prosthesis. A bone graft may be needed if there is not enough existing bone for attachment.
- The new joint is smoothed flush with the existing bone structure.
- The whole area is re-constructed and closed up. A drain may be inserted to remove fluid build-up.
Hospital stay and recovery time
In-patient stay: Average 5-7 days
Walk (with stick): Within 2-3 weeks (ideally)
Walk (unaided): By 6 weeks (usually)
Possible risks and complications
Due to its comparatively complex nature, revision hip surgery carries with it a slightly higher incidence of complications than initial hip replacement surgery.
These complications are often the result of weakened bone structure around the replacement area, and can include fracture, dislocation and infection. Having previously had a hip replacement, you will however be familiar with the risks and recovery process, so try to be as prepared as possible.
As with any surgery, there are other inherent risks to be considered, including blood clots, wound or scar irritation, unequal leg length, nerve damage, increased pain, dislocation, repeat failure of the joint, heart attack, stroke or death.
Rest assured that you will be in the safe hands of Dr. Letchford and his surgical team, and that every measure will be taken to minimise the chance of side effects or complications from occurring.
Prior to your surgery, there are several things that both you and Dr. Letchford will need to do to ensure everything goes smoothly before and after the operation.
- Existing medications
You should cease taking any blood-thinning or anti-inflammatory drugs, as well as any herbal or natural remedies you are taking, at least 10 days before your surgery.
- Medical evaluation
You will undergo a routine medical examination to make sure you are well enough health for the operation, and to identify any factors that might cause issues down the line, including body weight and existing infections or skin conditions.
- Dental evaluation
Dental work can introduce bacteria into the bloodstream. To safeguard against the chance of developing an infection, please have any dental work done well before or after your surgery. You may need to take preventative antibiotics for a few months to a few years after your surgery to protect against the risk of infection.
- Further tests and blood work
You will be sent for routine blood work to confirm you are healthy enough to undergo surgery. We may also perform heart checks or additional scans if the need arises.
- Home preparation
To help make your return home easier, it’s a good idea to make preparations, as you will have limited mobility after surgery. You might consider planning for loved ones to help you with daily tasks, and to arrange for furniture to be rearranged to help you get about easier.
It is recommended that you stop smoking for as long as possible before your surgery, as it can encourage clots while hampering circulation and oxygenation of the blood.
Recovery, rehabilitation and precautions
- Preventing injury or dislocation
After your surgery, try to take things slowly. Use a walking aid and try to avoid stairs. Try not to cross your legs, turn your feet strongly inwards or outwards, or bend your hips more than 90 degrees. You may also be advised to sleep with a pillow between your legs.
- Preventing infection
Keeping your wound dry and well dressed is very important. Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain.
- Preventing blood clots
You will be given a combination of anti-clotting drugs and a pressure bandage to help prevent clots from forming. If you notice any shortness of breath or unexplained pain, contact your doctor immediately.
- Staying nourished
You may experience some loss of appetite following surgery. To give yourself the best chance at a speedy recovery, try to eat a healthy, balanced diet and keep your fluid levels up.
- Exercise and physiotherapy
You will be appointed a physiotherapist who will help you to understand what kinds of exercises you need to do to regain strength and mobility, and explain what you can and can’t do with your new hip. It is important that you ease yourself back into light daily activity as soon as you can.
For more information on what to expect from your complex revision surgery, please take the time to read through the resources available at the American Academy of Orthopaedic Surgeons website.