Revision Hip Replacement

What is it?

A revision hip replacement is a follow-up operation to replace an artificial hip joint that is no longer functioning effectively. This can occur many years after the primary hip replacement surgery, due to the implant wearing out, or it can happen sooner as the result of some kind of problem with the artificial hip joint. In some circumstances the entire prosthesis needs to be replaced and the bone around the hip may have to be rebuilt. In other cases, only some of the prosthetic components need to be replaced. There can be damage to the bone and soft tissues around the joint, meaning the surgeon has to use an implant that is specifically designed for revision hip replacements. Revision hip replacement surgery is longer and more complex than primary hip replacements, leading to a greater risk of complications. There can also be poorer outcomes compared to the original surgery.

Who might need it?

You will be offered a revision hip replacement if your total hip replacement is no longer performing effectively and needs to be replaced. There can be various reasons for this, including:

• Infected hip implant. This is rare but it can occur while you are in hospital in the immediate post-surgical period, once you return home or even many years after your hip implant. Signs of infection include pain, hip joint instability and discharge from the infection site. If you develop an infection you may be offered a debridement procedure, which involves opening up your hip, washing out the bacteria and exchanging the ball and plastic socket liner. Alternatively, you may be given staged surgery to remove the implant and place a temporary cement spacer in your hip, which is then treated with antibiotics. Once the infection has cleared, a new prosthetic implant is inserted.
• Hip implant becoming loose. This may be because the bone has not grown onto the press-fit components as expected or because the bone cement has loosened. Certain types of high impact activities can lead to implant loosening and so, too, can being overweight as this puts the joint under strain. Artificial hip joints typically last between 15 and 25 years which means some younger patients may ‘outlive’ their hip prosthesis and require a replacement once it wears out.
• Recurrent dislocations. These may occur if the ball is not properly aligned with the socket within your prosthetic hip. You may need revision surgery to improve your hip alignment, or to insert a specially designed implant that can prevent dislocations.
• Fractures. If you fall, you can sustain a periprosthetic fracture, which is a broken bone around the components of your hip implant. Rarely, the implant itself can break. Depending on the location of the fracture, you may need revision surgery.
• Worn out implant. This is particularly likely to occur in younger patients, who may outlive their prosthetic implant, or in patients who are overweight or who participate in high impact activities that damages their artificial hip.

What to expect

You will need to make plans before going into hospital to ensure that you have support after your surgery as your mobility will be limited. On the day of the procedure you will normally be given a general anaesthetic so you will be asleep throughout. In some cases you will be given an epidural which means you will be awake but unable to feel anything from the waist down. Revision hip replacements take several hours. An incision will be made above your hip joint and the surgeon will check for signs of infection and damage to the soft tissues or prosthesis. The implant will be carefully removed and the bone surfaces will be prepared for the new implant. Finally, the specialised revision implant will be inserted and fixed in place. A drain may be inserted into your hip to collect any fluid and the incision site will be closed. You will be transferred to the recovery room where you will be carefully monitored as you come round from the anaesthetic.

Benefits of revision hip replacement surgery

As with primary hip replacements, the aim of revision hip replacement surgery is to relieve pain, improve mobility and increase stability of the hip joint. However, the outcomes are generally less favourable than primary hip replacements and there may not be complete relief from pain or restoration of hip function. There may also be a greater chance of complications, as described above.