Hip revision surgery, which is also known as revision total hip arthroplasty , is a procedure in which the surgeon removes a previously implanted artificial hip joint, or prosthesis, and replaces it with a new prosthesis. Hip revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient’s own body; or an allograft, which means that the bone tissue comes from another donor.
What are the reasons for needing a revision THR?
A revision THR may be required for a number of different reasons:
- The THR may become painful because it has been in place for many years and the components have begun to wear and loosen, moving a little in the bone. This type of loosening usually causes some bone loss and damage, and this bone loss needs to be dealt with at the time of revision surgery.
- THRs can dislocate on repeated occasions and revision surgery is needed to stop this distressing complication from happening.
- Patients may fall and sustain a fracture of the bone around the THR, called a peri-prosthetic fracture. This can require a revision THR.
- If a deep infection develops in a THR, revision surgery will frequently be required to eradicate the infection and to implant new non-infected components. A single operation may be performed to eradicate the infection (single-stage revision), but often surgeons prefer to do a two-stage revision involving two separate operations.
How many times can a THR be redone?
The truth is that there is no limit to the number of times a THR can be revised. Clearly, however, multiple revision procedures are not desirable as the more times a hip is revised, the more scar tissue is created in muscle, and this can cause limping and loss of function.
With modern THR techniques, we expect well-performed THRs using proven prostheses to last a minimum of 10–15 years, even in active individuals, before revision THR is required.
The younger the patient is at the time of their first THR, the more likely they are to wear out their THR and require revision surgery. Hence the drive to use harder-wearing THRs and to implant THRs that are smaller so that they are theoretically easier to remove if a revision THR is needed.
Preventing the need for revision hip surgery
The importance of awareness and postoperative surveillance: Some of the previously mentioned forms of failure can be prevented.
Dislocations can be prevented by following the surgeon’s instructions
Some forms of hip infection can be prevented by prompt treatment of other bodily infections and by taking antibiotics before certain dental and other procedures.
The prosthesis’ natural wear and tear is generally painless. Therefore, it is very important that the patient has his/her hip replacement regularly checked. A simple physical examination and radiographs are necessary at the intervals designated by the surgeon. If excessive wear and/or bone loss is detected at any time, close monitoring is necessary to determine the best possible time (if any) to have the hip replacement revised.
Risk of Revision THA Among Medicare Patients with Different Bearing Surfaces
Medicare THA patients with hard-on-hard (M-M, C-C) bearings had a similar risk of complications and revision THA compared to patients who had M-PE bearings during the first 2 years after primary THA. These findings provide a basis for additional analyses of the comparative effectiveness of THA bearing surfaces in the Medicare population.
There is a high complication rate after revision of large-head, MoM THA. If possible, femoral heads should be revised to a 36-mm head with careful counsel regarding activity during recovery to reduce dislocation risk. Based on experience with failure of fiber metal-backed cups, some now use high-porosity cups with screws regardless of bone loss. The question of taper wear contributing to failure needs further investigation but consideration should be given to using ceramic heads with titanium sleeves to reduce the potential for ion generation.