Reasons for revision
Aseptic loosening Wear and tear of the joint surface, partial loosening of a joint replacement, resorption (gradual breakdown) of the bone around the replacement causing the bone to become thin or cracking of the cement that holds the implants in place. Revision surgery for this type of loosening usually requires one operation. The loose implant is removed and a new one is put in.
Septic loosening The hip is loose due to infection. It is difficult to treat infections in the hip as the blood supply is reduced and the implants can make it difficult for antibiotics to get to the specific area. Therefore, the implant is removed with an antibiotic spacer inserted temporarily. The patient is treated with a minimum of six weeks antibiotics and when the infection is clear, another operation is needed to put a new implant back in the hip.
- We make sure you are as fit and healthy as possible before your surgery.
- Surgery takes place within a clean air environment and sterile equipment is used.
- Antibiotics are given before, during and after the operation.
- Specialist equipment is used to remove the hip implants and any cement, if it was previously used. If the bone left appears too thin, extra donated bone will be used to support the joint. (The NHS Blood and Transplant Tissue Services provide donor bone for these situations).
- Exercises and information about reducing the risk of hip dislocation will be given to you.
- Elastic stockings and blood thinning medication will be used to reduce the risk of a blood clot and you will be encouraged to get out of bed soon after surgery.
- It may take six months for the body to compensate for a leg length difference, but it often does. If there continues to be a length issue, this may be helped by physiotherapy and/or a shoe raise. This will be reviewed at your post-operative clinic appointments.
- Normal walking may not be possible and you may always have a limp.
- Pain relief
- Increased function
- Revision surgery can be more complex and the risks are higher than for first time surgery. The outcome is generally reported as being 80% as good as the previous joint, and can deteriorate further if the hip has been revised before.
- The surgery can be more complex and take longer. This can increase the blood loss and risk of infection.
- The tissues and muscles that have been re-opened may be weaker, increasing the risk of dislocation.
- Recovery can be slower and crutches or a frame may be needed for longer.
- The risk of getting a blood clot in the leg or the thigh may be increased.
- Due to the scar tissue from the previous surgery, the nerves may be ‘stuck’ down and, therefore, more likely to be damaged during surgery. This may cause numbness and reduced movement to the foot and thigh. This can take a few months to recover and, in a few cases, may be permanent.
- Bone thinning and removal of the hip implants can lead to more of the bone being removed, thereby shortening your leg. The stability of your joint and making sure it is unlikely to dislocate is a high priority. Although leg length equality is important, the length of the leg may need to be altered to maximise stability.
- Bone thinning may also lead to fractures or cracks, which may require fixation with cables, plates or bone graft. Occasionally, this requires an additional operation to fix. You may need to use crutches for up to three months.
- The life expectancy of a hip replacement is on average 10 – 15 years, so, depending on your age, further revision work may be required in the future.
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