Revision Total Hip Replacement

Revision Total Hip Replacement

Revision total hip replacement can be a complex procedure where one or more of the components of a total hip replacement need to be exchanged. Some of the causes for the need of revision hip replacement include:
  • Polyethylene wear, (plastic).
  • Recurrent dislocation.
  • Infection.
  • Loosening/pain.
  • Fracture around or below the implant.
  • Breakage of a component.
The surgical approach for a revision hip operation may need to be enlarged with respect to a first time surgery. Greater access to the bone for repair or removal of the implant is sometimes necessary. The soft tissues are typically, less flexible then at the initial procedure. There can be a decrease in the quality of bone available, to hold the new implant that is inserted.

One of the common reasons currently for revision total hip replacement involves that of polyethylene wear and subsequent inflammation in the hip joint. This can lead to destruction of bone (osteolysis). Current polyethylene manufacturing and sterilization techniques are felt to be a great improvement on those used in the mid 90's or earlier.

The exchange of the plastic liner inside of a metal shell is the least problematic of the many types of revision surgery. Removal of the actual shell (acetabular component) can be more damaging to bone quality. If a fracture occurs on the femur around the stem, (femoral component) it often needs to be removed and exchanged. Occasionally, these fractures can be secured with plates, screws, wire, and bone graft. This procedure is on the more complex end of the revision spectrum.

There is increased complication risk involved with revision surgery. This includes an increased risk for infection, bone injury, fracture, inability to secure the implant, and dislocation.

The recovery after hip replacement surgery can be relatively rapid, as in the case of a plastic exchange. The recovery maybe prolonged when the bone is especially weak, and/or there is a time of protection required for fracture healing. Overall the results of hip revision surgery, although not as uniformly predictable, are still quite successful and gratifying for the surgeon and the patient.

-JGM