Revision Hip Replacement

What is revision hip replacement?

Most hip replacement surgery is successful, however, sometimes the replacement comes loose, wears out, gets infected, becomes unstable, or even breaks. When this happens, it may need to be removed and a new replacement put in. This is called a revision hip replacement.

How do I know if my hip replacement needs to be revised?

Pain is the commonest symptom of a hip replacement that needs revision. It may be a sign that the hip is loose or infected. Other reasons include dislocation (hip popping out), leg length being too long or short, fracture of the bone around the replacement, and damage from metal particles in ‘metal on metal’ replacements or hip resurfacings. If you haven’t noticed any of these problems, then it is very unlikely that your hip needs to be revised.

How is a revision hip replacement performed?

Revision hip replacement surgery is performed under general anaesthesia. During the procedure, your surgeon will make an incision over the hip to expose the hip joint. Then the femur is dislocated from the acetabulum so that the old plastic liner and the metal socket can be removed from the acetabulum.

After removal, the acetabulum is prepared using extra bone and wire mesh to make up for the socket space and shape. Then the new metal shell is inserted into the socket using screws or special cement. A liner made of plastic or ceramic is placed inside the metal socket.

To prepare the femoral component, the top of the femur bone is cut into several pieces to remove the implant. The segments of bone are cleaned and the new femoral implant is inserted into the femur either by a press fit or using bone cement. The segments of the femur and the femoral component are held together with surgical wires. Then the femoral head component made of metal or ceramic is placed on the femoral stem. All the new components are secured in place to form the new hip joint. The muscles and tendons around the new joint are repaired and the incision is closed.

How effective is revision hip replacement?

The most important factor in whether revision hip replacement is successful is being sure what the problem is beforehand. It is also important whether any of the bone in the pelvis or femur has been worn away by the loose or infected replacement. If there is little or no bone loss, then revision has a high success rate. For example, approximately 90% of chronic infections will be cured, though it is often a two-stage process. The commonest problem in revision hip replacement is weakness or damage to the muscles. This develops when the first replacement is failing, before the revision surgery. It may be difficult to regain full strength, and a stick or walker may be required long term. It is possible to revise a hip replacement 2, 3 or more times if necessary, but each time the hip may be a bit weaker. Every revision is different, and it is important to discuss your particular problem with your surgeon.