Revision Total Hip Replacement

Hip revision surgery is performed to repair an artificial hip joint (prosthesis) that has been damaged over time, usually due to normal wear and tear of the prosthetic hip or sometimes due to infection. Revision surgery helps to correct the problem so the hip can function normally again.

Relief from pain is the main benefit of having hip revision surgery. Many patients may find that hip revision surgery improves mobility, strength and coordination of the torso and leg, in addition to improving the appearance of the hip and leg.

It may enable patients to return once again to normal activity with a pain-free hip. However, patients need to remember that the success of their revision surgery is reliant upon their commitment to carrying out their rehabilitation programme following surgery.

  • The Joint School is a programme run by the Mater Private to help prepare patients for joint replacement surgery. The aim is to ensure that they are not only as fit as possible for surgery but that they are ready to be an active participant in their own care.

    Patients meet with members of the entire team who will explain the roles of surgery, anaesthesia, physiotherapy, recovery and pain relief.

    The Joint School has been hugely successful in encouraging and enabling patients to become active participants in their care. This preparation and involvement also removes many of the fears and anxieties which some experience prior to surgery.

  • The Enhanced Recovery Programme (ERP) is a multidisciplinary and goal based approach which encourages the patient to become an active participant in their recovery process and rehabilitation. The goal is to minimise the physical and mental stress of surgery through a combination of preparation and participation so that patients can return to normal, daily activities as soon as possible.

    In practical terms this means that the nursing and physiotherapy teams commence rehabilitation within 24 hours of surgery. The anaesthetic and pain relief protocols have been enhanced – which has the benefit of allowing patients to move earlier and recover faster.

  • Within one month before the operation patients will be invited to attend the Pre-operative Assessment Clinic. During this visit they will be asked about their medical history and any medications they are taking. Blood tests will be carried out and patients may have an ECG and x- ray.

    Hip replacement surgery is generally carried out under spinal anaesthetic with sedation. A Consultant Anaesthetist will discuss with patients the anaesthetic options, as well as the risks and benefits associated with each. Pain management plays an important part in recovery and rehabilitation and is often of great concern for patients. The Consultant Anaesthetist and Nurse at the Clinic will talk to patients about pain management after surgery.

    The Pre-operative Assessment Clinic gives patients the opportunity to see the Physiotherapist and Nurse, ask any questions they may have and plan for their discharge from hospital.

    The risks associated with revision total hip replacement surgery may include:

    • Blood clots. Clots can form in the leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to the lungs, heart or in rare cases, the brain. A Doctor may prescribe blood-thinning medications to reduce this risk.
    • Infection. Infections can occur at the site of the incision and in the deeper tissue near the replacement hip. Most infections are treated with antibiotics, but a major infection near the prosthesis may require surgery to remove and replace the prosthesis again.
    • Fracture. During surgery, healthy portions of the hip joint may fracture. Sometimes the fractures are so small that they heal on their own, but larger fractures may need to be corrected with wires, pins and possibly bone grafts.
    • Dislocation. Certain positions can cause the ball of the new joint to become dislodged. To avoid this, it is often recommended that after surgery patients do not bend more than 90 degrees at the hip and don't let their leg cross the midline of the body. If the hip dislocates, a Doctor may fit a patient with a brace to keep the hip in the correct position. If the hip keeps dislocating, surgery is often required to stabilize it.
    • Change in leg length. The Surgeon takes steps to avoid the problem, but occasionally a replacement hip can make one leg longer or shorter than the other. Occasionally this is caused by weakness in the muscles surrounding the hip. In this case, progressively strengthening and stretching those muscles may help.
    • Loosening. Although this is a rarer complication with newer implants, the new joint may not become solidly fixed to the bone or may loosen over time, causing pain in the hip. Surgery may be required to correct this.
  • As is the case with total hip replacement, it is important to be as fit as possible in advance of revision hip replacement surgery.

    In advance of surgery, patients will attend the Pre-Operative Assessment Clinic at the Mater Private. A specialist team at the clinic will ensure that patients are fully fit and prepared in advance of the procedure and check that they are prepared for their recovery and rehabilitation at home. As mobility will be limited following surgery, it is important that patients have help with everyday activities such as cooking, cleaning and shopping, especially if living alone.

  • During a revision total hip replacement the original implants are removed and new components are implanted. The Surgeon will select the type of implant that best suits a patient's needs.

    • To reduce the risk of blood clots after surgery, patients may be given medication, wear specialist compression stockings and do ankle pump exercises for 2-3 days following surgery.
    • Rehabilitation and physiotherapy is started immediately following replacement surgery and will continue throughout the patient's stay at the hospital and at home. Patients will be given advice and instructions on what their limitations are and what exercises to do in order to enhance their recovery.

     

    Discharge

    A patient's discharge date will be determined by all members of the Healthcare team involved in their care, who will work in consultation with their family.

    Discharge from hospital normally occurs when patients reach specific goals such as the distance they can walk or how much their wound has healed. The Surgeon will discuss the expected length of stay prior to admission.

    Patients generally return to their own homes after discharge from hospital as they typically do better in their own familiar environment. They are given a home exercise programme and rarely require further physiotherapy.

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