Revision Total Hip Replacement Surgery
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
Pre-operative investigations for revision surgery are more extensive than those required in patients scheduled for a primary surgery. Often times, special radiographic (x-ray) projections, CT scan, or MRI of the hip may be necessary to determine position and fixation of the replacement parts (components), and to determine with precision the extent of bone loss around the failed implant. A preoperative aspiration (fluid sample) and/or special blood work may be needed if the surgeon suspects an infection in the failed hip.
Total 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 and replaces it with a new prosthesis. Total 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.
Unlike standard THR, however, total hip revision surgery can be a much longer and more complicated procedure. It is not unusual for a total hip revision operation to take 3-4 hours to perform.
The first stage in all hip revision surgery is the removal of the old prosthesis. The hip sock is removed first. The hip socket is cleaned and defects are filled with small amounts of particulate bone. The new shell and liner are then pressed into the acetabulum.
Revision of the femoral component is often the more complicated part of hip revision surgery. Dr.LaReau often uses specialized instruments to remove the existing prosthesis. If the prosthesis is firmly bonded or cemented to the bone, it may be necessary to open the femur bone with a small cut in order to remove the prosthesis.
The segments of bone are cleaned and the new femoral implant is pressed or cemented in place. Cadaveric bone grafts may be added to strengthen the femur. The segments of the femur are then reassembled around the new implant and bone grafts, and held in place with surgical wire.
After both parts of the prosthesis have been checked for correct positioning, the head of the femoral component is fitted into the new acetabular component and the incision is closed.
