I had a hip replacement done 25 years ago and the stem is loosening up. One surgeon said he would have to cut into the bone to get the stem out and recovery time would be extensive, but another surgeon told me that he can take out the old stem without taking out all of the old cement and can just put the new stem in with new cement. He said he couldn't fix leg length problems (which I don't seem to have a problem with right now) and I would not have the same mobility as if the "dug" out all of the old cement but that I would probably have more mobility than I do now since the joints are much better now than when I had mine done. I have been virtually pain free for 25 years and have had pretty good mobility, didn't jog or run but was able to do most anything I wanted to. I am 53 now and would rather give up a little mobility than have to heal from him cutting into the bone. Are you familiar with what the second surgeon is talking about in just putting the new joint in over the old cement?
need revision
- Thread starter mcgaughy
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Yes, I am very familiar with both procedures.
The issue of removing all the cement is one that has been a topic of debate in the orthopaedic community for some years. It's based largely upon the fact that where the revision has been necessitated by the presence of infection, it is absolutely essential that every scrap of old cement is removed. Trouble was that pieces of cement get locked onto the bone like barnacles on a ship's hull and are the very devil to shift! Equipment using ultrasound wands (which loosens the cement from the bone without actually damaging the bone) were even developed to deal with this. They are called OSCAR tools (Orthosonic System for Cemented Arthroplasty Revision)!
Also, if the femoral prosthesis is difficult to remove, the surgeon may have to cut a small window in the shaft of the femur, below the bottom of the stem, and push it out from below. This leaves a weakness in the shaft which is usually overcome by implanting a long stemmed prosthesis to extend below the window.
Incidentally, the acetabular cement comes out relatively easily, mostly attached to the cup, and is not the problem.
But now we are coming into a time when revisions for aging, loosening and/or wear are much more common and since there is no infection present, it was figured that there was no need to embark on these 3-4 hr marathons but to simply re-prepare the inside of the femur to take the second prosthesis. It's less invasive and traumatising that the alternative and, so far as I know, just as successful as in a primary THR.
Hope this helps.
However, you had a good run on your primary. I hope your revision goes as well.
The issue of removing all the cement is one that has been a topic of debate in the orthopaedic community for some years. It's based largely upon the fact that where the revision has been necessitated by the presence of infection, it is absolutely essential that every scrap of old cement is removed. Trouble was that pieces of cement get locked onto the bone like barnacles on a ship's hull and are the very devil to shift! Equipment using ultrasound wands (which loosens the cement from the bone without actually damaging the bone) were even developed to deal with this. They are called OSCAR tools (Orthosonic System for Cemented Arthroplasty Revision)!
Also, if the femoral prosthesis is difficult to remove, the surgeon may have to cut a small window in the shaft of the femur, below the bottom of the stem, and push it out from below. This leaves a weakness in the shaft which is usually overcome by implanting a long stemmed prosthesis to extend below the window.
Incidentally, the acetabular cement comes out relatively easily, mostly attached to the cup, and is not the problem.
But now we are coming into a time when revisions for aging, loosening and/or wear are much more common and since there is no infection present, it was figured that there was no need to embark on these 3-4 hr marathons but to simply re-prepare the inside of the femur to take the second prosthesis. It's less invasive and traumatising that the alternative and, so far as I know, just as successful as in a primary THR.
Hope this helps.
However, you had a good run on your primary. I hope your revision goes as well.
mcgaughy
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Thank you so much. This helps me to understand why there was so much difference between the two opinions. You are right, I had a really good run with the first one and I am grateful for that. The new doctor says that this could be my last time to have it revised. Thanks so much for your help.
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