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Revision of hip replacement

Josephine

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Sometimes it becomes necessary to redo a hip replacement but the reasons are varied. I'll try to explain a few:

Wear of the liner

The simplest of revisions if the liner is still in production. Liners are specific to one design and not interchangeable. If the appropriate implant can be obtained, it should take no longer than 1 hour to do.

Loosening

This can be either the cup or the stem that loosens. For both implants to loosen would be very unusual.
If it be the cup, it is relatively simple process to remove the implant and replace it.
If the stem, it might be more difficult because, although it is nominally loose, the prosthesis might still be difficult to get out especially if it is a uncemented implant.
Usually cement is always used in a revision.

Time for surgery depends upon how easily the femoral stem can be removed. But usually is no longer than a primary THR being about 1-1½ hours.

Malalignment
Most problems of pain, undue wear or even loosening are due to misalignment of one or both implants. Generally, if misalignment is identified or even suspected, both implants might be replaced.

Time for surgery depends upon how easily the femoral stem can be removed. But usually is no longer than a primary THR being about 1-1½ hours.

Idiopathic pain
This is pain without reason or moe properly, without a diagnosable reason. If prolonged and/or severe pain is being experienced, revision may resolve the issue. Many think that idiopathic pain is actually due to misalignment. Both implants will be replaced.

Time for surgery depends upon how easily the femoral stem can be removed. But usually is no longer than a primary THR being about 1-1½ hours.

Infection
Where infection occurs, there is a well defined process of treatment to eradicate the infection before revision can be done. This includes:
~ removal of prostheses. If these were put in with bone cement, it can be a long process as every particle of the old cement has to be removed
~ insertion of antibiotic loaded cement spacers which maintain the space for the prostheses
~ IV antibiotics via a PICC (peripherally inserted central catheter) line

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~ Repeated blood tests track the elimination of the infection. When tests are clear, the new prostheses can be implanted with new cement.

Time for the first surgery depends upon how easily the femoral stem can be removed and therefore could take anything from about 1½-2½ hours.
Second surgery to reimplant the new hip would be no longer than about 1-1½ hours.

Failure of metal ware

On rare occasions, the prosthesis, most commonly the femoral stem, can break. Mostly this is because they have been inserted in a bad angle at the beginning or the cement has not been distributed properly in the bone and/or prosthesis.
The biggest issue here is the removal of the bottom part of the stem. Very often, a small window has to be cut in the bone just below the fragment and it is pushed up and out from below. Then a longer stem femoral prosthesis has to be used to go across where the window was cut to make sure the femoral shaft does not fracture at that point.

Time for surgery depends upon how easily the femoral stem fragment can be removed. Otherwise is no longer than a primary THR being about 1-1½ hours but could be a lot longer.

Breakages in bone
(peri-prosthetic fractures)
Rarely, the bone might break around an implant, mostly the femoral shaft. This might be due to misalignment or to a serious accident like a bad fall or a car accident. In these cases, the femoral stem will be removed and replaced with a longer stemmed prosthesis to secure an internal fixation of the fracture. A period of non-weight bearing might be necessary.

Time for surgery depends upon how easily the femoral stem can be removed and how long it takes to fix the broken area. Could take anything from about 1½-3 hours.
 

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