Total Hip Joint Revision Operations

Original Editor - Lucinda hampton Top Contributors - Lucinda hampton

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Lucinda hampton  

Hip prosthesis.jpg

Description

Total Hip Joint replacement (THR) is a mostly successful procedure and usually results in allowing people to live normal lives without chronic pain and stiffness in the hip.[1] Failure rates stand at around 1% in the first 15 years following THR.[2] A 2018 report found that between 2007 and 2017 the rate of THR revision increased by 30% in the age group 45-64, mainly due to use of metal on metal implant at this time with a high mechanical failure.[3]

Revisional Total hip replacement is performed when the initial THR needs to be replaced. The surgery is a longer more complex surgery as the amount of bone available is reduced, the prosthetic parts are often larger/longer and extra bone is often required ( allograft from bone bank or artificial bone). This type of surgery has a slightly higher complication rate and the prosthesis usually has a shorted life span.[4] A 2018 research article found that revision arthroplasty is associated with higher infection rates , lower outcomes and higher financial expense compared to primary replacements.[5]

Indication

Revisional Total hip replacement (THR) is performed when the initial THR has a major problem. This may arise due to

  • Wearing out of THR
  • Loosening of THR
  • Infection
  • Metallosis ( a condition involving deposition and build up of metal debris in soft tissue in the body, particularly in regard to metal implant wear and tear in joint replacements)[6]
  • Periprosthetic fracture ( a fracture around the implant, usually the result of a fall)[7]
  • Ongoing pain
  • Significant leg length discrepancy[4]
[8]



Clinical Presentation

  • Pain clipart.jpg
    The primary reason for revision hip replacement surgery is pain. This may be due to: plastic wear; dislocation; osteolysis; periarticular fracture; infection; hardware of components causing irritation.[9]

Diagnostic Tests

X-rays are essential

Blood tests to check no infection present

CT for closer visualisation of anatomy

Bone scans to look for any loosening[9]

Pre-Op and Post-Op Physiotherapy

This follows the same protocol as Total Hip Surgery ( see Physiopedia page THR ).

Be aware however that the surgeon may have specific advice to follow, especially as this is a more complex procedure and not all orthopaedic surgeons will take on this surgery. eg Non or partial weight bearing to commence.

The total rehabilitation phase in hospital and home may also be longer due to more extensive damage and repair.

Hip exercise 6.png


Resources

https://www.news-medical.net/?tag=/Hip-Replacement

Fun fact.jpgBefore I had my THR when I went dancing I did the "Twist and Shout" Now. I don't.!

References

  1. OrthoInfo. Revision THR. Available from: https://orthoinfo.aaos.org/en/treatment/revision-total-hip-replacement/ (last accessed 1.3.2019)
  2. BMJ journals. TRH:indications for surgery and risk factors for failure. Available from: https://ard.bmj.com/content/56/8/455 (last accessed 1.3.2019)
  3. Eureka Alert. Rate of hip revision surgery declines in all age groups except middle age. Available from: https://eurekalert.org/pub_releases/2018-03/wkh-roh032218.php (last accessed 2.3.2019)
  4. 4.0 4.1 The Hip and Knee Centre.Revision Hip Replacement. Available from: http://www.hipandknee.com.au/revisionhip.html (accessed 1.3.2019)
  5. Markus Weber, Tobias Renkawitz, Florian Voellner, et al., “Revision Surgery in Total Joint Replacement Is Cost-Intensive,” BioMed Research International, vol. 2018, Article ID 8987104, 8 pages, 2018. Available from: https://www.hindawi.com/journals/bmri/2018/8987104/abs/ (last accessed 2.3.2018)
  6. Wikipedia. Metallosis. Available from: https://en.wikipedia.org/wiki/Metallosis (last accessed 2.3.2019)
  7. OrthoInfo. Fracture after THR. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/fracture-after-total-hip-replacement/ (last accessed 2.3.2019)
  8. Joseph Gondusky,MD. Revision of a hip replacement: Why how and what to expect. Available from: https://www.youtube.com/watch?v=OVGmopGEP74 (last accessed 1.3.2019)
  9. 9.0 9.1 Specialist Orthopaedic Group. Revision hip replacement. Available from: http://www.orthospecialist.com.au/revision-hip-replacement.html (last accessed 1.3.2019)