In hip replacement
surgery the diseased portions of the
hipbones are cut away and replaced
with a two-part prosthesis, or artificial
hip joint. With revision surgery the
first prosthesis is removed and replaced
with a new one. Sometimes this is
a long process involving more than
one surgical procedure, and is certainly
more taxing than the original replacement
surgery.
The human hip, like the shoulder,
is a ball and socket joint, in which
the ball of one bone (the femur, or
bone of the upper leg) fits into the
socket of another (the pelvic bone).
As a free-moving joint in the body,
the normal hip can move backwards
and forwards, from side-to-side, and
can perform twisting motions.
Like other
free-moving, or synovial joints, the
hip contains a liquid, which lubricates
the joint whenever you move it. It
is held together with ligaments--
straps of tough, sinewy tissue, which
hold the joint together. Full function
of the hip joint depends on the successful
coordination of many interrelated
parts, including bones, muscles, tendons,
ligaments, and nerves.
Reasons
for Revision Hip Surgery?
Artificial
joints do not last forever, and many
show signs of loosening after a period
of 10-15 years. When an artificial
joint is no longer securely attached
to the bone, it is commonly because
the bone absorbs next to the prosthesis;
thus, new abnormal motion occurs,
resulting in pain on weight bearing.
Revision surgery is an attempt to
correct the problem in order to get
the hip back to a condition where
it can function normally.
Patients who
have had an artificial joint implanted
in their hip are usually people aged
55 or older who developed severe and
debilitating arthritis in the hip
joint. After a period of 10-15 years,
the artificial joint may no longer
fit securely. The pressure brought
to bear on the hip, a major weight-bearing
joint, eventually loosens the prosthesis
and compromises its effectiveness.
Sometimes revision
surgery is needed because infection
has spread to surrounding tissue in
the joint. Infections can be dangerous
because it is possible for them to
spread rapidly throughout the body,
regardless of their point of origin.
When infected, the muscle, tendon,
and ligament tissue in the joint can
become damaged, losing elasticity
and strength. Infection damages the
bone, destroying bone stock that was
present in the original surgery. If
infection has developed in the hip
joint, more than one revision surgery
may be required. A first procedure
may be needed to take out the old
prosthesis scar tissue and then infuse
the joint with antibiotics. At a later
date, when the hip is cured of infection,
surgery for a new prosthesis can be
performed.
Pain relief
is the most reliable potential benefit
and often the major reason for hip
revision surgery. For most people,
a hip revision also offers better
movement, strength, and coordination
of the torso and leg. Another benefit
is an improvement in the appearance
of the hip and leg. When a prosthesis
is successfully replaced, the patient
may experience another long stretch
of time with relatively few problems
in the hip.
Surgical
Procedure for Hip Revision Surgery?
Surgery to
repair or replace a loosened prosthetic
hip joint is usually more difficult
than the initial hip replacement.
There may be less bone for the surgeon
to work with, or more bone grafting
may be needed to secure the second
implant. The recovery period for revision
surgery is usually longer as well,
in part because the patient is older
and often in weaker general health.
In preoperative
evaluations, the surgeon tries to
determine the exact surgical method
to be used, taking into account the
particulars of your individual case.
He or she decides on the type and
size of the new prosthesis. An effort
is made to determine whether you will
need additional bone grafts or other
procedures to improve the quality
of bone and tissue in the joint. If
the joint has been damaged by infection,
the surgeon will explain the need
for multiple surgeries. Deep infections
cannot always be cured.
Surgery is
performed by means of open incision.
Commonly, these difficult operations
take several hours. The old prosthesis
is removed and, if possible during
the first surgical procedure, replaced
with a new one.
Rehabilitation
of Hip Revision Surgery?
There are a
number of things to watch for after
any form of surgery: call your doctor
if you notice any drainage or foul
odor from your incision, or if your
temperature rises to over 100.4 degrees.
Your doctor should also be notified
of any increased tenderness, redness,
or swelling. The incision should be
cleaned once a day with regular soap
and water, and then dried carefully.
If redness or drainage from the wound
is noted, please notify your physician
immediately.
A physical
therapist will help you begin walking,
first with a walker and then independently.
Major surgery
like hip joint revision requires a
period of adjustment. Take it easy
during this time, trying to focus
on the healing process and in gradual,
practical improvements to your general
condition. It is important to exercise
your legs, as this reduces swelling.
Elevate your legs above your heart
whenever you are at rest. After hip
revision surgery, a patient will only
get around with a walker. Normal everyday
things like getting into a car or
walking up steps will be difficult.
It won’t be long before a patient
can put weight on the injured leg.
Having already taken part in physical
therapy after the initial hip replacement
surgery, a patient will be familiar
with the physical therapy. After about
a month, a physician will take x-rays
of the leg to monitor its healing.
After about six months, patients with
hip revision surgery will be able
to walk without a limp, and the hip
should no longer cause pain. People
who have hip revision surgery must
be particularly cautious about infection.
After the procedure, it is wise to
always tell your dentist or physician
that you have an artificial joint.
Having a large
metal implant in your hip may sometimes
set off metal detectors in an airport
or at a public event. Just as before
the revision surgery, you should carry
a card identifying you as a patient
with an artificial implant.
Possible
Complications of Hip Revision Surgery?
Hip revision
surgery is usually an elective procedure.
The original artificial joint should
be replaced with one of the high-quality
prostheses currently available.
There may occasionally
be unforeseen complications associated
with anesthesia, including respiratory
or cardiac malfunction. The procedure
may be complicated by infection, injury
to nerves and blood vessels, fracture,
weakness, stiffness or instability
of the joint, pain, or the need for
additional surgeries.
Patients who
may be at increased risk for complications
include those who are immunocompromised
in some way, such as patients with
severe rheumatoid arthritis or systemic
lupus. Those with disease, drug, or
radiation-induced immunosuppression
are also at increased risk, as are
patients with insulin-dependent (type
1) diabetes, malnourishment, hemophilia,
or those who have had previous prosthetic
joint infections.
Many variables
affect the ultimate success of hip
revision surgery, including the strength
of the patient’s bone and musculature,
his or her general health (including
mental and emotional health) and lifestyle.
Commitment to rehabilitation is a
key part of the process, as improvement
to the hip joint is determined not
only by surgery but also by rehabilitative
effort.
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