Revision Total Hip Replacement Surgery: A Patient Information Guide

 Dr Spelman will always aim to provide you with a clear understanding of Revision Total Hip Replacement Surgery, a procedure required when an existing hip replacement no longer functions as intended. A revision surgery may be needed due to wear, loosening, infection, or other complications associated with the original hip replacement.

What is Revision Total Hip Replacement Surgery?

 In revision total hip replacement, the worn or damaged components of an existing hip prosthesis are removed and replaced with new implants. The procedure can involve replacing one or more components of the hip joint, including the femoral stem, acetabular cup, or both. Revision surgeries are typically much more complex than primary hip replacements due to factors like bone loss, scarring, and the need for specialized implants and techniques.

Benefits of Revision Hip Replacement

 1. Pain Relief: The primary goal of revision surgery is to alleviate pain caused by implant failure, infection, or wear. Many patients experience significant pain relief and improvement in mobility after revision.

 2. Restoration of Function: Revision surgery aims to restore joint stability, function, and alignment, allowing patients to resume daily activities and improve their quality of life.

 3. Infection Management: For patients experiencing infection in their hip joint, revision surgery can eradicate the infection through the removal of infected components and thorough cleaning of the area, sometimes requiring a two-stage procedure with temporary antibiotic spacers.

 4. Improved Implant Longevity: Newer materials and techniques used in revision surgery can increase implant durability, offering the potential for an extended lifespan of the revised joint.

Risks and Complications

Revision surgery is a complex procedure and carries higher risks than primary hip replacement. Here are the key risks to consider:

1. Bone Loss: Significant bone loss can occur as a result of the failed implant or during its removal. Special implants or bone grafts may be required to address this issue and restore bone structure. There may also be additional implants or adjuncts to the revision procedure required

 2. Higher Risk of Infection: Infection rates in revision surgeries are generally higher than in primary hip replacements, even in cases where the original hip replacement is not infected. Meticulous techniques and sometimes two-stage procedures with antibiotic spacers are employed to minimize this risk.

 3. Increased Risk of Dislocation: Due to changes in the soft tissues and the mechanical alignment of the joint, revision hip replacements are more susceptible to dislocation, particularly if the original joint has been dislocated previously.

 4. Decreased Mobility: Patients undergoing revision surgery often experience a longer and more challenging recovery period, and they may not regain the same level of mobility as with their original hip replacement.

 5. Higher Complication Rates: Revision surgeries are generally associated with higher rates of complications, including nerve damage, leg length discrepancies, dislocation, infection and blood clots, due to the complexity and duration of the procedure.

Revision Statistics from AOANJRR

 According to data from the AOANJRR, revision rates vary significantly depending on the type of implant, patient factors, and surgical approach. For primary hip replacements, the average revision rate is approximately 5% after 10 years, or 8% after 21 years. However, revision surgeries themselves have a higher re-revision rate, with approximately 15-20% of patients requiring further revision within 10 years after their initial revision surgery.

Patients who have had a revision are at a higher risk of needing additional surgeries, especially if they experienced complications such as infection or instability. AOANJRR data also indicates that younger patients (under 55) and those with high levels of physical activity may face higher rates of revision due to implant wear or mechanical failure.

While revision total hip replacement is a procedure with a high success rate for pain relief and functional improvement, it is essential to understand the risks involved, the complexity of the surgery, and the potential for further revisions in the future.

As always, Dr Spelman is here to discuss any questions or concerns you may have about revision hip replacement surgery and guide you through the decision-making process to ensure the best possible outcome.