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Revision Hip Replacement

Total Hip Replacements may require revision surgery for a number of reasons. These include infections, recurrent dislocations, loosening of implants and periprosthetic fractures.Revision surgery is much more challenging than a first time replacement. These should be done by surgeons specialized in revision surgery.
The hospital also should have facilities for after care such as intensive care. Special instruments are required to remove the original implants without causing additional damage to the remaining bone. Br Bipin gets revision hip and knee cases referred from around the region and does these at the Medical Trust Hospital.

Special instruments are required to remove the original implants without causing additional damage to the remaining bone. Reconstruction of the joint is carried out using special revision implants. In cases with extreme bone loss allografts were traditionally used for reconstruction.
How ever, the availability of porous trabecular metal implants have revolutionized revision surgery with bone loss. Trabecular metal augments are available in different shapes and sizes. With these implants it is possible to reconstruct large defects without the need for allograft. This also provides primary stability and patients can often resume early weight bearing.

Revisions for Infected Replacement

If a replacement gets infected, simple antibiotics are often ineffective to cure this. The only way to clear a deep infection is by removing the components. Sometimes it is possible to re-implant a new hip in the same sitting. More often the surgeon will decide to leave the patient with a temporary antibiotic impregnated spacer instead of a full replacement (sometimes the patient is left without a hip) for a period of about 2-3 months. This period without a hip is used treat any remaining infection with antibiotics.

This is called a two stage revision and this is the most accepted way of elimination infection with 90-95% success rate. In spite of all this, if the pathogen (bug causing infection )is particularly virulent it is difficult for any surgeon to guarantee that the infection will get cleared. It is exactly for this reason that all precautions are taken at the primary surgery to ensure that infection does not get into the new joint- antibiotics, rigid aseptic technique, antibiotic loaded bone cement, laminar flow theatres and so on.

Revisions for Aseptic Loosening

Even when infection is not a problem, revision surgery still is a major undertaking to the surgeon and also to the patient. All replacements eventually fail by loosening around the artificial joint. As the joint starts to become loose the bone around it becomes thin. The biggest issue here is handing of bone loss. The commonest way of handling this is with the use of bone allograft. This is bone obtained from bone donors. ADD PICTURE 4The other option now available is the use of porous trabecular metal implants which comes in a variety of size and shapes. These are expensive but it is possible to reconstruct even very large defects without the need for allograft.



Revision For Fractures

If the patient has a heavy fall after a hip replacement they can develop a fracture around the stem. If this happens generally an operation is required to fix this. In some cases one can retain the replacement and do a plating. If the fracture is too extensive the patient may require a revision of the stem.



Revision For Dislocation

atients with hip replacements may develop a dislocation due a number of patient related and surgeon related factors.
Surgical treatment for dislocation is required in cases with malpositioned components. In such cases it is possible to correct the malposition and obtain a stable hip which does not dislocate.