Dr. Gens Goodman, DO
Hip and Knee Replacement Surgery
REVISION HIP REPLACEMENT
The most frequent reason for revision of a cemented total hip replacement is loosening of the implant from surrounding bone. Loosening of a porous-coated, cementless implant is very rare. The revision of porous coated components usually is necessary because of wearing out of the polyethylene liner in the cup. In many cases patients may have no symptoms, and the diagnosis of a damaged joint surface is made from patients’ x-rays. Revision surgery is advised in these cases to prevent further bone damage that could lead to a more complex procedure later. For this reason, we ask our patients with well-functioning hip replacements to see us every 3-5 years. This is necessary to monitor signs of wear from our long-term patients’ x-rays. These signs usually begin to appear in the first 10 years after surgery.
Preparation for revision surgery is more complex than for an initial surgery. Revision patients who had their primary surgery at another institution can help us by obtaining detailed records of previous surgeries so that we know exactly what types of damaged parts need to be replaced. Revision surgery can be relatively simple when it involves just the exchange of a ball and liner. However, the procedure is complex when it involves replacing a failed cemented stem or cup, since cement removal is tedious and time consuming. When the procedure includes removing cement or repairing damaged bone, the operation takes longer, and a patient’s recovery time might be longer than for the first-time hip replacement.
Scar tissues from previous surgery and bone from the failed hip replacement require special attention both during and after surgery. For example, bone grafts may be used to rebuild areas where bone loss has occurred. Patients also may require multiple blood transfusions when revision surgery takes longer.
We customize the rehabilitation plan for each revision patient on the basis of the difficulty and the extent of surgery. Customized rehabilitation can be as simple as limited exercise or limited weight bearing, or as complex as using a brace for 6 to 12 weeks.
In a small percentage of primary and revision hip replacement surgeries, a bone graft is needed to correct a deficiency in the patient’s hip anatomy. The bone graft, which is obtained from a bone bank, has been tested for disease. While the testing process for bone graft is even more stringent than the testing process for blood, there is a small risk of disease transmission.
Heterotopic Ossification and Radiation
Following total hip replacement, some patients may develop abnormal bone formation in the muscles and ligaments surrounding the hip joint. This condition, known as heterotopic ossification, can cause stiffness in the joint. In most cases, but not all, we can identify patients who are at higher than normal risk for developing heterotopic ossification. Radiation therapy, given before surgery, can reduce the risk of heterotopic ossification for these patients. Radiation therapy is low dose, painless, and does not cause sickness. The decision for radiation therapy is made before surgery, and the therapy is usually done at an outside hospital.
Revision Total Hip Replacement