Treatment for a Total Hip Replacement
How should I prepare for revision total hip replacement?
It will be difficult to move around after surgery and you may need help for several weeks with tasks of daily living (cooking, shopping, bathing, and doing laundry).
Your provider, a social worker, or a discharge planner at the hospital can help you make arrangements to have someone assist you at home. Depending on your condition, you may need to stay at a nursing facility or rehabilitation center for some time after you leave the hospital. Your healthcare team can also help you arrange for a short stay in an extended care facility during your recovery if necessary.
How is revision different from a total hip replacement?
Revision total hip replacement is a more complex procedure and takes longer to perform than primary total hip replacement. In most cases, the surgery takes several hours.
To begin, your doctor will follow the line of the incision made during your primary total hip replacement. The incision may be extended, however, to allow the old components to be removed. Once the incision is made, your doctor will expose the hip joint.
After exposing the joint, your doctor will examine the soft tissues in your hip to make sure that they are free from infection and other problems, such as a reaction to the metal components. He or she will assess all parts of the prosthesis to determine which ones have become worn or loose or shifted out of position.
Your doctor will then remove the original implant very carefully to preserve as much bone as possible. If cement was used in the primary total hip replacement, this is removed, as well. Removing this cement from the bone is a time-consuming process that adds to the complexity and length of the revision surgery.
Occasionally, a controlled "fracture" of the femur (thighbone) will be performed in order to remove a well-fixed stem. The femur will be put back together once the new stem is in place.
After removing the original implants, your doctor will prepare the bone surfaces in the pelvis and the femur for the revision implants. In some cases, there may be significant bone loss in these areas. If this occurs, metal augments or bone graft can be added to make up for the bony deficits.
Finally, your doctor will insert the specialized revision implants. Often multiple screws are required to hold the new cup in place until bone grows in. Your doctor will test the motion of the joint to ensure the implants are well-fixed and that the ball is stable inside the socket.
Special "trial" implants are usually tested prior to inserting and fixing the final components. A drain may be placed in your hip to collect fluid or blood that may remain after surgery.
After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. When you wake up, you will be taken to your hospital room.
What are the risks of revision total hip replacement?
Because a revision total hip replacement takes longer and is more complex than primary total hip replacement, it has a greater risk of complications. Before your surgery, your doctor will discuss each of the risks with you and will take specific measures to help avoid potential complications.
The possible risks and complications of revision surgery include:
- Blood clots
- Pulmonary embolism—a blood clot in the lungs
- Leg-length inequality
- Heterotopic ossification—new bone may form where it is not normally present
- Damage to nerves or blood vessels
- Failure of the bone to attach to the metal implant
- Implant loosening
What is recovery for revision total hip replacement like while in the hospital?
You will most likely stay in the hospital for several days. Although recovery after revision is usually slower than recovery after primary hip replacement, the type of care you will receive is very similar.
After surgery, you will feel some pain. Your doctor and nurses will work to reduce your pain, which can help you recover from your surgery faster.
Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Opioids can provide excellent pain relief, however, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Specific exercises will help strengthen your leg and restore function so that you may begin walking and resume your other daily activities as soon as possible after surgery.
You may have weight-bearing limitations at first, depending on the complexity of your surgery. You may also be given certain hip precautions (positions to avoid) in order to prevent dislocation.
Blood Clot Prevention
Your doctor may prescribe one or more measures to prevent blood clots and decrease leg swelling. These may include special graded compression stockings, inflatable leg coverings (compression boots), and blood thinners. Foot and ankle movement will be encouraged immediately following surgery. This is done to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.
One of the most serious complications facing patients who undergo revision surgery is infection. Although infection occurs in only a small percentage of patients, it can prolong or limit full recovery. To prevent infection, you will be given antibiotics both before and after surgery. The risk of infection is slightly higher after revision surgery than after primary total hip replacement.
What is recovery like for a revision total hip replacement?
You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.
You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. If you are not allowed to put weight on your operative leg, you may need to use a walking aid for a longer period of time.
You may have stitches, staples, or glue running along your wound or sutures beneath your skin. The stitches or staples will be removed several weeks after surgery. Sutures beneath your skin will not require removal.
Avoid soaking the wound in water until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
It is important to continue moving and exercising when you are home. Your physical therapist will provide you with specific exercises to help increase your strength and mobility and improve your ability to do everyday activities. Your therapist will also work with you to ensure that you understand and are following your hip precautions.
Follow your doctor's instructions carefully to reduce your risk of developing complications, including blood clots and infection, during the first several weeks of your recovery. He or she may recommend that you continue taking the blood-thinning and antibiotic medications that you started in the hospital.
How do most patients feel after revision total hip replacement?
Most patients who undergo revision surgery have good long-term outcomes. This includes relief from pain, increased stability, and better function. Complete pain relief and restoration of function are not always possible, however, and some patients may still experience some pain or dysfunction following revision surgery.