Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation, most commonly referred to as a “ball and socket”. After surgery, the prosthetic ball and socket restore movement in the hip during the life-span of the prosthesis.
An x-ray of total hip
replacement prosthesis with labels showing the "ball and socket."
As with any other
mechanical device, a total hip replacement can be subject to various forms of
mechanical or biological failure. Some of these conditions may require a
re-operation of the hip replacement to address the cause of failure and its
consequences. A re-operation of a total hip replacement is called a “revision.”
WHY CONSIDER A HIP REVISION?
The majority of
elderly patients who receive a hip replacement retain the prosthesis for 15 to
20 years, and sometimes for life. However, some patients may need one or more
revisions of a hip replacement, particularly if the initial hip replacement
surgery is performed at a young age and the patient chooses to have a very
active physical lifestyle.
Pre-operative
investigations in patients who will undergo revision surgery are more extensive
than those required in patients scheduled for a primary surgery. Often times,
special radiographic (x-ray) projections, CT scan, or MRI of the hip may be
necessary to determine position and fixation of the replacement parts, and to
determine with precision the extent of bone loss around the failed implant. A
preoperative aspiration and/or special blood work may be needed if the surgeon
suspects an infection in the failed hip.
REASONS FOR HIP REVISION
Revision hip replacement is a relatively infrequent operation. The most frequent reasons for revision are: a. repetitive dislocation of a hip replacement b. mechanical failure (implant wear and tear – loosening - breakage) c. Infection
Repetitive (recurrent) hip dislocation : As mentioned above, a hip replacement has a structure that resembles that of a natural hip (a ball and socket). For a hip replacement to function well, the ball has to be inside the socket at all times. The factors keeping the ball inside the socket are the alignment and fit of the ball and the socket, and the forces generated by the strong muscles and ligaments around the hip joint. A hip replacement is designed to have a large range of motion. However, some hip positions or trauma can force the hip ball out of the socket, a condition referred to as dislocation.
Dislocations are
relatively infrequent, particularly in the healthy patient who carefully
follows precautions given by the surgeon and physical therapist. However, some
patients are predisposed to this complication: the elderly, debilitated
patients, or those who get a hip replacement after a hip fracture or after
multiple hip surgeries.
Patients who suffered
a hip dislocation are predisposed to additional dislocations, as the dislocated
ball disrupts the important muscles and ligaments around the hip. Multiple
dislocations are infrequent, but in patients who have suffered multiple hip
dislocations, the orthopedic surgeon may recommend revision surgery.
Mechanical wear,
implant loosening, and breakage: The mobile parts of a hip replacement that
move against each other will slowly wear and tear during the regular use of the
replacement. The younger and the more physically active the patient is, the
faster the wear. The wear consists of the generation of very small particles
from constant, repetitive movement of the mechanic parts during the use of the
hip. Depending on the type of hip replacement, the particles can be made out of
plastic, cement, ceramic, or metal. The patient’s immune system will recognize
those particles as foreign and generate an immune response (like an allergic
reaction). A strong reaction to the wear particles can result in the destruction
of bone around the hip replacement. If the bone destruction is severe enough,
the components of the replaced hip may become loose.
A loose component can
move against the surrounding bone, compounding the bone loss. If the bone loss
is severe enough, a spontaneous bone fracture can occur (known as a pathologic
fracture).
Mechanical wear and
tear leading to loosening of the prosthesis (implant) is one of the most
frequent forms of mechanical failure. However, other forms of mechanical
failure are possible, like breakage of the prosthesis.
THINGS TO KEEP IN MIND WHEN CONSIDERING REVISION
HIP SURGERY
During revision
surgery, the surgeon may need to remove or exchange one or more parts of the
hip replacement. The parts that are not attached to the bone can be safely
exchanged with minimal to no removal of the patient’s bone. However, if the
metallic parts in contact with the bone need to be changed, some bone loss
generally occurs. In addition, some of the musculature around the hip will be
lost, thus affecting the strength of the hip and the patient’s function after
surgery. The results of revision surgery are not as predictable as those of the
primary surgery. Complications are more frequent.
A revision of a hip replacement is generally more challenging than the initial operation and it should not be regarded or compared to a “change of tires on the car.” The results of surgery and the durability of the revised hip replacement are less predictable than those of the primary operation. With every revision surgery, there is some loss of muscular mass, bone, or both. The duration of surgery is generally longer and the likelihood of complications higher than during the primary surgery.
* * * * *
DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE, Bavla, Ahmedabad is a one-stop healthcare centre offering a complete range of orthopaedic services. We deal in all kinds of diagnostic, surgical and therapeutic orthopaedic treatment solutions designed for patients belonging to all age groups.
At DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE, Bavla, Ahmedabad, we are entirely patient-oriented and service-focused. We believe that our patients deserve the best-in-class facilities and world-class orthopaedic treatment. Hence, we never fail to put our best foot effort to help them and take care of them. We give attention to every detail related to the patients both during as well as after the surgeries. We take at most care to prevent any type of infection or probable complications after the surgical treatments provided by us.
DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE offers its expertise for comprehensive care for an array of orthopaedic afflictions including hip, knee and joints problems, led by highly reputed and experienced Orthopaedics Doctor in Bavla, Ahmedabad. DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE have a team of expert and experienced doctors and support staff. We are equipped for various specialties ranging from Sports Medicine, Trauma, Joint Replacements surgery, Spine Problems, Arthritis Treatment, and Pain Management. We at DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE use the latest equipment and techniques to diagnose and treat the ailments and strive to provide the highest level of patient care to help them resume their normal life as early as possible.
We at DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE perform various surgical procedures that involve the latest key hole fracture surgery, minimal invasive Spine Surgery, Revision Hip / knee Replacement Surgery, Arthroscopy & Sports Injuries, most delicate Hand surgery, Shoulder & Elbow Surgery, Foot & Ankle Surgery, plastic surgery. Our team of the highly experienced orthopaedic surgeon is supported by the most advanced medical equipment and the most advanced state-of-the-art technology.
(DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE)
DR. DEVAL K. PARIKH
MBBS, D.ORTHO, F.I.A.S.
Consultant Orthopaedic &
Joint Replacement Surgeon
First Floor, Bavla City Centre,
Dhedhal Cross Road, Bavla, Dist. Ahmedabad.
Email : devalkparikh1812@gmail.com
Call for Appointment : +91 80000 33208, +91 99980 33208
Source : by DEV ORTHOPAEDIC & JOINT REPLACEMENT CENTRE, Bavla, Ahmedabad.
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