This guide has been written to help patients understand why they need a hip revision and what their surgery might involve.
Why do I need a revision of my hip replacement?
Whilst the vast majority of hip replacements are functioning well 10 years after being put in, some hips may fail earlier than expected. Most hips that need revision have with time become loose, and this in part is due to the ball wearing away the socket. This creates an inflammatory process and the stem and/or socket get loose.
Other hips may fail due to infection. Dislocation is another reason for revising your hip, particularly if the hip repeatedly comes out of joint.
Less commonly, patients fracture around the stem of their hip replacements and require revision.
How will my revision operation differ from my first hip replacement?
Revision surgery is more major surgery. The procedure itself often takes three or more hours to perform and involves the careful removal of your old hip and preparation of the often weakened and damaged bone. This more extensive surgery does have slightly increased risks of both infection and dislocation compared to first time surgery but recent studies have shown that the patient satisfaction and outcomes following redo surgery, is nearly as good as after primary hip replacement.
Getting ready for surgery
Once you have seen the surgeon in clinic and been consented for surgery, you will be placed on a waiting list. One or two weeks before surgery you will be brought along for a pre-assessment. At this clinic, routine tests including blood tests, urine tests, MRSA screening swabs, etc will be arranged and if necessary you will be seen by an Anaesthetist.
Coming into hospital
Nowadays nearly all of our revision hip replacements come in on the day of their surgery. Every effort will be made to put revision operations at the beginning of the operating list. Once ready for theatre and having seen your Surgeon who have marked your leg and answered any final questions, you will be seen by the Anaesthetist. You will be asked to wear some compression stockings which will remain in place for the next six weeks. These will reduce the risk of you getting a blood clot.
Depending on the problem with your primary total hip replacement, all or part of your hip will be removed and replaced. After the operation your Surgeon and physiotherapist will decide on how rapidly you are able to weight bear. Most of our revision patients go home within five or six days of surgery. A small drain will be removed from the site of your leg the day after surgery. Many revision patients will be catheterised when in theatre, so that an accurate assessment of your urine output can be made. The catheter will usually be removed at day two or three.
Your hospital stay
We anticipate revisions going home at day five or six and you will be up and walking usually on day one or two. When you can walk safely and your wound is clean and dry, you will be discharged.
How soon will I recover?
Revision hip surgery varies considerably from patient to patient but the majority of patients will be fully weight bearing at six weeks and should be walking comfortably usually with one stick. You will be assessed by the senior physiotherapist or surgeon at six weeks. Patients who have had their hip revised are often followed up on a long term basis with X-rays every few years.
What about work?
Return to work is normal by eight weeks, but needs to be tailored depending upon how extensive revision surgery you have required.
What about driving?
Patients are usually fit to drive at week six, but have to be safe to do an emergency stop.
What about day to day activities?
Whilst on the ward your physiotherapist will teach you how to safely get in and out of bed, give you advice on dressing, toileting etc. In particular, you will be told how to get in and out of bed, in and out of a car and in and out of a bath.
Do not be frightened to resume normal sexual relations, being careful not to force your hip into an uncomfortable position. Initially it may be safer lying upon your operated side or back.
You will be shown how to get in and out of bed on the ward. It is advisable to sleep on your back, though you may sleep on your operated side with a pillow between your knees to prevent your leg from turning in.
For the first six weeks you can only have a walk-in shower or strip wash sitting on a high stool. You should not attempt to have a bath until after your first outpatient appointment. Should you then require any aids to enable you to get in and out of the bath contact Occupational Health.
What about the garden?
Patients are often keen to get back to gardening. The most important point is to remember to take care picking things up off the ground and your physiotherapist will advise you how to avoid putting your hip at risk. Even heavy digging should be possible by three months.
Movements to avoid following surgery
You should avoid bending at the hip, twisting your waist and crossing your legs.
What are the risks of surgery?
Total hip replacement is a major operation and even in the best of hands is associated with some risk.
Your surgeon will discuss these risks with you in clinic before you sign a consent form.
Revision hip replacement has slightly increased risks compared to total hip replacement.
Risks that need to be discussed include infection (1%), dislocation 1% to 4%), blood clots, leg length change, nerve injury and loosening.