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When an initial hip replacement has failed it may need to be redone (revised) to address the problem. Hip joint replacements fail for many reasons but the most common are infection, dislocation, loosening from the bone, and wear of the plastic part. Revision strategy depends on the underlying problem but can involve replacing just part of the hip replacement or replacing all the parts.
Patients with previous hip replacements with a diagnosis of loosening, infection, instability, liner wear or arthrofibrosis may be good candidates for revision. There are also other less common reasons someone may need a hip replacement redone that can be discussed with the doctor. Sometimes revision hip replacement is delayed for medical reasons to be sure a patient can safely undergo surgery. Consults with cardiologists and other specialists may sometimes be needed for clearance.
Will I have activity restrictions after revision hip replacement?
Usually after revision hip surgery you will have some motion restrictions, especially the first 6 weeks due to risk of dislocation. Restrictions will be specific to the incision used for revision surgery.
When can I return to work after hip replacement?
We allow patients 3 full months to recover before return to work if needed. Many patients are ready much sooner, especially if their work does not include prolonged activity or heavy labor.
When can I drive?
After having a right hip replacement revision, it is recommended to avoid driving for 4-6 weeks. After a left hip replacement driving is allowed after 2-3 weeks when patients are off high dose pain medicine.
After your evaluation, if you are deemed a candidate for hip replacement revision you have a few tasks that will help you prepare for surgery. Lab work and an EKG will be ordered to ensure that your health is optimized and there are no concerns for your anesthesiologist. These tests and your medical history will be reviewed at an appointment prior to your scheduled surgery.
A pre surgery online class will review the procedure, expectations and your readiness for knee replacement revision. All your pre-surgery activities will be given to you in the form of a checklist to make it easy to remember and complete.
If you see any specialists, like a cardiologist, for conditions that may affect your surgery we will work with you to get clearance to ensure the surgery is as safe as possible.
Revision hip replacement starts in the preop area where you will receive your anesthesia. Anesthesia usually includes a spinal (which will make your legs sleep). Sometimes if spinal is not possible or recommended you may have general anesthesia.
After anesthesia, you will go to the operating room and receive sedation to ensure a relaxing sleep throughout the surgery. Once you are asleep, the surgeon will review the planned procedure with the team and then the surgery will start.
Your old incision will be used to enter the hip joint and extended if needed. The old hip replacement and bone are exposed, and then next steps will depend on your diagnosis and specific treatment plan but usually involve removal of one or more parts and replacement with new implants.
When the surgery is complete, the incision is then closed using dissolvable sutures so that no stitches or staples need to be removed. A dressing is placed over the incision, and you will be taken to the recovery room where you will wake up before going to your room to complete your requirements for discharge.
Most patients will be able to return home the same day or next day after surgery. Requirements to go home include walking independently with a walker, adequate pain control, using the restroom and being able to eat and drink.
Revision hip replacement recovery takes approximately 6 weeks to 3 months. Revision hip replacement surgery is expected to be painful, but you will be given pain medication to assist in your recovery.
Remaining mobile with walking is important to ensure a more rapid and full recovery. Physical therapy may be recommended in some cases but is not always required after hip revision surgery. During recovery frequent icing, regular walking, stationary bike, and elevation are usually recommended. Swelling and bruising are normal in the early recovery period. Maintaining a healthy diet with high protein intake also results in improved healing, energy and recovery.
Two weeks after surgery your incision will be checked to ensure proper healing. Your dressing will be removed during that office visit. It is ok if you are still using walker or cane at this stage of recovery. Specialized collagen dressings may be ordered at this visit or before to assist with wound healing if you are at risk for wound complications.
After 6 weeks a Xray will be done in the office, and you will see your new hip. You will most likely no longer need cane or walker at this visit and be released to normal activity. However, it is normal to have residual swelling, aches and pains and warmth at this visit.
If you are not meeting goals at your 6-week visit you will have another post-op visit at 3 months post-surgery to check progress. The next visit is typically one year after surgery to repeat an Xray.
If your revision was related to infection multiple surgeries are sometimes required for full recovery so the recovery timeline may be longer.
Complications after Revision Hip Replacement are rare but there are some risks that every patient should be aware of. Early risks are infection and blood clots. You will be given medication and special preparatory soap and nasal decolonization to prevent infection and blood clots. Other complications are very rare but can include ligament or tendon injury, dislocation, leg length discrepancy, artery or nerve injury, and medical complications like heart attack or stroke.
Revision Hip Replacements do have higher risk than first time hip replacements. Infection is more common but still rare. Revision hip implants also typically do more work to stabilize your hip and there has often been more soft tissue disruption so dislocation risk can be higher. Every effort is made to reduce these risks at the time of surgery.
Dr. Catherine Cahill is certified by the American Board of Orthopedic Surgery and has performed over 5000 total joint replacements. She performs hundreds of joint replacements per year including a high volume of revision total hip and total knee replacements.