Total Hip Replacement Revision or Change

What is it?

Hip replacement revision is a surgical procedure increasingly necessary due to rising life expectancy. With an average life expectancy of around 20 years post-surgery, a patient receiving a hip replacement around age 60 may experience prosthesis wear at an age where their functional demands remain high.

Increased life expectancy and a rise in younger patients requiring surgery have led to a significant increase in hip replacement revisions in recent years.

Therefore, two primary reasons, independent of external factors, can necessitate total hip replacement revision:

• Increased life expectancy;
• Increased number of younger patients receiving hip replacements;

While modern technology produces high-quality hip prostheses, the physiology of a replaced hip differs significantly from a natural hip.

Beyond the two reasons above, numerous factors can affect prosthesis function. Examples include:

• Natural loosening of moving parts, accelerated by stress and causing instability;
• Hip prosthesis dislocation, possibly due to wear or improper movement;
• Overuse, common in younger or overweight patients;
• Infection, potentially from bacterial colonization;
• Femur fracture where the prosthesis is inserted, requiring a longer stem;
• Fracture or wear of prosthesis components, a rare but possible occurrence affecting fragile parts;

Before Treatment

Diagnosing hip prosthesis failure involves a thorough examination where the specialist reviews the patient's medical history and assesses their progress.

Diagnostic tools include:

• Laboratory tests, including blood tests (CBC, ESR, CRP, procalcitonin, interleukin-6) and potential intra-articular fluid culture;
• Pelvis and hip X-ray, to evaluate bone structure and prosthesis components;
• CT scan;
• MRI (with M.A.R.S. technique) to assess tissue condition;
• Three-phase and labeled leukocyte bone scan;

Treatment

This is a complex procedure requiring meticulous pre-operative planning, appropriate implants and instruments, and expert surgical techniques.

Surgical procedures can be diverse and complementary:

• Removal of loosened or worn components and possibly cement. Whether it's the cup or stem, this carries risks of vascular-nervous damage or femoral diaphysis fracture. Osteosynthesis (using metal bands, plates, or screws) may be necessary. If the femoral bone is thin or the stem is firmly anchored, osteotomy (bone window) may be performed for easier extraction, preventing fracture. A new cemented stem or a longer revision stem is then used to bond to the distal femur, bypassing damaged bone;
• Reimplantation of a new prosthetic component. This uses a cemented or uncemented (press-fit) implant, potentially with screws to secure the cup, depending on bone condition;
• Septic prosthetic mobilization. This involves infected prosthesis removal and reimplantation, either in a single procedure or, more commonly, two procedures separated by 2-3 months. An antibiotic cement spacer is used during the interval to heal tissues and maintain space for the final prosthesis, preventing limb shortening;
• Debris disease. Metal-metal prostheses with adverse reactions are revised after thorough surgical cleaning of the joint, removal of reactive tissues, and abundant washing. Ceramic-polyethylene or ceramic-ceramic bearings are preferred in these cases;

EXPRESS QUOTE

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After the Procedure

Physical rehabilitation usually begins within 24 hours to reinforce surgical work. Recovery time varies by patient.

Rehabilitation is similar to post-initial implantation, though surgeons often advise extra caution to minimize damage to the new implant.

Rehabilitation varies greatly; report any unusual symptoms to your surgeon for assessment.

Expected Results

In hip prosthesis revision surgery, the surgeon must meticulously plan and have appropriate equipment for a durable implant.

Clinical results depend on "available bone capital", muscle trophism, and prior revisions.

Patients with healthy bone, strong muscles, and no prior revisions have a higher success rate.

Advances in prosthesis technology aim to make revision results increasingly comparable to initial implantations.

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