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Hip Revision

A revision hip replacement is performed to treat a failed hip replacement. The preparation and recovery usually is similar to undergoing a primary hip replacement. There may be some exceptions to the instructions listed for a standard hip replacement as below. The surgeon will explain to you at the time of listing.

You should aim to be in the best overall physical and mental condition possible to help achieve the best results from your surgery.

 

Preparing your body

  • stop smoking
  • manage a healthy weight
  • practice your exercises before your surgery
  • manage existing medical conditions
  • make sure there are no infections - tooth abscess, bladder infections, infected leg ulcers, insects bites, cold & flu
  • manage your medicines as instructed in the preoperative period, such as blood thinners,

 

Preparing your mind

  • ask a family member or friend to support you through this process
  • ask your doctor or your surgeon if you would like any help
  • feel free to ask your surgeon if you may have any questions to about the procedure
  • feel free to make notes or print these documents for future reference

 

Preparing your home

  • create a safe home environment for your recovery
  • have a chair with firm seat higher than your knee level
  • some adaptive equipment might help you - toilet seat, ice pack, raised toliet seat, long-handled aids
  • stock up on groceries and toiletries remove rugs and mats
  • remove clutter or furniture that may cause obstruction when using a walking aid

 

Preparing for your hospital stay

  • bring essential clothing and items of personal care
  • bring your glasses, hearing aids, splints and medicines
  • do not bring any valuables or jewellery
  • make note of your fasting instructions

Hospital admission

  • Most patients are admitted on the day of surgery. You will be checked upon on admission and will meet your anaesthetist and the surgeon
  • Your anaesthetist will discuss different anaesthetic techniques for your procedure
  • A member of the surgical team will mark your limb with indelible ink

 

Surgery

  • The procedure takes approximately 60-90 minutes
  • You will have a dressing over the surgical site which will remain for approximately 14 days

 

Recovery and rehabilitation during hospital stay

  • Your rehabilitation will start as soon as on the day of surgery
  • You will have physiotherapy everyday you are in the hospital- It is normal to have some pain following surgery but pain medications will help you with this.
  • It is important that your pain does not restrict you from moving around following surgery
  • You will have a blood test and an Xray after surgery
  • You must perform ankle pump exercises when resting and remain well hydratred to minimise your risk of getting a blood clot
  • You will be given an injection or tablet to minimise the risk of getting a blood clot further

 

Checklist before your discharge from hospital

  • You will be able to walk short distances
  • You will be able to walk up and downstairs (if needed)
  • Get on and off a chair and your bed independently
  • Get on and off the toilet independently
  • You will be able to perform your home exercises independently
  • Shower and dress with appropriate support
  • Pain is manageable and have access to pain medications
  • Able to give your own blood thinning medicine (injections)

 

Hip exercises

  • Learn your exercises - ankle pumps, static gluteal squeezes, static quads, inner range quads, active hip flexion and abduction, standing weight transfer, standing hip flexion, extension and abduction and heel raises
  • Practise your exercises prior to surgery
  • You will have physiotherapy everyday you are in the hospital
  • After surgery, practise your exercises everyday, 10 reps, at least 3 times a day, within limits of pain
  • Pace yourself and take regular break between activities
  • Change position every 20 minutes or so to stop your joint getting stiff
  • After surgery, practise your exercises everyday, 10 reps, at least 3 times a day, within limits of pain
  • Continue to take pain medications as prescribed
  • Pain and swelling can be related to over-activity
  • Continue to take blood thinning medication as prescribed
  • You must keep your wound clean and dry until it has fully healed
  • You will have an appointment to see your surgeon at 6-8 weeks

 

Returning to normal life

  • You can stop using your walking aid as soon as and when you're instructed by your physiotherapist or the surgeon or when you're confident to walk without limping
  • You may feel safer to continue to use walking aid if walking outdoors for long distances
  • You may start driving after 4-6 weeks, once your pain is under control and you're off strong pain medications
  • You are advised to check with your insurance provider before you start driving
  • You may return to work once your pain is under control and off strong pain medications, usually 6-8 weeks. You may have to plan how you can get to work in the early stages. It is recommended that you have a phased return to work.
  • You may travel but make sure you can move your joint regularly.
  • You must not travel by air for first six weeks and if the flight is for more than four hours, avoid the journey for three months after surgery

Please contact your local emergency department, surgeon or your GP if you experience any of the following symptoms -

  • fever
  • increasing redness or oozing from your wound
  • increase in pain that does not respond to your medication
  • pain or swelling of your calf that is not relieved by elevation
  • trouble breathing or shortness of breath

As with all procedures, hip surgery carries some risks and complications.

COMMON: (2-5%)  

LESS COMMON: (1-2%)

RARE: (<1%)

 

COMMON: (2-5%)  

Blood clots: a DVT (deep vein thrombosis) is a blood clot in a vein. These may present as red, painful and swollen legs (usually). The risks of a DVT are greater after any surgery (and especially bone surgery). Although not a problem themselves, a DVT can pass in the blood stream and be deposited in the lungs (a pulmonary embolism – PE). See later. This is a very serious condition which affects your breathing. Your doctors may give you medication through a needle to try and limit this risk of DVTs from forming. Some centres will also ask you to wear stockings on your legs, while others may use foot pumps to keep blood circulating around the leg. Starting to walk and getting moving is one of the best ways to prevent blood clots from forming.

Bleeding: this is usually small and can be stopped in the operation. However, large amounts of bleeding may need a blood transfusion or iron tablets. Rarely, the bleeding may form a blood clot or large bruise within the wound which may become painful & require an operation to remove it.

Pain: the hip will be sore after the operation. If you are in pain, it’s important to tell staff so that medicines can be given. Pain will improve with time. Rarely, pain will be a long-term problem. This may be due to altered leg length or any of the other complications listed below, or sometimes, for no obvious reason.

Prosthesis wear/ loosening : Modern operating techniques and new implants, mean that most  hip replacements last over 15 years. In some cases, this is significantly less. The reason is often unknown. Implants can wear from overuse. There is still debate as to which material is the strongest. The reason for loosening is also unknown. Sometimes it is secondary to infection. This may require removal of the implant and revision surgery.

Altered leg length: the leg which has been operated upon, may appear shorter or longer than the other. This rarely requires a further operation to correct the difference or shoe implants.

Joint dislocation: if this occurs, the joint can usually be put back into place without the need for surgery. Sometimes this is not possible, and an operation is required, followed by application of a hip brace or rarely if the hip keeps dislocating, a revision operation may be necessary.

 

LESS COMMON: (1-2%)

Infection: You will be given antibiotics just before and after the operation and procedure will also be performed in sterile conditions (theatre) with sterile equipment. Despite this there are still infections (1 to 2½%). The wound site may become red, hot and painful. There may also be a discharge of fluid or pus. This is usually treated with antibiotics, but an operation to washout the joint may be necessary. In rare cases, the implants may be removed and replaced at a later date. The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required.

 

RARE: (<1%)                       

Altered wound healing: the wound may become red, thickened and painful (keloid scar) especially in Afro-Caribbean people. Massaging the scar with cream when it has healed may help.

Nerve Damage: efforts are made to prevent this, however damage to the nerves around the hip is a risk. This may cause temporary or permanent altered sensation along the leg. In particular, there may be damage to the Sciatic Nerve, this may cause temporary or permanent weakness or altered sensation of the leg.

Bone Damage: the thigh bone may be broken when the implant (metal replacement) is put in. This may require fixation, either at time or at a later operation.

Blood vessel damage: the vessels around the hip may rarely be damaged. This may require further surgery by the vascular surgeons.

Pulmonary Embolism (PE): A PE is a consequence of a DVT. It is a blood clot that spreads to the lungs and can make breathing very difficult. A PE can be fatal.

Death: this rare complication can occur from any of the above complications.

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