Complex Revision Hip Replacement

What is complex revision hip replacement?

Complex revision hip replacement involves the partial or total replacement of a previous hip prosthesis, from a simple liner exchange to total component replacement. It may also require bone grafting and further hardware implantation to ensure stability, and thus represents a lenghtier and more complex operation than a primary total hip replacement and typically requires more time.

Although hip prosthesis can be expected to last, comfortably, for between 15 and 20 years, patients who receive a hip replacement during younger asdulithood are likely to require revision as they age.

Indications and contraindications for complex revision hip surgery

Complex revision hip replacement can be used for:

Cases of implant failure: where the primary hip replacement components have worn out or failed, or where the implant has become loose or unstable, for example as a result of bone loss due to osteolysis.

Infection: where treatment of deep or chronic infection neccesitates removal of infected components.

Fracture: where fractures have formed in the bone surrounding in the implant.

Dislocation: where it is not possible to manage the dislocation conservatively.

Malalignment: where the implant is misaligned.

Contradindications for complex revision hip surgery include: 

Active infection.

Poor General Health, including uncontrolled heart disease or severe lung disease.

Poor bone quality. including advanced osteoporosis.

Allergies to the material of the implant.

Non-cooperation with clinical instruction.

Benefits and complications of complex revision hip replacement

Benefits

  • Restores mobility and function to the hip joint, alleviating pain and improving quality of life.
  • Can prolong implant lifespan.
  • Can support treatment of infection without long-term functional compromise.
  • Allows preservation of bone.

     

Known complications

  • Post-operative infection.
  • Deep vein thrombosis (DVT) and pulmonary embolism.
  • Wear and loosening of the implant, requiring revision. 
  • Nerve injury.
  • Vascular injury and bleeding.
  • Dislocation of the hip, requiring reduction.
  • Muscle weakness, joint stiffness, or instability.
  • Allergic reaction.
  • Scar tissue formation.

The surgery

Complex Revision Hip Replacement is a challenging procedure that often requires considerable advance planning, since it commonly requires additional bone reconstruction, soft tissue modification and the use of custom-made implants.

Preparation prior to surgery

  • You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
  • Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
  • Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility.


On the day of the surgery

  • You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
  • The surgical site will be prepared.
  • You will be administered general or spinal anaesthesia.
  • An incision will be made in the hip, where possible following the line of your original hip replacement surgery.
  • With the hip exposed, your surgeon will proceed to remove the existing implant, while preserving as much bone as possible. The removal of an implanted stem can often neccessitate the breaking of the femur. If this is the case, it will be repaired during your surgery. 
  • Steps will be taken to repair or modify the bone of the hip to receive the replacement implant.  
  • The wound will be sutured and dressed.


After your surgery

  • Wound care: your incisions will be closed with sutures and covered by a waterproof dressing. After 14 days, the sutures will be removed. Prior to this, you may clean the wound gently with warm water and soap, being careful to dry it thoroughly. 
  • Pain and swelling: You may experience mild to moderate pain in the hip and groin. You will be prescribed painkillers to manage these symptoms. Immediately following surgery, you may experience some numbness, although this will resolve without intervention. Inflammation can be controlled by icing (15 minutes per hour maximum) during the first week.
  • Mobilising: Weightbearing will be increased gradually, under supervision. Crutches may be used initially and non-impact exercises with a physiotherapist, designed to improve strength, flexibility and range of motion, may commence later. High-impact activities should be avoided during healing. You may required assistive devices, including grab bars or a raised toilet seat, to improve mobility at home. 
  • Aftercare: after 6 weeks, you will be asked to complete further X-rays to assess healing, and at three, six and twelve months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing. 

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.