Total Hip Revision
This is performed when an existing hip replacement is not doing so well. This can be due to normal wear years after the initial operation or early failure because of problems. These include:
- Infection
- Pain
- Dislocation
- Altered leg length
- Fracture
Diagnosing the reason for failure is of the utmost importance and can be achieved by careful questioning, examination and directed investigations. Infection is one of the most difficult problems to treat and sometimes involves at least two operations to put right. Most of the time there is a solution, but sometimes there may not be and it is up to a good surgeon to know the difference between these situations and advise the patient accordingly. This also involves the patient having realistic expectations as to what is possible.
The risks with this kind of surgery are higher and the patient should be followed up indefinitely after the procedure as well as having access to the surgeon at short notice should they run into problems.
This kind of surgery requires careful planning with access to many surgical implants and tools so most of the more complex procedures are carried out in a Specialist Centre by Fellowship trained surgeons with experience in this field.
Case Study 1...
This is a 25 year old Charnley hip replacement which like the previous case has worn out. The plastic cup and cement behind it have completely come away from the bone so the hip is dislocating and is very painful. In this case there is more bone loss and the patient is over 80years old. In cases like this it is sometimes better to replace the area of bone loss with an ‘augment’ made of titanium to help hold the new socket in place.
Case Study 2...
This 43 year old lady was involved in an accident and broke her right hip. It was fixed at her local hospital with the 3 screws you can see on the X-ray. Unfortunately this did not heal properly and so she is in a lot of pain, unable to walk or work. This can happen after any fixation of a broken bone but in the hip, it requires a hip replacement as the non-healed head of the femur (ball part) is now dead bone. On this X-ray you can see the screws have gone right through the head of the femur and are grinding into the socket causing pain and irreparable damage to the cartilage.
Case Study 3...
This 60 year old man had a motorcycle crash over 40 years ago and smashed his right hip and socket of the pelvis. He was treated with traction for nearly 1 year (lying in a bed with the leg pulled out straight) and then had to have an operation to try and rebuild his hip. He did well for the first 10 years or so but now has severe arthritis in the hip. It is very stiff and painful, his leg is short and the metal plate and pins have broken and are stuck deep within the bone.
