10 reasons for early hip replacement revision surgery

After a hip replacement, you may be expecting to have it revised one day. Sometimes, revision surgery can be required much earlier than a patient and surgeon might expect. Learn from Mr Amol Chitre (a leading UK orthopaedic surgeon) about 10 reasons for early hip replacement revision surgery.

Do all hip replacements need revising?

Generally, a well-done hip replacement should last at least 10 years and we should be aiming for a revision rate of less than three per cent at 10 years, i.e. less than 3 in 100 hip replacements will require revision within 10 years.

Hip replacements are made from man-made materials, so as yet, none can claim to last forever. A good, well-performing hip replacement should last many years and most surgeons will use hip implants with a proven track record. Hip implants are evaluated by an independent body (the Orthopaedic Data Evaluation Panel – ODEP) and are given a rating based on their performance. You can find your implant’s ODEP rating on the ODEP website.

Why do hip replacements need revising?

If a hip replacement needs to be revised before the 10-year mark, it’s usually because of a complication.

Reasons for hip replacement revision surgery:

1. Infection

This is a difficult problem. It can occur early and may be an issue if there are problems with the wound healing immediately after surgery. If there is a lot of discharge from the wound or if it persists for longer than two weeks, it is always a good idea to get your hip checked by your surgeon.

If caught early enough, there is a reasonable chance that washing out the wound and cleaning out the infection may prevent the need for revision surgery. However, if the infection persists for a long time, the chances of avoiding revision surgery reduce. Longer term, infections may cause the hip to become painful and the implant to loosen, even without the wound being an issue. This may occur after an infection in another part of the body such as a chest or water infection, with the infection then spreading to the hip.

2. Dislocation

If your hip dislocates early on after a hip replacement, it needs to be put back in to joint (reduced) as soon as possible. In a good number of cases, once the tissues have healed from the surgery it will not dislocate again. However, if your hip dislocates on a number of occasions more than six weeks after the initial operation, it may benefit from being revised to stabilise it and prevent further dislocations.

3. Loosening

Either one or both parts of the hip replacement may come loose from the bone they are fixed to. This usually occurs several years after the first operation. If it occurs early on (i.e. less than five years after surgery) we should be concerned about the possibility of infection within the hip.

4. Leg length problems

Significant leg lengthening after a hip replacement is unusual. It’s more common when uncemented femoral components are used. If leg lengthening does happen, it can be painful, cause increased tension in all the tissues around the hip resulting in pain and also result in a persistent limp. Usually, the body is good at adapting and even a lengthening of up to 1cm may be adapted for by changes around the body. Differences greater than this might result in considering revision surgery if the hip remains painful.

5. Thigh pain

This is more common with uncemented implants and may be a result of the bone being directly irritated by the metal of the component.

6. Metal reactions

This is usually only a problem in hips that use a “metal-on-metal bearing”. It remains a problem with metal-on-metal resurfacing operations and because of the sometimes very severe problems that this can cause. People with this type of hip should have surveillance check-ups regularly. This is why metal-on-metal hips, either resurfacings or hip replacements, are currently rarely used.

7. Component fractures

The components in good quality hip replacements are made to very high specifications using very high-quality materials. Despite this, as with any man-made material, they can break. This can happen with metal stems that are placed within the thigh bone. Occasionally, if the components used are ceramic, the ball or the socket may shatter, resulting in the need for urgent revision before the fragments cause more damage.

8. Wear

If the hip replacement has been in place for a long period or subjected to particularly high use, the components may wear out. This can in turn cause dislocation or cause the hip replacement to become loose.

9. Fracture

If the bones fracture near or around the hip replacement components, the components themselves are very likely to become loose. In this case, the hip will need to be revised.

10. Unexplained pain

Rarely, a hip will continue to be painful after a hip replacement. Unfortunately, if we cannot find a problem such as those above, the results of revision surgery are much less predictable and the decision as to whether or not revision surgery is indicated is much trickier. This requires careful consideration and discussion with your surgeon.

Discover how you can benefit from Mr Chitre’s first-class patient care – visit his profile.