Hip revision surgery: when is it necessary?

Hip revision surgery is the removal of either part of or all of your hip implant, and the insertion of a new one to replace it. But why might you need hip replacement revision surgery? Our expert orthopaedic surgeon Mr Rohit Jain explains the common reasons for the procedure and whether primary or revision hip surgeries are going ahead during the COVID-19 era.
 

How long can hip replacement last?

Thanks to evolving technology, materials and newer techniques available, hip joint replacements are lasting a lot longer than they were in the past.

A recent study published in the high impact journal, the Lancet, looked at the national joint registries across the world. A lot of countries including the United Kingdom keep a national database that captures the entire hip and knee joint replacements, which are carried out. The idea is to keep a track of how the various kinds of implants are performing. The data surmised that three-quarters of hip replacements last for at least 15 to 20 years. Approximately six out of ten hip replacements last for almost 25 years.
 

How has hip replacement evolved?

Within the last 25 years, technology has significantly evolved. A recent evolvement is the use of highly cross-linked polyethylene, which is made from a type of plastic and the wear is very low and acts as one of the bearing surfaces. Combining this with the ceramic ball has significantly decreased the amount of wear present in the hip joint.

This change in bearing surfaces has significantly increased the longevity of a hip replacement. We are now also using robotic and custom-made joint replacements. Time will tell if these latest advancements increase the longevity of the implants.
 

What are the common reasons for hip revision surgery?

The commonest reasons for hip revision surgery are:
 

• Infection
• Repetitive instability in the hip joint – where the ball keeps coming out of the socket. 
• Mechanical failure of the component – over a long period of time, the implants may de-bond from the body, which leads to loosening or breakage of the metal work.
• Fractures - if someone has a fall and fractures around the component.
   

Is hip revision surgery going ahead during the pandemic?

Currently, all elective orthopaedic surgery is being resumed, which includes primary and revision hip replacement. We have been operating again since around August-time but now that we are in the second wave* of the pandemic, it is having a negative impact on the efficiency on the work done in a day. We have to take a lot more precautions ahead of surgery.

The patients are made aware that there is an increased risk of acquiring COVID-19 infection in the postoperative period, which can be severe and can lead to loss of life. Patients have to agree to take these risks ahead of surgery.

Patients have to self-isolate two weeks before joint surgery. Three days prior to surgery they have to take a COVD-19 swab test. The result of this has to be negative for surgery to proceed.

Additionally, there will be a preoperative anaesthetic assessment to make sure that there is nothing untoward, which may have a negative impact on the outcome of the surgery.

The additional precautions reduce the incidence of acquiring an infection whilst in the hospital.


*The information in this article with regards to COVID-19 is dated November 2020 and is subject to change.

You can book an appointment with Mr Jain here via his Top Doctor’s profile if you would like advice for primary or revision hip replacement surgery.