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Hip Replacement Revision

By

Sarah Lewis, PharmD

What is a hip replacement revision?

A hip replacement revision removes a previously implanted artificial hip joint, called a prosthesis, and replaces it with a new one. Hip prostheses can become infected and inflamed, dislocated, or loosened by wear and tear. Your surgeon may recommend a hip replacement revision if this happens. A hip replacement revision can restore pain-free range of motion and function in a damaged hip prosthesis.

A hip replacement revision is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a hip replacement revision. 

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Why is a hip replacement revision performed? 

Your doctor may recommend a hip replacement revision to replace a damaged artificial hip joint with a new one. Your doctor will only consider a hip replacement revision if other treatment options have not improved your condition. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a hip replacement revision to replace a hip prosthesis that is damaged due to: 

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  • Dislocation of the original artificial joint

  • Infection of the original artificial joint causing chronic hip pain and swelling 

  • Loosening of the original artificial joint causing hip pain and reduced range of motion

Who performs a hip replacement revision?

Orthopedic surgeons perform hip replacement revisions. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments.

How is a hip replacement revision performed?

Your hip replacement revision will be performed in a hospital or surgery center. It involves making an incision in the hip to remove the old hip implant, scar tissue, and any damaged cartilage and bone. Your surgeon prepares the remaining bone to hold the new hip implant. Your surgeon then places the new hip implant, tests it, and secures it permanently in place. 

Your hip may need treatment after removing the old implant if it is infected. You will have a second surgery to place the new implant after treating the infection.

Types of anesthesia 

Your surgeon will perform your hip replacement revision using either general anesthesia or regional anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your hip replacement revision

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.

  • The surgical team will monitor your vital signs and critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a hip replacement revision?  

As with all surgeries, hip replacement revision involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock 

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a hip replacement revision

Complications of a hip replacement revision are not common but include:

  • Dislocation of the new joint

  • Formation of new bone along the hip joint causing pain and reduced range of motion

  • Loosening of the new joint causing pain and possibly requiring additional surgery to secure it

  • Nerve, muscle, bone, or blood vessel damage

  • Uneven leg lengths, possibly requiring shoe lifts

  • Wear and tear of the new joint requiring another replacement

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.

  • Informing your doctor if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed 

  • Telling all members of your care team if you have any allergies 

How do I prepare for my hip replacement revision? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a hip replacement revision by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Arranging for a ride home after hospital discharge. It is also a good idea to have someone stay with you for the first 24 hours.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:

  • Why do I need a hip replacement revision? Are there any other options for treating my condition that will produce a similar outcome?

  • If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • When will I start physical therapy? Where do I go for it? 

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you? 

  • How should I contact you? Ask for numbers to call during and after regular hours. 

What can I expect after my hip replacement revision?

Knowing what to expect can help make your road to recovery after a hip replacement revision as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. 

You will likely stay in the hospital for several days. Some people get more treatment in a rehabilitation center after discharge from the hospital. Rehabilitation helps improve mobility and joint function so you can safely return home.

You will have physical therapy to help you recover and regain hip strength and movement. You may also need to use crutches or a walker for a few weeks to protect your hip. Your surgeon or therapist will tell you when it is safe to return to your normal activities.

Recovery after surgery is a gradual process. Recovery time varies depending on the type of anesthesia, your general health, your age, and other factors. Full recovery takes up to three months. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after a hip replacement revision. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Numbness or tingling in the affected leg or foot 

  • Pain that is not controlled by your pain medication

  • Unexpected drainage, pus, redness or swelling of your incision

How might a hip replacement revision affect my everyday life?

A hip replacement revision may reduce your symptoms and improve hip function so you can lead an active, normal life. A hip replacement revision can help you to be more independent and return to activities, such as walking and navigating stairs.

You will need to protect your new hip implant by avoiding:

  • Contact sports

  • Falls and activities with a high risk of falls

  • High impact activities such as running

  • Joint overloading activities such as heavy lifting

  • Sports requiring lateral movements such as skiing

You may also need to sleep with a pillow between your legs and avoid crossing your legs or bending your hip past 90 degrees for a period of time after surgery.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 24, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Joint Revision Surgery. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00510
  2. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
  3. Revision Hip Surgery. Cedars Sinai. http://www.cedars-sinai.edu/Patients/Programs-and-Services/Orthopaedic-Center/Treatment/Revision-Hip...
  4. Revision of Total Hip Replacement. Emory University Healthcare. http://www.emoryhealthcare.org/orthopaedics/procedures/hip-care/hip-replacement-revision.html
  5. Revision Total Hip Replacement. Hospital for Special Surgery. http://www.hss.edu/conditions_revision-total-hip-replacement-overview.asp
  6. Total Hip Replacement. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00377

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