A total hip replacement may require surgical correction or “revision” for any number of reasons. These include:
- Pain in the hip joint
- Instability in the hip joint
- An injury to the hip
- Damage or deterioration of the artificial joint
- Loosening of the implant in the bone
- Bone loss (osteolysis)
A total hip replacement is a major surgery that replaces an injured or damaged hip joint with a prosthesis. If this initial surgery fails in some way, subsequent surgery is required to correct the problem. This subsequent surgery is called “revision.”
What Causes Total Hip Replacement Failure?
There are many reasons that a total hip replacement may fail. The femoral (related to the thigh bone) or acetabular (related to the hip socket) portions of the prosthesis may become loose. This may or may not cause pain, but commonly requires surgical correction.
In some cases, pain results from the hardware used in the implant or to bone loss around the implant. Artificial hip joints use a polyethylene or plastic liner for smooth motion; this liner may become torn or degrade due to wear and tear. In some cases, the plastic liner can be replaced without changing out the entire hip prosthesis.
Although it is rare, a problem in the original surgery leading to deep infection or an improperly implanted prosthesis may require surgical correction. Infections are rare but can occur with any surgical procedure. In case of infection, the infection must be addressed and then the old hip prosthesis removed and replaced.
The prosthesis used may have been defective and require replacement.
Furthermore, the hip prosthesis may need to be replaced if it sustains damage from an accident or traumatic injury.
A total hip replacement may succumb to “wear and tear” over time. Artificial hips of today are designed to last 20 or 30 years. Eventually an artificial hip may succumb to wear and tear.
Who Requires Total Hip Replacement Revision?
If you have had total hip replacement, you should be under the care of a specialist. Some failed total hip replacements occur immediately after surgery. If you have fever or abnormal pain after surgery, you may have an infection. If your recovery does not progress normally or you have abnormal pain, there may be a problem with the prosthesis.
Following total hip replacement, it is crucial that you see your doctor for regular check-ups. Many hip problems can be diagnosed with an X-ray before you experience any symptoms at all.
Typical symptoms that you may have failed total hip replacement are pain in the hip, groin, or thigh as well as limited mobility. Some people describe feeling that the hip joint might “give out.”
If you have had a total hip replacement and are experiencing symptoms in your hip, including pain, lack of flexibility, limited mobility, trouble walking, or a sense that the hip joint is unsafe, it is important to have an expert in hip surgery evaluate the status of the hip. This can usually be done with a physical examination, radiography (X-rays) or other images, and a visit with a specialist.
Total hip replacement patients should see their physicians for regular check-ups of the artificial hip, even if there are no symptoms or discomfort. It is possible that damage to the prosthesis may have occurred even without symptoms being present.
Failed total hip replacement requires another hip surgery or revision to address the problems. The type and extent of surgery required depends on the reason for failure of the first total hip replacement. Dr. Clohisy and his staff have extensive experience in this type of procedure, which can be more complex and last longer than the original surgery.
Depending on the reason for the revision, all or part of the original artificial hip prosthesis must be removed and replaced. In some cases, it may be possible to replace just a portion of the original artificial hip. Bone grafts are sometimes used to help rebuild damaged bone.
What to Expect from Surgery and After Surgery
Failed total hip replacement is major surgery performed under general anesthesia. Dr. Clohisy and his team will explain the nature of the procedure and how long it will last. You should expect to spend several days or even a week in the hospital. While you may be able to get out of bed or walk the day after surgery, you will be walking with crutches or a walker for six to twelve weeks. Discomfort is normal after surgery but can be managed. If you experience uncontrolled discomfort after surgery, discuss this with the doctor or nurses.
All surgery has potential risks as well as benefits. While the success rate for failed total hip replacement surgery is very high and the procedure is well established, the success rate is slightly lower for a revision hip replacement surgery than for the original total hip replacement. This reflects the increased level of complexity of the revision.
Facts and Figures About Hip Replacements
- 32,000 hip revisions were performed in the U.S. in 2000
- Women are more likely to have total hip replacement and are more likely to have a failed hip revision compared to men
- Of those under 50 years of age who received a total hip replacement, 65% still had the original prosthesis 25 years later
- It is expected that in 2015, there will be 600,000 total hip replacements performed in the U.S. It has not been estimated how many failed hip revision surgeries will occur
(Statistics from http://www.surgery.com/procedure/hip-replacement-surgery/demographics.)