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There are many reasons why a total hip replacement may need to be revised. It may be because the hip has worn out, or it may be because it is infected, or the reason may be because there is a break in the bone adjacent to the hip replacement surgery, and the break has also caused loosening of the artificial hip replacement surgery. The hip may also require revision, if it frequently comes out of its socket.
The results of a revision total hip replacement surgery depend upon the reason for getting a total hip replacement done, as well as the manner the hip was revised. If significant stripping of the soft tissues was needed to achieve fixation, patients, especially elderly patients, have difficulty in rehabilitating the muscles, and most of them walk with a cane in the opposite hand for a long time.
If adequate fixation was not achieved surgically, or if the bone deteriorates after the procedure, there may be loosening at the interface between the implant and the bone, or between the cement and the bone, and there may be failure of the revision total hip replacement surgery in India. If the patient dislocates the revision total hip replacement, that may need surgery to decrease the risk of subsequent dislocations.
Revision hip replacement surgery is performed when there are no other options. If revision is performed for a fracture next to the artificial joint, then the surgery is done to achieve ambulation. It is impossible to ambulate a person with a displaced fracture next to an artificial joint that could have given rise to loosening of that joint. To conclude, revision hip surgery in India is performed only when absolutely necessary.
When the surgery is performed, thorough medical testing is done before the surgery to ensure that the patient is optimized to undergo the surgery. In addition, most orthopedic surgeon have a medical doctor to follow the patient closely in the postoperative period. Preoperative, in addition to the routine medical check up, patients who are elderly with cardiac issues will need a cardiac evaluation and may need additional tests prior to the revision hip replacement surgery.
The time taken for the hip replacement surgery depends on what is being performed. If it is a minor surgery, like exchange of the head and the plastic, the surgery is done within less than an hour. If it’s a major reconstruction, it may take 3 to 4 hours. The time for the surgery is always less than the time the patients go inside the OT and are next seen by their relatives.
We always tell the relatives that there is a lot of time that goes by before the actual surgery starts – time for anesthesia, for prepping and draping the patients etc. After revision hip replacement surgery in the postoperative care unit it is important to ensure that the patient has settled down in the postoperative care area before the nurse calls for relatives to see the patient.
Our strong preference is for patients to go home from the hospital after revision hip replacement surgery. However, if the patient is not able to do the activities of daily living at home, especially if they’re living alone, they may be shifted to a rehab facility.
Revision hip replacement surgery cost in India is quite variable as it depends upon lot of factors like, complete or partial revision replacement, type of implant used to get the hold in bone etc.
Recovery from revision hip replacement surgery depends on the amount of the work that was done to revise the joint. If only the head and the plastic are exchanged, which means that the parts not attached to the bones were exchanged, recovery from the revision hip replacement can be very fast. Sometimes even faster than a regular hip replacement surgery because the components that are attached to the bone are not removed.
Depending upon whether the artificial part attached to the thigh bone or to the pelvis is removed, the surgery becomes additionally complex. If both part of the components are removed, the surgery recovery takes more than only replacing one part of the hip.
It’s extremely important to follow hip dislocation precautions after revision hip replacement surgery. The risk of a hip dislocating after the revision hip replacement surgery is significantly higher than after a primary hip replacement surgery. When patients sleep, they should ensure that their knees are separated and they do not bend their hips beyond 90 degrees. If they sleep on the side of the hip replacement, they might get pain on the outside of the hip joint, because typically the incision is sore after the surgery.
If they decide to sleep on the opposite side, they should be extremely careful not to cross over their knee to the other side and touch the bed, because this is exactly the position in which the hip dislocates especially if the hip is flexed. If they keep their knees separated with the cushion/apparatus given to them after the surgery, they are allowed to sleep on the opposite side.
Most patients with revision hip replacement surgery are able to weight bear as tolerated immediately after the procedure. Walking is a very important step for the patient to develop confidence. In addition, weight bearing is extremely important to prevent the risk of blood clots after the surgery. Walking is also important so that the patients can gain muscle bulk after hip replacement surgery that may have been deteriorating for a long time, which necessitated the surgery in the first place.
Depending upon the reason why the revision hip replacement surgery was performed, patients may need blood transfusions during the surgery, or immediately in the postoperative period. If revision hip surgery is done in its most minor form, in which only the head and the plastic are replaced, the possibility of needing blood is very low. On the other hand, if there is a major surgery that need augmentation of bone with metallic implants, the possibility of needing a blood transfusion is extremely high.
Stay in Hospital
Most patients with revision hip replacement surgery are in the hospital for about five to six days. Patients who are able to weight bear as tolerated are able to leave the hospital after being cleared from a medical perspective, and once they do not need IV pain medications. Hip replacement surgery patients who have had a revision done for infection, or if infection is suspected after revision hip replacement surgery, then the hospital stay is about five to seven days.
The reason for the extended stay in the hospital is to ensure the patient leaves on the correct antibiotic if they have an infection. The results of the tissue from the joint sent to the lab takes about three to five days to return in its most accurate form. I typically use tissue cultures taken from five different places to ensure I get the most accurate results if infection is suspected, or if the revision is for infection.
Will the revision hip replacement surgery be painful?
Typically, the pain from a revision hip replacement surgery is different from the pain that was there from the reason to have hip replacement surgery in the first place. The patient has only postoperative pain from the surgery which only gets better after the surgery.
Will I need a private nurse after revision hip replacement surgery in India?
Most patients do not need a private nurse after hip replacement surgery.
Will I need help at home after revision hip replacement surgery?
When patients have revision hip replacement surgery, we tell them they should be the center of the world and they should get all the help that they need. A visiting nurse, as well as a physical therapist, is allowed by most insurances in the postoperative period to help after revision hip replacement surgery.
Will I need physical therapy when I go home after revision hip replacement surgery?
Physical therapy is needed after hip revision surgery to strengthen the muscles, to help in gait, and to improve ambulation. Physical therapy is also needed for education to ensure that the patients follow hip dislocation precautions. The physical therapist visiting home will also advise on how the house can be altered (if needed), at least in the postoperative period.
As an example, the physical therapist will advise on how to get in and out of bed. The physical therapist will also advise on how to use the high chair, or how to convert the existing chairs in the house into high chairs with the use of non-collapsible blankets or cushions.
What are the consequences of not following through the recommended physical therapy program?
We strongly recommend that the patients follow the physical therapy program until they are independent. Most patients after revision hip replacement surgery are weight bearing as tolerated, and I encourage them to walk as much as needed. Contrary to patients after primary hip replacement surgery where physical therapy is hardly needed, patients having undergone revision hip replacement surgery need physical therapy for a significantly longer period depending upon the extent of the surgery that was done.
How often will I need to be seen by a doctor following the surgery?
Patients are seen on a daily basis by the physiotherapist. A visit to the surgeon is usually required after 2 weeks and then after one month initially. Patients who have gone to rehab facility see the orthopedic surgeon back in about six weeks with an x-ray.
What exercises can you do after revision hip replacement surgery?
Exercises after revision hip replacement surgery include exercises to strengthen the muscles and the tissues around the affected hip, as well as the affected extremity, as well as exercises to strengthen the contralateral extremity. In addition, I also advise patients to do exercises for the back, and core strengthening of the abdominal muscles for better stability and improving gait. Additionally, there are gait training exercises taught by physical therapists after revision hip replacement surgery.
How long does a revision hip replacement surgery last?
Unfortunately, the data around revision hip replacement surgery is not accurate as that after primary hip replacement surgery, especially considering the various reasons why the surgery is performed. The lack of numbers of revision hip replacement compared to primary replacement, there is no strong data to tell the patients how long the hip revision will last. Typically if the stability of the prosthesis is good with accompanying good bone stock, the thought is that the revision hip replacement surgery will last as much as primary hip replacement.