As is the case with most surgery and certainly with primary for first time hip replacement surgery, there are serious risks associated with revision or redo hip replacements. These risks include all those listed in the section on primary hip replacement surgery and more. Please review those complications as the following are risks in addition to those listed as associated with primary hip replacement surgery. (To learn about risk associated with primary surgery, click here.)
Change in the length of the leg: Revision surgery can result in changes in leg lengths. The risk is probably higher than with primary surgery because often the quality of the soft tissues and the bone available for the surgeon to work with is not the same as in the case of the primary surgery. Of course the operating surgeon tries his best to match the length of the legs on the two sides but that may not always be possible. Usually the discrepancy is small and a shoe raise on the shorter side is all that is required.
Thrombosis: As revision surgery is more prolonged and the state of the soft tissues and bone often not as good as when first time surgery is carried out, patients undergoing revision surgery are at a high risk of thrombosis. On occasion, patients undergoing this type of surgery may not be as mobile as the patients having first time surgery. This factor too may contribute to the higher risk of blood clot formation. Most surgeons ensure that the usual precautions against blood clot formation are in place and these include the use of drugs such as low molecular weight heparin, surgical stockings, mobilising the patients early and occasionally the use of calf or foot pumps. Any clot (thrombus) formed in the blood vessels can break off, travel in the blood stream and lodge in another blood vessel supplying blood to an important organ such as the brain, heart and lungs. By blocking the blood supply to that organ, the clot produces local damage. That is how, a stroke, or heart attach or a pulmonary embolus can result.
Dislocation: The risk of dislocation after revision surgery is higher than after primary surgery, probably five times or so or about five in a hundred. As the risk is highest in the first few weeks after the surgery, it is for this reason that patients are advised not to lie on their side, to not bend their hip more than a right angle such as when sitting in a low chair or attempting to bend to the floor or reach for their toes. Also, crossing the legs or twisting the hip could cause a dislocation and should be avoided.
Infection: This remains one of the more serious complications and while uncommon is probably about five times as high as after primary surgery rising to about 10%. In order to reduce the risk of infection, patients are given antibiotics routinely into the vein just prior to the surgery and for two doses after. Scientific studies have shown that antibiotics given in this manner play a significant role in avoiding infection. To learn more about infection after surgery, click here.
Nerve injury: Rarely, the sciatic nerve may get injured. The risk of such an injury is about 2 or 3 out of a thousand. Such a patient may notice that he or she is unable to pull the ankle and foot upwards or downwards and that the feeling in the skin in the calf or shin area may not be quite normal. He or she may be aware of patches of numbness or pins and needles. In the unfortunate situation when the injury does occur, it usually involves only a portion of the sciatic nerve and is reversible. In other words, a substantial recovery occurs with time in the majority of patients.
Fracture of the thigh bone: The word 'fracture' is a technical term for a break in the bone. A fracture of the thigh bone is a risk during the operation and certainly more so that at the time of primary surgery. This is again due to the soft tissue and bone quality that the surgeon has to work with in the revision scenario. The tissue can be quite hard, inflexible and stuck down and the bone quality in terms of strength, poor. The fracture can occur when the surgeon is attempting to dislocate the hip joint, or it may occur later as he is manoevuring the hip to the right position to insert the femoral component. Surgeons who do a high number of revision operations often have set precautionary procedures to reduce the chance of a fracture to the minimum possible.
Loosening of the artificial hip: As with primary hip replacement surgery, there can be no guarantee that the revised hip will last a life time. Redone hips can loosen just as the primary ones and numerous research studies have shown that the longer term results with this type of surgery are not as good as with the first time hip replacement operation.. It is true however, that the results of revision surgery are improving all the time as the newer technologies became available to the surgeons who are now also able to reconstruct more difficult cases in a reliable manner than was possible 10-15 years ago.
As with primary surgery, it is important for pateints to have regular check ups after the operation to pick up early, any signs of failure so that the problem can be dealt with earlier and more easily than would be the case if the hip replacement was left loose for a long period. This is because a loose hip replacement can cause "silent" i.e., without producing pain or other symptoms, damage to the bones into which it is anchored. This progressive damage can remain unknown to the patient and may be discovered only during a chance x-ray for an unrelated reason or only after the bone cracks and becomes painful. Occasionally, a specialist may have to advise a revision operation based upon the X-rays alone even though the patient may not be experiencing any symptoms.
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