There is little doubt that revision hip surgery is generally much more involved and complicated than the first time or primary hip replacement operation. Overall, it is a more lengthy operation and associated with a higher level of risk. Patients generally take longer to get over this type of surgery. It is however, crucial to understand that while the primary hip replacement operation is a fairly standard and predictable procedure, the revisions vary from patient to patient. In fact it is hard to see two patients with exactly the same problem hip. The implication therefore is that solutions for patients who have failed hip replacements have to be tailored individually. There are a number of factors to be taken into account when planning the surgery for the patient and these include:
1. What is the cause of the hip failure in the first place?
2. Is there an infection in the hip?
3. Which of the hip replacement components have failed and need to be changed?
4. What has been the consequence of the failure of the components? For example, is there bone loss? If so, how much?
5. How have the implants been fixed in the first place? Has cement been used or not? How will the implants be removed without causing damage to the bone and soft tissues?
6. Is the remaining bone stock enough to anchor the new replacement components? If the answer is yes, then is the bone stock more suited to taking a cemented implant or one without cement? If there is significant bone loss then how is that to be made up or circumvented?
7. Will it be neccessary to only replace one component of a hip replacment? If so, what is the make and model of the hip in place? Are the "matching" components still available from the manufacturers and how long ahead of the surgery do those components need to be ordered in?
8. Is it necessary to use non standard components to deal with the patient's particular situation? What implants and from which manufacturer would be most suitable?
All of the above go through the surgeon's mind when he or she is evaluating a patient with a failed hip replacement that needs surgical correction. In understanding and learing of the various options available to the surgeon, one can look at the various components on the surgery and how those areas would be dealt with:
Loose socket
Loose femoral component
Both components loose
Bone loss on the socket side
Bone loss on the femoral side
Surgery for unstable or dislocating hips
Infected replacements
Back to introduction to revision hip surgery