Houston Methodist. Leading Medicine

Hip FAQ

Question:

Mother is having so much trouble with her total hip replacement she is actually considering having the operation done over again! Tell me what we should know before heading into this kind of major surgery.

Answer:

Hip Joint replacements are becoming common place these days. Last year, there were 300,000 total hip arthroplasty (THA) procedures done in the United States. And that means an anticipated higher number of revision (re-do or second) surgeries. Surgeons planning a second or revision surgery after the first total hip replacement must consider many factors. The biggest and most important one is bone loss. But to better understand your mother's situation, it might be helpful to know why a revision surgery is planned. The major reasons primary (first or original) hip replacements fail requiring revision surgery include 1) aseptic (without infection) loosening, 2) hip instability (partial or complete dislocation), 3) osteolysis (bone loss) around the implant, and 4) periprosthetic (around the implant) infection. As you can see from the list, bone loss is a big problem that must be addressed whenever a second surgery is planned. In fact, it's not just bone loss but also bone quality or density (called bone stock) that must be considered. And there are different patterns of bone loss from patient to patient. So, it's never a one-surgery-fits-all kind of problem. Each patient must be carefully evaluated before surgery (pre-operatively). X-rays and CT scans provide the surgeon with details needed in the planning process. Is there infection that must be dealt with? What's the patient's general health? (Is the patient healthy enough to have another major surgery)? How much bone loss was caused by the first surgery? Is there already a leg-length difference that could get worse with a second (revision) procedure where more bone will have to be removed? Other factors the surgeon must look at include the presence of cement and/or hardware (metal plates, screws, wires) that must be removed; location of blood vessels, nerves, and ureters (tube from the kidneys to the bladder) in relation to the acetabulum (hip socket); scar tissue from previous surgeries; and damage from radiation for cancer in the pelvis. Every effort to manage patient pain after hip replacement is made using conservative means before considering revision surgery. When the problem is infection, other treatment should be tried first (e.g., antibiotics, debridement). When weakness is causing pain and difficulty walking, physical therapy should be provided. But in the end, when all other efforts to salvage the joint fail, revision surgery may be necessary. If your mother will allow it, perhaps a visit with her to the surgeon's office may help answer your questions. There's nothing wrong with exploring all treatment options before a second operation and she may need and appreciate your concern on her behalf. Neil P. Sheth, MD. Acetabular Bone Loss in Revision Total Hip Arthroplasty: Evaluation and Management. In Journal of the American Academy of Orthopaedic Surgeons. March 2013. Vol. 21. No. 3. Pp. 128-139.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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