Mr Freedman - Orthopaedic Surgeon
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Modern hip replacements are generally designed and expected to last a long time but there are a number of situations in which a hip replacement may need to be re-operated on and part or all of the implants changed (revised). Depending on the reason for revision, time since first surgery and nature/technique of the first operation, revision procedures are often more complex than the first operation and require careful planning and surgical skill.
Why may a hip replacement need to be revised?
Pain is the primary reason for revision. Usually the cause is clear but not always. Situations where there is a clear and treatable cause for the pain generally do bettter after surgery than hips without an obvious cause for pain.
Plastic (polyethylene) wear. Many hip replacements designs include a polyethylene liner inside the socket. Revision for isolated polyethylene wear is one of the easier revisions scenarios, as only the plastic insert is changed.
Dislocation (instability) means the hip is popping out of place. Revision surgery for recurrent dislocations is often involved surgery as recurrent dislocations often imply that (i) Either the current implant is not positioned adequately and needs to be removed and completely changed or (ii) That there is a problem with the muscles, tendons or capsule around the hip, and that this may need to be compensated for with a different prosthesis design. Surgical options for treating recurrent dislocations include of dual mobility and constrained liners. Depending on the cause for your dislocation/s Mr Freedman will provide you with treatment recommendations.
Fracture: After a fall or accident, a patient may sustain a fracture around an existing joint replacement. In some situations the prosthesis is still stable in the bone and the fracture can be fixed while retaining the existing implant, but in other fracture patterns the prosthesis can come lose because of the fracture. Specific revision implants may be required to help fix the fracture as well as reestablishing a stable prosthesis and functioning joint.
Loosening of either the femoral or acetabular component. This usually presents as pain but may be asymptomatic. For this reason, after joint replacement surgery you must have your joint followed up for life as there can be changes on X-ray that indicate that the hip may need to be revised despite having no symptoms.
Infection usually presents as pain but may present as an acute fever or a general feeling of unwell. In some circumstances the infection can be treated and the initial prosthesis retained but for severe infections or infections not responsive to medical treatment, the prosthesis may need to be removed and a new clean implant inserted.
Osteolysis (bone loss) This can occur due to cement or polyethylene particles being released into the hip joint that result in bone being destroyed. Osteolysis has become less common with modern implants but is often still seen in implants that were inserted in patients in the past.
Pain from hardware, such as cables or wires causing irritation.
If you are having pain, instability or other problems from your hip replacement Mr Freedman will see you, assess the situation and provide you with treatment advice. If necessary, arrangements can be made to revise (change) the implant.
Most surgeons in Melbourne will utilise an extensile surgical approach such as a posterior or anterolateral approach for revision surgery. Mr Freedman does likewise for many revision cases but in select circumstances is able to perform revision surgery through the anterior approach.