Why should I have a hip revision?
There are several reasons why hip replacement surgery may fail. In some cases hip revision surgery may be appropriate where the previous prosthesis is removed and replaced.
What should I do before my surgery?
Following consultation with Mr Hoad-Reddick and thorough investigation, hip revision may be suggested as the best form of treatment. The type of prosthesis will depend largely on the reason for failure. At this appointment you will receive a booklet from Mr Hoad-Reddick ‘What you need to know about your joint replacement’ containing more information.You can also download it here.
Once you have decided to proceed with surgery, please contact the HR Orthopaedics office on 0161 722 0007 to arrange a convenient date for your surgery.
If you are insured, you will need to contact your insurance company and obtain an authorisation number which you should take with you on admission. Your insurance company may ask you for a Procedure Code which is W3732. Prices for self-funding patients can be given on request and more information is on our information page for self pay patients.
The hospital will contact you to attend for preoperative assessment approximately two weeks prior to surgery. At assessment, blood and urine tests will be performed along with a heart trace (ECG) to ensure you are healthy enough to undergo anaesthetic and surgery. The pre-operative nurse will advise whether you should stop taking any of your medication.
You will see a physiotherapist and occupational therapist, if possible on the same day as your preoperative assessment; you will be given advice on mobilization, postoperative exercise and rehabilitation. Home circumstances will be assessed and any necessary measures to assist you on discharge can be arranged.
You will be required to fast for a period of time before your operation; this will be confirmed in writing along with your admission details.
What happens on the day of my surgery?
You will be admitted to hospital usually the same day as your operation. Mr Hoad-Reddick will explain the procedure again and consent forms will be signed. The operated leg will be marked and an expected position on the surgery list will be given, and is decided depending on medical conditions of all patients that day.
An anaesthetist will see you to discuss your anaesthetic and postoperative pain relief.
Following surgery you will be taken to the recovery unit until your condition is stable. You will have an intravenous drip in your arm to administer fluids or drugs, you may have a catheter in-situ; these are both usually removed at twenty four hours following surgery. Once stable you will be taken to the postoperative unit for close monitoring before returning to your room on the ward. The physiotherapist will visit you on the unit to institute basic exercises.
What are the risks associated with hip revision surgery?
As with any operation, hip revision carries risks as well as benefits; the majority of patients undergoing such surgery will encounter no significant complications. 19 out of 20 patients are delighted with the outcome. 1 in 20 may experience dissatisfaction due to a variety of complications.
Infection: To reduce infection risk, surgery is performed in a specially ventilated ‘clean air’ operating theatre and most patients are given a short course of antibiotics at the time of surgery. Despite these measures deep infection can occur in 1:100 cases necessitating removal of the artificial joint until infection has cleared. This would also be treated with antibiotics.
Blood clot (DVT): Occasionally a blood clot can form in the deep veins of the leg causing pain or swelling in the calf, in a minority of cases this can break away and travel to the heart or lungs and become a risk to life. The overall risk of fatal lung clot is 1:600. To reduce this risk you will be given calf pumps to increase the blood flow and an anticoagulant drug to inject into your stomach for twenty eight days following surgery, in keeping with current recommendations from the National Institute for Clinical Excellence (NICE).
Leg length: Care will be taken at the time of surgery to avoid shortening or lengthening of the leg. If Mr Hoad-Reddick feels your hip is unstable during the operation, he may choose to lengthen your leg marginally to stabilize the hip; this is rarely required.
Residual pain:In the majority of cases, hip replacement significantly improves pain and mobility; residual pain can occur and in most cases will resolve in time.
Neurovascular injury: Very rare occurrence of damage to vessels or nerves in the region of surgery.
Dislocation: An artificial hip is at risk of dislocation in the early postoperative period, physiotherapy advice will be given to avoid the hip ‘at risk’ positions. Dislocation would result in a return to the operating theatre to put the hip back in place. This risk is significantly reduced by close patient adherence to the strict post operative guidelines and compliance with physiotherapy.
Fracture: This can occur in rare cases when the stem impacts into the femur. If this occurs a wire will be put round the femur.
Failure requiring revision surgery: Recurrent dislocation, fracture or wear of the implants over time can necessitate revision surgery.
What happens after my hip revision surgery?
Exercise and mobility are an extremely important part of rehabilitation and require full patient participation for optimal recovery and outcome. You will commence physiotherapy with the aid of a walker if necessary, progressing onto crutches – crutches should be used for up to 6 weeks post-op.
An inpatient physiotherapist will see you each day during your stay at the hospital, teaching you to climb stairs safely and giving advice on mobilizing and hip ‘at risk’ positions.
24 hours following surgery a routine check X-ray and blood test will be performed.
Routine post-operative review with Mr Hoad-Reddick will be carried out at six weeks, three months, one year, three years and five years.
When can I go home?
Revision surgery involves a complex procedure of varying severity. The length of hospital stay following surgery depends on the complexity of surgery and the individual. The nursing staff will advise on wound care and dressings. Mr Hoad-Reddick uses glue and a buried stitch; as such there are no stitches to be removed. For further information please download our wound care booklet. After being discharged you will be sent a clinic appointment by post. This will be with Mr Hoad-Reddick six weeks following surgery and a physiotherapy review the same day if possible.
You can return to driving once safely off crutches and mobilising without a limp; this is usually at six weeks postoperatively.