27091 Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer

Name of the Procedure:

Removal of Hip Prosthesis; Complicated, Including Total Hip Prosthesis, Methylmethacrylate with or without Insertion of Spacer

Summary

This procedure involves the removal of a previously implanted hip prosthesis, which is typically complicated by factors such as bone cement (methylmethacrylate) adhesion. It may include the insertion of a temporary spacer to maintain joint space and allow for future re-implantation.

Purpose

The primary goal is to remove a hip prosthesis that has failed due to infection, loosening, or other complications. This procedure aims to alleviate pain, address infection, and prepare the joint for a future replacement if necessary.

Indications

• Persistent pain in the hip joint
• Infection or sepsis associated with the prosthesis
• Mechanical failure of the hip implant
• Loosening or displacement of the prosthesis
• Osteolysis (bone loss) around the hip implant
• Recurrent hip dislocations

Preparation

• Fasting for 8-12 hours prior to surgery if general anesthesia is used.
• Adjustments or temporary cessation of certain medications, such as blood thinners.
• Pre-operative blood tests, imaging studies (X-ray, MRI or CT scans), and possibly infection screening (e.g., blood cultures).

Procedure Description

1. Anesthesia: The patient receives general or regional anesthesia.
2. Incision: A surgeon makes an incision over the hip joint.
3. Prosthesis Removal: The surgeon carefully removes the prosthesis, including any associated bone cement (methylmethacrylate).
4. Cleaning: The joint area is cleaned thoroughly to remove debris and, if applicable, to address infection.
5. Spacer Insertion: In some cases, a temporary spacer impregnated with antibiotics may be inserted to maintain joint space and control infection.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the issues encountered.

Setting

The procedure is performed in a hospital operating room, equipped for orthopedic surgeries.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Possibly an infectious disease specialist (if infection is a concern)

Risks and Complications

• Common Risks: Pain, bleeding, infection, blood clots, and reactions to anesthesia.
• Rare Complications: Nerve or blood vessel damage, persistent infection, hip instability, fractures, and additional bone loss.

Benefits

• Relief from chronic pain and discomfort.
• Removal of a source of infection or inflammation.
• Preparation for a future, more successful hip replacement.

Recovery

• Hospital stay of several days.
• Pain management with medications.
• Physical therapy to maintain mobility and strength.
• Follow-up appointments to monitor healing and plan for future treatment.
• Full recovery time can vary but often spans several weeks to months.

Alternatives

• Conservative Treatments: Physical therapy, pain management, and antibiotics for infections.
• Revisions: Less extensive revision surgeries to correct specific issues without full prosthesis removal.
• Pros and Cons: Conservative treatments may offer temporary relief but might not address root causes, while less extensive revisions may not be as effective as a complete removal in severe cases.

Patient Experience

• During the Procedure: Under anesthesia, so the patient will not feel pain during the surgery.
• After the Procedure: Initial pain and discomfort managed with medications. Limited mobility and the use of walking aids or crutches. Physical therapy sessions to aid recovery. Regular assessments to plan for any subsequent procedures.