Name of the Procedure:

Revision of Total Hip Arthroplasty; Both Components, with or without Autograft or Allograft

Common Name(s): Hip Revision Surgery, Total Hip Replacement Revision

Summary

Revision of total hip arthroplasty is a surgical procedure to replace both the acetabular (hip socket) and femoral (thigh bone) components of a previously implanted artificial hip joint. This may involve the use of bone grafts from the patient (autograft) or a donor (allograft).

Purpose

This procedure addresses issues with a failing or problematic hip replacement. The goals are to alleviate pain, restore function, and increase the longevity of the hip joint.

Indications

• Persistent pain or discomfort in the hip
• Loosening or wearing out of the prosthetic components
• Infection in the hip joint
• Fracture around the prosthetic components
• Dislocation of the hip joint

Preparation

• Pre-procedure fasting as instructed by the healthcare provider
• Adjusting or stopping certain medications (e.g., blood thinners)
• Preoperative imaging tests (X-rays, CT scans)
• Blood tests and a medical evaluation

Procedure Description

1. Anesthesia: The patient is given general anesthesia or regional anesthesia (spinal or epidural).
2. Incision: An incision is made over the hip to access the joint.
3. Removal of Components: The existing prosthetic components are removed carefully.
4. Bone Grafting (if needed): Autograft or allograft bone may be used to rebuild bone stock.
5. Implantation of New Components: New prosthetic components are implanted.
6. Closure: The incision is closed with sutures or staples.
7. Dressings and Bandages: The wound is covered with sterile dressings.

Duration

This procedure typically takes 2 to 4 hours.

Setting

The operation is performed in a hospital's surgical suite.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians
• Possibly a Physician Assistant or a Nurse Practitioner

Risks and Complications

• Infection
• Blood clots
• Nerve or blood vessel damage
• Hip dislocation
• Bone fracture
• Differences in leg length
• Need for further revision surgery

Benefits

• Reduced pain
• Improved mobility and function
• Enhanced quality of life Improvements can often be noticed within a few weeks after surgery, with continued progress over several months.

Recovery

• Hospital stay of 3 to 5 days
• Physical therapy beginning immediately post-surgery
• Pain management with prescribed medications
• Restrictions on weight-bearing and certain activities for several weeks
• Full recovery may take 6 months to a year
• Follow-up appointments for monitoring progress

Alternatives

• Non-surgical management with physical therapy and medications
• Partial hip revision (only one component replaced)
• Enhanced prosthetic options based on specific patient needs

Pros:

• Non-surgical options involve less risk and no recovery time from surgery.

Cons:

• May not adequately address the problem if the existing components are severely compromised.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia. Post-operatively, they may experience discomfort, swelling, and bruising, which is managed with pain medication. Physical therapy will aid in recovery, and adhering to care instructions will facilitate a smoother healing process.