What is Revision Hip Surgery?
Revision hip surgery is a repeat hip surgery performed in certain patients to correct the problems or complications of previous hip surgery and overcome its limitations.
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. Stability of the hip joint is achieved by the labrum, ligaments, and tendons that encase the hip and support the hip movements. Any damage to these structures may warrant hip surgery.
Some of the hip conditions that may affect the hip joint structures necessitating hip surgery include:
- Rupture of the labrum
- Arthritis
- Hip dysplasia
- Avascular necrosis
- Hip impingement or femoroacetabular impingement (FAI)
- Hip bursitis
- Snapping hip syndrome
Indications for Revision Hip Surgery
Revision hip surgery may be recommended when previous hip surgeries such as debridement, hip labrum repair, hip labrum reconstruction, femoral osteoplasty, and periacetabular osteotomy have failed to resolve painful and debilitating hip symptoms associated with the hip conditions.
Preparation for Revision Hip Surgery
In general, preoperative preparation for revision hip surgery will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Revision Hip Surgery
Based on the hip condition and failure of the surgery to treat that condition, a patient may need to undergo revision hip surgery. The procedure is performed arthroscopically or as an open surgery under regional and general anesthesia. During an arthroscopic surgery, tiny incisions (portals), about a half-inch in length, are made around the joint area. Through one of the incisions, an arthroscope is passed. A camera attached to the arthroscope displays the images of the inside of the joint on a monitor, which allows your surgeon to view the damage and carry out the required repair. During an open surgery, a long incision of several centimeters is made over the hip joint to access the treatment area and carry out the required repair.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after revision hip surgery will involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Revision hip surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Postoperative pain
- Damage to nerves and vessels
- Thromboembolism or blood clots
- Dislocations (rarely)
- Anesthetic/allergic reactions