Revision Hip Replacement
At times, a hip replacement can fail for various reasons and may need to be replaced again. This second operation is called revision surgery. It is a complex procedure in which all or part of the existing hip implants are removed and replaced with new implants. Some of the common reasons for revision hip replacement are wear and/or loosening of the prosthetic components, infection, recurrent dislocation, bone loss around the prosthetic components, and muscular dysfunction due to limb length inequalities.
Below are before (left) and after (right) X-rays of a sixty-seven-year-old woman who was never happy with her initial hip replacement which was performed two years prior to her consultation. She had significant pain and had difficulty bearing weight. Her before (left) X-rays show a loose prosthesis in the socket with significant shortening of her thigh bone (limb length inequality) and extra bone formation around the joint (known as heterotopic ossification). All implants were completely removed and the hip was reconstructed with a new hip prosthesis. The excess bone was removed during the revision surgery.
Below are the X-rays of a 67-year-old male who presented with a painful total hip replacement that was ongoing for two years prior to his consultation. He was diagnosed with chronic infection as well as adverse local tissue reaction to metal debris. These diagnoses were associated with severe acetabular bone and soft tissue loss (left picture). He underwent a two-stage revision surgery consisting of placement of an antibiotic eluting cement spacer (middle picture) with final reconstruction using a cup-cage and dual mobility constructs two months later (right picture).
Below are intraoperative images as well as a postoperative X-ray of a 26-year-old very active male who presented with pain and leg length discrepancy following a total hip replacement performed five years prior to his consultation. He was diagnosed with adverse local tissue reaction from catastrophic polyethylene wear. Patient underwent a complex revision hip replacement due to extensive proximal femoral bone loss from the metal debris and need to perform an extended trochanteric osteotomy to remove his well-fixed femoral component.
Below are before (left) and after (right) X-rays of a 74-year-old female who presented with dislocation of her total hip replacement after a fall. She had a fracture of her proximal femur resulting in loosening and subsidence of the femoral component. The femoral component was revised.
Below are before (left) and after (right) X-rays of a 79-year-old male who presented with a proximal femur fracture after a fall. The fracture resulted in loosening and subsidence of the femoral component, which was revised.
Below are before (left) and after (right) X-rays of a 56-year-old male who presented with fracture of his femoral component. Extended trochanteric osteotomy was used to remove the remaining implant embedded in the femoral canal. A new femoral implant was inserted the the proximal femur repaired with cerclage wires.
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