Hip Replacement Revision Surgery

revision surgery

What does it mean to have a hip replacement revision surgery?

A surgery following an initial hip replacement surgery is known as revision surgery. This is a second hip replacement performed after the initial hip implant surgery has been completed. There are various reasons someone might need a revision surgery after their initial hip replacement has been completed, but it is an experience all hip patients look to avoid. Revision surgery is painful, costly, and often leads to further complications. 

Why would someone need a hip replacement revision surgery?

The most common reasons for needing hip revision surgery include:

  • Repetitive dislocation of a hip replacement
  • Infection
  • Defective design or mechanical failure

Repetitive Dislocation

Repetitive dislocation happens when the hip becomes dislocated shortly after the initial hip replacement surgery. This can occur for a variety of reasons. The first reason could be that the patient didn’t properly follow the surgeon’s post-operation instructions. When the muscles, bone, and tissue are disrupted during hip replacement surgery, they need time to readjust to their new surroundings. If the patient pushes their physical limitations too early in the healing process, the result can be dislocation. A second reason could be that the surgeon failed to use the proper sized components, or improperly inserted the hip replacement components. While this is a rare occurrence, it does happen from time to time.

Infection

Infection can occur both during and after the hip replacement surgery.

Defective Design or Mechanical Failure

If a hip implant is defectively designed, mechanical failure can occur in the form of wear, loosening, or breakage. Metal-on-metal hip replacement systems have become notorious over the past decade or so for their mechanical failure. No matter the type of implant, there have been consistent occurrences of device failure where one metal component rubs against another. While some devices have been recalled, others have not. Some examples of problematic metal-on-metal hip implant systems include:
• DePuy ASR
• DePuy Pinnacle
• Stryker Rejuvenate and ABG II
• Stryker V40 femoral head component
• Smith & Nephew Modular SMF and Redapt
In all of the above named hip implant models, the devices are failing at points where metal rubs against metal, shedding metal particles into the patient’s blood stream, soft tissue, and other organs. Since a majority of metal-on-metal hip implants are made of cobalt and chromium, doctors are finding that patients may test positive for high metal levels in their blood stream. High metal levels can lead to problems such as osteolysis, necrosis, and pseudo tumors.

What happens in an initial total hip replacement surgery?

In a traditional hip replacement surgery (total hip arthroplasty), the surgeon must dislocate the joint, reshape and replace the hip components, and repair any other muscle and soft tissue affected by the operation before stitching the patient back together.

total hip replacement surgery step-by-step:

  1. The initial incision is typically between 10 and 12 inches. As you could guess, soft tissue and muscle must be disrupted in order to reach the patient’s bone.
  2. Next, the hip joint is intentionally dislocated by removing the head of the femur bone from the pelvis. The socket in the pelvis is known as the acetabulum.
  3. In a total hip replacement, the doctor will cut off the head of the femur bone using a bone saw.
  4. A tool called a reamer will then be used to reshape the socket (acetabulum) where a new acetabular component is inserted. The new component resembles a cup and often has holes in it, allowing for bone to grow around it over time.
  5. Often times, a liner will be placed inside the cup to help facilitate smooth movement between the new femoral head and new hip socket.
  6. Next, the surgeon drills deep inside the femur bone to insert a prosthetic stem that will be connected to the new femoral head. Over time, bone grows around the inserted components.
  7. Once the new femoral head is attached to the rest of the femur bone and everything is sized properly, the surgeon begins the process of repairing any tissue and muscle affected by the initial incision. Once this is completed, the hip replacement surgery can be completed.

What happens in a revision surgery?

Revision surgeries require additional steps in order to retrieve the problematic hip components making the results less predictable and complications more frequent.

Revision surgery for hip replacements generally occurs in three phases:

  1. An incision larger than the initial incision is made in the hip joint in order to remove the problematic components. Surgeons sacrifice soft tissue and muscle in an effort to cause minimal damage to the bone that now contains the hip replacement components. Using special equipment, surgeons remove the components and any cement used to hold the components in place. This is a rather gruesome process, as it involves digging and sawing through bone that has now grown around the implant.
  2. The second phase is all about replacing bone lost in the process of recovering the problematic hip components. Surgeons typically use bone graft or additional metal supports to create a solid foundation for the new hip replacement components.
  3. In the third phase, the new components are placed via the same method mentioned above.

If infection is the reason for revision, an additional step may be needed between phases two and three. In this situation, a spacer containing antibiotics to help fight the infection is implanted until the infection clears. Once the infection has cleared, new components can be inserted.

The importance of following up with your orthopedic surgeon

Hip implant recipients, and especially those with metal-on-metal hip implants, should take care to follow up with their orthopedic surgeon if they’re experiencing any of the following symptoms:

  • Pain in the groin, hip or leg
  • Swelling at or near the hip joint
  • A limp or change in walking ability
  • Noise (popping, grinding, clicking or squeaking) from the hip joint

Even if you’re showing none of the above symptoms you may still be at risk for high metal levels and the associated problems it may cause. Ask your doctor about the following tests to ensure you are not at risk for high metal levels and revision surgery:

  • Using a needle to remove fluid from around the joint (joint aspiration)
  • Soft tissue imaging
  • Blood tests, including checking levels of metal ions in the blood.

What do I do if I have high metal levels or need revision surgery?

GoldenbergLaw has been fighting for the rights of those injured by defectively designed metal-on-metal hip implants for over 30 years. We understand the inherent complexities of these types of litigations and know how to handle your claim. We will work with you to not only seek the compensation you deserve, but also to restore your quality of life. Please call us for a free consultation at 612-333-4662 or toll free at 844-680-6100.