Most patients who have a hip replacement experience many years of pain-free movement and an improved quality of life thanks to their new prosthetic joint. However, in rare cases complications develop after surgery and this can lead to patients needing follow-up surgery (called a revision hip replacement).
Unfortunately, revision hip replacements can have poorer outcomes than primary hip replacements so our aim as orthopaedic consultants is always to minimise the risk of follow-up surgery wherever possible.
Study into revision hip surgery outcomes
A recent study by researchers in the Netherlands (published in Bone Joint Journal 2022; 104-B(7): 859-866) looked at the different reasons for patients requiring a revision total hip replacement and how these affects surgical outcomes.
Researchers from Sint Maartenskliniek in Nijmegen reviewed a prospective cohort of 647 patients having a full or partial revision hip replacement at a single high-volume centre, with a minimum of two years’ follow-up.
The reasons for needing revision hip replacement surgery were classified as: infection; aseptic loosening of the prosthetic implant; dislocation of the hip; structural failure and pain. The study team looked at patient-reported outcome measures and other standardised scoring measures (such as modified Oxford Hip Score) to compare pain, complications and failure rates between the different patient groups.
The findings of this study are encouraging. Irrespective of the reason that patients needed a revision hip replacement, the outcomes achieved were generally good.
Unsurprisingly, patients with the highest pain scores and lowest function prior to surgery showed the greatest improvements following revision surgery. Pain scores tended to be highest among patients who had a dislocated hip while patients who needed revision surgery because of an infection or aseptic loosening had lower scores.
Researchers also looked at complications from revision hip replacement surgery and the need for re-operations. Overall complication and re-operation rates were in line with previous research studies and they found no difference between the different groups of patients. This is good news as it means that no matter why you might require a revision hip replacement, you are not at any greater risk of complications or needing further surgery.
Why you might need revision hip replacement surgery
There is a small risk of complications after hip replacement surgery, some of which might affect your comfort and quality of life while others can be serious and potentially life-threatening.
Blood clots: In the immediate post-surgical period, your surgical team will monitor you carefully for complications linked to anaesthesia, such as a deep vein thrombosis. You will be given medication to minimise the risk of blood clots and encouraged to get out of bed soon after surgery. When you are discharged from hospital, you will be advised of the signs to look out for that could indicate a possible blood clot.
Dislocation: A hip dislocation (where the prosthetic ball comes out of the hip socket) occurs in around 1-3% of patients who undergo hip replacement surgery. It is more common in older patients and those who have weak muscles around the hip or poor hip stability due to a condition like rheumatoid arthritis. Your orthopaedic surgeon will advise you on movements to avoid to decrease the risk of dislocation.
Infection: Infections occur in around 1-2% of patients who have a hip replacement. You may be particularly at risk of you are overweight or have diabetes or inflammatory diseases like rheumatoid arthritis. In some cases, your surgeon may advise you to take antibiotics ahead of surgery to minimise the risk of infection.
Other complications include:
- Loosening of the prosthetic implant, the chance of which tend to increase over time.
- Fractured femur which can occur during surgery as the prosthetic stem is fitted inside the femur or in the post-surgical period.
- Different leg lengths after surgery, which can be corrected with special shoe inserts. In some cases, while the leg may feel longer, the real reason may be that the patient has become accustomed to walking on a hip that has lost joint space and may simply need to adjust to their new hip.
- Damage to soft tissues, blood vessels or nerves which may lead to a loss of sensation in the leg or increased weakness. Such problems are rare.
Your surgical team will take every measure possible to reduce the risk of complications and you will be given exercises to support you to make a good recovery, as well as being advised of signs of problems to look out for.
Contact Professor Joseph Queally if you have any questions about hip replacement or revision hip replacement surgery.
