Hip Revision Surgery Fundamentals
Hip revision surgery is performed to repair an artificial hip joint that has been worn or damaged over time. This can result from an infection or just normal wear and tear of the prosthetic hip. Revision surgery helps to correct the problem so the hip can function normally again.
The use of artificial hip implants is extremely effective in improving hip joints that are damaged by injury or some form of arthritis. Artificial joints, including hip joints, do not last forever. The typical life of an artificial hip joint is 12 – 15 years, depending on the patient’s daily use of the joint. After a period of normal wear and tear of the hip joint, the prosthesis does not fit as securely and is not as effective. In these cases, hip revision surgery may be recommended by your doctor.
Revision surgery may also be recommended if an infection has developed in the tissue surrounding the joint. If infected, the muscle, tendon, and ligament tissues in the hip joint will become weakened and damaged. The infection will also damage the bone.
What are the benefits of hip revision surgery?
Relief from pain is the main benefit of having hip revision surgery. Many patients may find that hip revision surgery improves mobility, strength, and coordination of the torso and leg in addition to improving the appearance of the hip and leg. Revision surgery may enable patients to return once again to normal activity with a pain-free hip. But keep in mind that successful hip revision surgery is also contingent on the patient’s diligence with his or her physical rehabilitation program following surgery.
What are the risks of hip revision surgery?
Keep in mind that hip revision surgery is a voluntary but typically safe procedure. Unforeseen complications may develop that are associated with anesthesia, such as respiratory or cardiac malfunction. In addition, complications may arise with an infection, injury to nerves and blood vessels, weakness, stiffness or instability of the joint, pain, or the possibility of needing more hip surgeries.
What happens during surgery?
During hip replacement surgery, the diseased portions of the hip are removed and replaced with an artificial hip joint. With hip revision surgery, the artificial hip joint is removed and replaced with a new one. In cases of infection, more than one hip revision surgery may be required. In these more severe cases, the first surgery will be needed to remove the old prosthesis scar tissue and treat the joint with antibiotics for the infection. When the hip is cured of infection, surgery is performed to provide a new prosthetic.
What happens after surgery?
After surgery, medicines or therapy may be prescribed by your orthopaedic surgeon to prevent blood clots. To decrease your chances of having a deep vein thrombosis (DVT) after surgery, you may be given medication and instructed to wear special stockings following surgery.
How long is the recovery period after hip surgery?
Hip revision surgery requires a period of adjustment. It is important for patients to exercise their legs to reduce swelling and elevate their legs above the heart when resting. After surgery, patients will use a walker. Patients should keep in mind that normal activities such as getting into a car or climbing stairs will be difficult. After approximately a month, the physician will take X-rays of the leg to monitor healing. After approximately six months, patients will be able to walk without a limp and without pain in the hip.
What is the rehabilitation after surgery?
Physical therapy is started immediately following replacement surgery and continues months after surgery. A physical therapist will provide goals and instructions for you to complete while in the hospital and at home. These goals and instructions may include limitations on weight-bearing activities following surgery and specific exercises that will help you in recovery.
How can I manage at home during recovery from hip revision surgery?
The following are recommendations for home care activities following hip revision surgery:
When riding home from the hospital, make sure to stop every 45 to 60 minutes to get out of the car and do some walking. Also, do ankle pumps in the car while riding. If you are flying home, request an aisle seat and keep the operative leg extended in the aisle. You should request to be boarded last on the plane.
Resting & Sleeping
When resting or sleeping in bed, it is recommended that you lie on your nonoperative side for the first four to six weeks following surgery. Make sure you have a pillow between your legs and also a second pillow to support your foot and ankle. If you lie on your operative side, keep in mind that this may not be that comfortable in the initial weeks following surgery and is not recommended immediately following surgery. When you lie on your back, you must have a pillow between your legs.
For positioning during sexual relations, make sure to consult your physician or physician assistant. Intercourse may be resumed approximately three weeks after surgery following the precautions outlined by your physician.
Reaching typically requires too much bending and is typically not comfortable for patients following hip surgery. It is recommended for the first four to six weeks after surgery you use long-handled reachers that may be obtained from your occupational therapist or a medical supply store.
For dressing, to prevent lifting your knee higher than your hip on the surgery side, you may be given a long shoe horn and a dressing stick which will help you in putting on and taking off your shoes, socks, and pants independently. Remember to always put your operative leg in the pants first. If you wear tie shoes, elastic shoelaces may be used to eliminate the need for tying.
Your physical therapist will teach you the correct way to go up and down stairs using handrails and/or crutches.
Remember to use your good leg first followed by the crutches and the surgery leg. When going down stairs, the crutches and surgery leg go first followed by the good leg.
For bathing, do not attempt to get into the bathtub to take a bath or to use an overhead shower. The excessive bending at the hips needed to get into and out of the bathtub should be avoided.
Remember not to bend too far or stoop when performing household chores. Chores that you should avoid that may involve excessive bending include cleaning the floor, taking out the rubbish, and making beds.
Following revision surgery, you will need to use a walker based on your condition, which your occupational or physical therapist will provide for you. Make sure to stay on your walker until your doctor or physical therapist advises that you use a cane. Your doctor will decide how much weight you can put on your surgery leg. In most cases, you will be able to put 100 percent of your weight on your surgery leg unless otherwise notified. Your physical therapist will help teach you how to use your walker correctly and help you to obtain the appropriate equipment for use at home. A bag or basket attached to your walker will allow you to carry small items when walking.
Eating & Exercising
Eat well-balanced meals and make sure to complete the exercises that you have been taught in physical therapy three times a day. Keep in mind that it can take over a year for your muscles to become strong, so it is extremely important to do your exercises to help ensure a safe and effective recovery. Also, remember to elevate both of your legs when sitting to minimize swelling.
It is recommended that you not drive for eight weeks following surgery. You may go out in a car (as a passenger) after you return home, but make sure to avoid sports cars and cars with bucket seats because of the low seat height. To get in and out of a car, park the car several feet away from the curb. Stand on the street and turn your back to the car and sit down. Slowly slide back on the seat, keeping your legs straight, not leaning forward. Get into the car by swinging your legs around to the front of the seat, keeping your legs together.
How frequently should I schedule follow-up appointments with my doctor following hip surgery?
Post-operative visits help your surgeon know that your hip is healing well. Make sure to schedule your first evaluation within the recommended time frame indicated by your surgeon. This recommended timeframe is two, six, and twelve weeks following your hip replacement surgery.
If you have a problem before you schedule your return appointment, make sure to call your doctor’s physician assistant immediately.
In addition to the first follow-up appointment after discharge, this additional schedule is recommended:
- Three months following the date of surgery
- One year following the date of surgery
- Annually on the anniversary date of surgery
It is important to comply with this schedule and to see your doctor regularly for routine office visits to ensure safe and effective recovery from hip revision surgery.