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Hip revision surgery

Published by Bupa's health information team, November 2008.

This factsheet is for people who are planning to have a repeat (revision) hip replacement, or who would like information about it.

Hip revision surgery (also called repeat hip replacement) involves replacing an artificial hip joint that has been damaged or worn away.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About hip revision surgery
Preparing for your operation
About the operation
What to expect afterwards
Recovering from hip revision surgery
What are the risks?
Further information
Questions and answers
Related topics
Sources

About hip revision surgery

During your original hip replacement, your hip joint was replaced with metal, porcelain or plastic hip parts. The artificial joint usually lasts around 10 to 15 years after which it needs replacing. Renewing an artificial hip joint is more complicated than the original operation. The existing artificial hip joint needs to be taken out before the new one is fitted; this extends the time and complexity of the operation.

You may find that your new joint, although a big improvement on your old joint, may not improve your life as much as the original hip operation.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Two weeks before your operation you will be asked to attend a pre-admission clinic for a blood pressure check and routine blood and urine tests. A nurse or physiotherapist (a specialist in movement and mobility) will talk to you about your needs at home, so that any necessary arrangements can be planned before you go into hospital.

Hip revision surgery usually requires a hospital stay of five to seven days and it's usually done under general anaesthesia. This means that you will be asleep during the operation. Alternatively you may prefer to have the surgery under regional anaesthesia. This completely blocks feeling from your waist down and you will stay awake. You may be given a sedative with regional anaesthesia to help you relax during the procedure. Your surgeon will advise which type of anaesthesia is most suitable for you.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your surgeon will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You will also be asked to consent to placing your name on the National Joint Register, which is used to follow up the safety, durability and effectiveness of joint replacements.

Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, compression stockings.

About the operation

Hip revision surgery usually takes two to three hours.

A cut is made along the hip and thigh usually over your previous scars. The original artificial hip joint is removed and replaced with new parts. The cut is closed with stitches or clips and covered with a dressing.

Fine plastic tubes may be left in your wound for up to 48 hours afterwards. These allow blood and fluids to drain into a bag.

What to expect afterwards

You will be given painkillers to help relieve any discomfort as the anaesthetic wears off. If you have regional anaesthesia, you won't be able to feel or move your legs for several hours after your operation. You won't have any pain either.

A special pillow may be placed between your legs to hold your hip joint still and stop it from dislocating (when the ball part comes out of the socket).

For the first day or so, you may have an intermittent compression pump attached to special pads on your lower legs. By inflating the pads, the pump encourages healthy blood flow and helps to prevent blood clots forming in the veins in your legs. You may also have compression stockings on your legs. These help to maintain circulation.

Starting from the day after your operation, a physiotherapist will usually guide you daily through exercises designed to help your recovery.

You will stay in hospital until you are able to walk safely with the aid of sticks or crutches. This is usually about five days.

When you are ready to go home, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first week.

Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment before you go home.

Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches and clips are removed 10 to 14 days after surgery.

Recovering from hip revision surgery

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them.

There are certain movements that you shouldn't do in the first eight weeks. For example, you shouldn't cross your legs or twist your hip inwards and outwards. Your physiotherapist will give you further advice and tips to protect your hip.

You will be able to move around your home and manage stairs. You will find some routine daily activities, such as shopping, difficult for a few weeks and you will need to ask for help. You will need to use crutches for about six weeks.

You may be asked to wear compression stockings for several weeks at home. They are difficult to put on and take off, and you will need someone to help you with this.

You can usually return to work after six to eight weeks. But if your work involves a lot of standing or lifting, you may need to stay off for three months.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

Your hip will continue to improve for at least six months.

What are the risks?

Hip revision surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

Side-effects specific to hip revision surgery include:

pain and discomfort in hip
pain and swelling in your knee and ankle

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to hip revision surgery include:

infection - this is usually treated with antibiotics
joint dislocation - most likely to happen immediately after surgery and you may need further surgery
hip fracture - tiny cracks can occur whilst removing the old implant or fitting the new joint and this may require further surgery
unstable joint - your new joint may in time loosen and need further surgery
difference in leg length - your operated leg may be slightly shorter or longer and you may need to wear a raised shoe on the shorter side to correct your balance

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

Arthritis Research Campaign
0870 850 5000
www.arc.org.uk