What is Hip Arthroscopy (Keyhole)?
In a Total Hip Replacement, damaged parts of the hip are replaced with prostheses or artificial components. In a Revision (Redo) Hip Replacement, the prostheses themselves are replaced with another set of artificial parts. One or more parts, such as the stem, cup or the socket may be replaced, but there are cases where the entire replacement hip has to be changed.
A revision or a redo may be needed when the replacement hip stops functioning the way it’s supposed to and causes a significant amount of pain or discomfort. This can happen if the prosthesis has been in use for a very long time, and as such, has started to become loose or worn out. There are also cases where the prosthesis becomes dislocated.
Exactly how long it will take to do a hip replacement revision varies from case to case, but generally, the revision procedure lasts two to four hours, or about twice as long as it took to replace the original hip. This kind of surgery is done under general anaesthesia.
After making a larger incision than was made during the first hip replacement, the surgeon will use special tools to remove the parts of the prosthesis that need to be replaced, taking care not to damage the surrounding bones. He will also carefully remove any cement that was used in the first procedure.
Next, the surgeon has to prepare the bone for receiving the replacement prosthesis by using bone grafts or augments made out of porous metal. Once the bone is ready, he will then install the second prosthesis using implants that may or may not use cement.
For revisions done because of an infection, one or two separate procedures may be carried out depending on how badly the hip has become infected. If a single procedure is done, the hip itself is cleaned out and the infected parts, both tissue and prostheses will be removed. The infected components are changed, and the patient is given antibiotics.
If two separate procedures are used to fight the infection, the first procedure involves removing the infected prosthesis and installing a temporary replacement containing antibiotics. When the infection has been cleaned out, the second procedure will be for installing the permanent prosthesis.
Stabilisation surgery will involve general anaesthesia, which means that you will be asleep throughout the procedure. It usually takes about 30 minutes to an hour depending on what the surgeon needs to do inside your shoulder joint. You may have it sitting on a deckchair position or in a side-lying position.
Once the anaesthetic has taken effect, your surgeon will make 2-3 small incisions around the shoulder through which the arthroscope (a tube-like telescope) will be inserted. This instrument has the same thickness as that of a drinking straw and has a camera on its tip.
Because revision hip replacement is more complicated than a replacing a hip for the first time, the risk involved in the procedure increases. Bleeding, blot clots in the legs, infection, heart attack, stroke and pulmonary embolism are some of the risks of a revision, as well as blood vessel or nerve damage.
There is also the possibility of the length of the legs becoming unequal, the bones around the site getting fractured, and the prosthesis becoming loose or dislocated again. Overall, the hip might still be painful even after undergoing revision.
Since revision hip replacement is a complex procedure, preparations begin well before the day of the surgery itself. The surgeon may ask for an X-ray to help him assess the condition of the replacement hip, such as to see whether it has loosened. He may also use digital imaging of the hip to be replaced to help him plan how he will carry the procedure out.
It’s also a good idea to talk to the anaesthetist who will be taking care of you during surgery, beforehand.
How well you follow the recovery instructions and rehabilitation programme that will be given you has a huge impact on how fast you recover from the procedure, and how well your replacement hip will function in the long run. With patience, you may eventually get back to doing everyday tasks like putting on your socks and shoes, getting in and out of a car, sitting down or going for a walk.
Many people who undergo revision hip replacement have physical therapy for about two to four months. You may be advised not to put any weight on your replacement hip for about six to eight weeks. Sleep with a pillow between your legs for six weeks, and try not to turn your foot inwards and bend your hip at the same time because that could dislocate the replacement hip.
Be sure to wear the hip brace that may be given you and to do the recommended strengthening exercises every day. Using a raised or booster toilet seat may also help. Also be sure to not bend your hips farther than 90°, cross your legs, bend down to pick things up, or sit on chairs that are too low.
Pain is your body’s way of telling you that something is not right. Don’t just brush it off and risk the chance of compromising your movement and interupting your daily activities. Get it checked today for the right intervention the soonest possible time. Book your appointment with Dr. Dutton, here.
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