Question

Primary & Revision Total Hip Replacement Surgeries - Is There A Difference?

Dr.Tanmoy Karmakar · Accepted Answer

Primary Total Hip Replacement Surgery is generally a successful procedure, allowing people to restore their active and painless lifestyle. It involves the replacement of a hip joint with a prosthesis or an implant made of different materials. But, over a period of time, this procedure might fail for a number of reasons. When such a failure happens, revision surgery is employed. The Revision Total Hip Replacement Surgery is hence the second operation that removes parts of the first prosthesis to replace them with a new set.

The ultimate goal of both the procedures, namely Total Hip Replacement Surgery and Revision Total Hip Replacement Surgery is the same that is to improve the quality of life by bettering the functionality and relieving pain. However, these two surgeries are different in their procedure and complexity. Revision Total Hip Replacement Surgery is more complex and takes much longer time. It requires good planning and use of specialized tools and implants for achieving good results. Use of specialized implants compensates for the damage to soft tissue and bone that makes it difficult for the surgeon to use standard Primary Hip Implants.

Revision Total Hip Replacement Surgery can manifest itself into two forms:

There might be the need to remove the entire prosthesis and its replacement. It might also involve rebuilding the bone around the hips with augments or bone graft.

In another case, there is a possibility that only some parts or components of the prosthesis need to be removed and replaced.

When to go for Revision Total Hip Replacement Surgery:

When there is wearing and loosening of Implant, it does not function properly. For proper functioning, the implants can be cemented into place or press- fit allowing the bone to grow onto them. If this does not happen, the components get loose leading to pain. Loosening of implants might be caused by excessive body weight, rigorous physical activity, and wearing of the plastic liner inserted between metal cup and ball. Also, younger patients might also have to go through a Revision Surgery when the implant completes its life expectancy.

If there is a bacterial infection in the Total Hip Replacement, Revision Surgery is employed. This is so because antibiotics cannot alone eliminate bacteria from joints. In such cases, two stages of the operations are required. But sometimes, a single stage operation is also employed. However, it has limited application.

When there is a recurrent hip location in the ball and socket joint, Revision Surgery is opted to properly align the joint and to insert the implant.

In case of a periprosthetic fracture (when bone around the implant breaks), Revision Surgery is required.

When metal used in implant breaks or degrades, it may cause damage to soft surrounding tissue and bone. This would require a corrective Revision Surgery.

Preparation for the Surgery:

The patient undergoes a thorough physical examination. It is to ensure that undergoing surgery would not be harmful in any possible way. X-Rays, MRIs, and CT scans are employed to fully understand the structure of the joint. Laboratory tests are conducted to ascertain the fitness of the patient to undergo the procedure. It should be noted that post- surgery, the patient is not able to function at all and requires help even to perform petty tasks for himself. Thus, suitable arrangements should be made accordingly in advance for the same.

Post-Operative Care:

Post-operative care involves pain management, preventing infection, physical therapy, wound care, and prevention of blood clot. It ensures healthy recovery.

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