Correction of a Loose Hip Replacement

What is a Hip Replacement?

A hip replacement is a surgical procedure where an injured or damaged hip joint is replaced with an artificial hip joint known as a prosthesis.

What is Correction of a Loose Hip Replacement?

Reoperation of a total hip replacement to resolve a painful hip condition and loss of motion due to a loosened prosthesis (artificial hip joint) is known as correction of a loose hip replacement. This loosening occurs due to wear and tear of the implant surfaces and subsequent weakening of the surrounding bone. During this corrective surgery, a partial or complete exchange of the prostheses that were implanted during the original surgery is done.

Anatomy of the Hip

The hip joint is a ball-and-socket joint. It is made up of the head of the femur (thigh bone) which fits into a socket in the pelvis known as the acetabulum. The bones are held together by protective tissue, ligaments, tendons, and muscles. Synovial fluid within the joint aids in smooth movement of the bones over one another.

What are the Indications for Correction of a Loose Hip Replacement?

Some of the indications for correction of a loose hip replacement include:

• Hip injury or fracture
• Obesity
• Infection
• Wear and tear
• Recurring dislocation of the hip
• Osteoarthritis
• Rheumatoid arthritis
• Avascular necrosis
• Congenital hip disease
• Septic arthritis
• Ankylosing spondylitis

Preoperative Assessment Before Correction of Loose Hip Replacement Surgery

A preoperative assessment will be made before hip revision surgery to check your overall health and to make sure you are ready for the surgery. You will be asked about any medications or supplements that you may be taking, and you may need to stop them temporarily if necessary. You will have an anesthetic assessment to decide on what type of anesthesia will be used during surgery. An anticoagulant such as heparin may be given since the surgery carries the risk of blood clots. You will also be given antibiotics to reduce the risk of wound infection post surgery.

Procedure for Correction of a Loose Hip Replacement

The procedure is usually performed under general anesthesia. After adequately sterilizing the surgical area, your surgeon will make a small incision on the side of your hip and will meticulously remove all or some parts of the damaged or loosened original hip implant. Your surgeon will then replace it with a specialized revision implant and close the incision with suture or staples and cover with sterile dressings.

If significant bone loss is noted in your joint, then bone graft or metal augments would be used to reconstruct the bone first before placing the prosthesis.

If prosthetic infection is found to be the reason for loose implant, then your surgeon will perform the revision in two separate surgeries to give the body time for the infection to clear first and then go back in to place a new prosthesis.

Postoperative Care and Instructions

Within 24 hours post surgery, most patients are able to sit and stand and will be encouraged to walk with help. A physical therapist or nurse will provide appropriate instructions on management of the hip as it heals. Patients may be asked to use compression stockings and blood thinners to prevent the possibility of blood clots in the legs. Most patients take about 6 weeks to 3 months to walk normally and engage in normal activities.

Other instructions that need to be followed post surgery include:

• Limit weight-bearing activities
• Use assistive devices such as a walker, cane, or crutches
• Suture and dressing care
• Physical therapy and exercise regimen to strengthen muscles
• Adherence to medications 
• Adherence to follow-up appointments

What are the Risks and Complications Involved with Correction of a Loose Hip Replacement?

Risks and complications that are involved with correction of a loose hip revision surgery include:

• Infection
• Bleeding complications
• Weakness
• Dislocation
• Stiffness or instability of the joint
• Leg-length inequality
• Fracture of the femur
• Blood clots in the legs
• Inability to replace the prosthesis
• Damage to nerves and blood vessels
• Further implant loosening
• Anaesthetic complications

What are the Benefits of Correction of a Loose Hip Replacement?

Benefits of correction of a loose hip replacement include:

• Relief from pain
• Improved range of motion
• Improved mobility, strength, and coordination
• Improved flexibility
• Decreased stiffness
• Improved quality of life

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