Revision surgery can be complicated and requires specialist training and instrumentation.
Successful hip revision surgery starts well before the surgery is performed. It is extremely important that the surgeon evaluates and investigates the patient’s clinical concerns and described symptoms. An accurate diagnosis and understanding of why the hip is causing problems or failing is essential to a successful outcome.
While many causes of failure detailed above are obvious, some are more subtle. Listening to our patients as they describe their symptoms is the most helpful way to target investigation and determine the treatment required. The surgeon must start the revision surgery with a clear understanding of the problem and what is required to achieve a successful outcome. This must be clearly communicated at the time of consent, with the possible risks and any specific concerns discussed. A shared decision-making process surrounding revision hip surgery will ensure realistic expectations for both patient and surgeon.
In revision surgery the decisions should be supported by an MDT approach. The options could involve plans to revise only the bearing surface combination, exchanging the liner within an uncemented socket and a femoral head, leaving the components alone. Alternatively, the acetabular and/or the femoral components themselves might be required to be removed. Clearly if the components are already loose, in the absence of severe bone loss or damage, this might not always constitute a major challenge but if the hip is to be revised for other reasons, such as instability, infection or leg length inequality and the components themselves are not loose, this can constitute a considerable challenge.
The presence of severe bone loss on either or both sides of the joint, particularly in the presence of an infection, can make revision surgery increasingly complicated and a major surgical challenge. For these reasons, not all surgeons who carry out primary hip replacement surgery will carry out revision surgery. Surgeons who carry out revision surgery require specialist training and experience. Clinical exposure to and a full understanding of all the various techniques that are available is crucial, alongside the availability of all the necessary instrumentation and equipment that can be used to facilitate such a technically challenging procedure. My training was always directed towards more complex primary and revision hip surgery. My practice reflects my experience over many years in these cases.
Hip revision surgery requires a multi-disciplinary approach within the surgical team. There are additional complexities surrounding the anaesthetic techniques used. The procedure frequently takes longer than primary total hip replacement, there are issues surrounding bleeding both peri and post-operatively and perhaps a slightly increased risk of complications, all of which makes it very important that the surgeon, the anaesthetist, theatre team and ward staff work closely together to reduce any chance of peri-operative concern.
The risks of hip revision surgery depend largely on the exact complexity of the procedure but are similar to those detailed in the section on primary hip surgery though perhaps at a slightly increased frequency.
Despite the fact that hip revision tends to be of a slightly greater magnitude in terms of surgical trauma than a primary total hip joint replacement, the outcomes following hip revision surgery when performed with a definite diagnosis, following appropriate investigation, when well-planned and performed by an experienced surgeon working in the correct environment with all the necessary equipment using a multi-disciplinary approach, are good. Complications are rare when surgery is planned well and performed carefully. The patient should expect a good outcome.