Revision of Hip Replacement

For those that have had a total hip replacement, they’ll be pleased to know that revision hip replacement surgery is quite rare. As long as the initial hip replacement surgery was performed to a high standard and the patient responded well, there’s no reason why the new artificial hip joint shouldn’t last several years. However, in some cases where there have been early onset complications or if your hip was replaced a few decades ago, a revision (redo) may be necessary.

Also known as: redo hip replacement

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Everything you need to know

For those that have had a total hip replacement, they’ll be pleased to know that revision hip replacement surgery is quite rare. As long as the initial hip replacement surgery was performed to a high standard and the patient responded well, there’s no reason why the new artificial hip joint shouldn’t last several years. However, in some cases where there have been early onset of complications or if your hip was replaced a few decades ago, a revision (redo) may be necessary. This is because over time an artificial hip joint can wear away just like your original hip. When this happens, you may experience pain in the hip muscles or around the hip.

If your artificial hip joint becomes damaged, for example due to:

Infection
Dislocation
Fracture of your thigh bone or pelvis
Injury to the nerves or blood vessels
Formation of blood clots in the leg veins…

… you will notice your pain returning. A revision isn’t always needed. However, in some cases it may be your best option.

Before Surgery

If you agree with your doctor that a hip revision surgery is right for you, we will help you prepare, but you should also try to eat healthily in the run up and stop smoking if you can.

Before your surgery, you will also need to come into hospital for a pre-assessment, where we can check your fitness for surgery. This is a standard check and includes blood tests, heart and lung function tests as well as an MRSA test. We will also give you some specific antibacterial soap and lotions to use in the run up to your procedure, which will help reduce your risk of contracting MRSA. If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

From midnight on the day of your surgery, do not eat or drink anything. This includes water, chewing gum and boiled sweets. Brush your teeth with toothpaste only on the morning of surgery.

On surgery day, it’s a good idea to wear loose, comfortable clothing and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, a book, any prescription medications and a change of clothes. Your doctor will let you know if you can take any medications with a sip of water before surgery or if you should wait until after.

Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts. Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.

During surgery

Firstly, you’ll have an intravenous (IV) line fitted into a vein. This is usually on an arm or hand. Through this, your surgical team can quickly give you medications and fluids. The surgical team will also place monitors on you so you can stay safe throughout the surgery.

The surgery will begin with the team giving you a general anaesthetic or spinal sedation with a local anaesthetic (you will be asleep no matter which one you receive).

The doctor will then make an incision on the hip being treated and will remove all or part of the old hip replacement (such as the metal or ceramic ball and/or the socket).

At this stage, a bone graft may need to be created using donor bone or part of another in your body. The new hip prosthesis will finally be inserted and screwed into place. This new joint will be made-to-measure and specific to each patient. This reduces the risk of future complications.

After surgery

Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. You will usually be able to walk the same day or the day after with the help of a walker or crutches. During your stay, our nursing team will make regular checks to make sure your recovery is going to plan. You will also be visited by a physiotherapist and an occupational therapy if needed. Before you are discharged, you will need to be cleared by the physiotherapist and nursing team, have a check x-ray and blood tests. Your surgeon will also visit you and make sure you are happy.

You will be able to go home after 24- 48 hours.

It will take approximately two weeks for your wound to heal, and you should see your doctor at this point for a post-surgery check.

After a revision hip replacement, most people will need to rest and follow strict restrictions for around 6 – 8 weeks.

This includes:

Not bending your new hip beyond 90 degrees – as this can cause hip dislocation.
Not crossing your legs as this can cause wear and tear.
Not twisting when standing as this may cause a hip fracture.
Using the shower instead of the bath

In the initial stages of recovery you should also use crutches or a walker and have someone help you with your activities. This will help prevent excess pressure on your artificial joint replacement. You can begin physiotherapy at around the four- week mark. However, each person’s surgery is a little different and so the recovery process will vary. As such, you may need to wait longer before starting therapy.

The timeline for returning to work for a revision hip replacement is usually between 3 -6 months. Your recovery will be affected by the type of hip revision surgery you needed.

Recovering from a revision hip surgery usually takes much longer than from an initial hip replacement. It could take people up to 18 months to fully recover, especially the surgeon need to cut bone or reattach muscles/tendons to the hip. If you’re feeling any hip pain at any point, it’s important that you reach out to our team. We’ll be there to support you and help keep your recovery on track.

Medically reviewed by Mr Sujith Konan - MBBS MD(res) MRCS FRCS(Tr&Orth), Honorary Associate Professor (UCLH)

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.

Find out more

Appointment

You will have an initial consultation with a lower limb orthopaedic surgeon.

Treatment plan

During this appointment, you’ll go through your medical history, the risk and benefits of surgery and what to expect from recovery. Together, you will decide whether a hip replacement is the best option for you.

Pre-op assessment

If you decide to go ahead with surgery, you will need to come in for a pre-assessment, which is a standard ‘fitness for surgery’ check.

Surgery

The surgery itself should take a couple of hours. You will be able to walk with crutches or a walker the same day or the day after and can go home after 24- 48 hours.

Aftercare

You should use crutches or a walker for the first couple of weeks and have someone help you with your activities during this time. You will need rest and follow strict guidelines for 6-8 weeks post-surgery. Most people can start returning to work and their usual activities after 3 – 6 months.