Specialists in Hip Revision Surgery
11 Specialists found
Information About the Field of Hip Revision Surgery
What is a Hip Revision Surgery?
A hip prosthesis replacement or hip revision refers to the surgical replacement of a prosthesis in the hip joint, which can be caused by various factors: Wear, infections, and aseptic loosening. Another distinction is made between the number of components that are replaced.
In general, revisions are always necessary when the durability of the artificial joint has been reached, or loosening and wear occur. It depends on factors such as the patient's age, activity, and general state of health when precisely this is the case. On average, it is said that a prosthesis can serve its purpose for 15 years before a revision has to be considered.
Hip revisions also become obligatory if the patient suddenly has restricted mobility and pain after years of pain-free treatment. In these cases, the doctor uses imaging techniques to examine the prosthesis fit and diagnoses whether the prosthesis components should be replaced during surgery.
Hip Revision in Case of Prosthesis Infections
Prosthesis infections are rather rare in the history of joint prostheses with about 3 percent. Nonetheless, there are alarming signs that may indicate an infection: swelling, redness, and overheating in the area of the joint can occur, although these symptoms do not always have to be present. As usual, with infections, the blood parameters also increase as a result of an increase in white blood cells (leukocytosis) and general signs of infection such as fatigue and fever. However, this diagnosis must be distinguished from patients with systemic diseases. The doctor can confirm his diagnosis with CT, MRI, X-rays, scintigrams, and joint punctures and biopsies, which are examined in microbiological laboratories.
The Gram-positive bacteria S. aureus and S. epidermidis are the cause in every other patient with a prosthesis infection. In rare cases, Gram-negative bacteria can also be the cause. Patients with diabetes mellitus, rheumatism, obesity, or psoriasis, and patients with previous prosthesis surgeries have an increased risk of infection.
The treatment of a prosthesis infection depends individually on the type of infection, its severity, and duration, as well as the patient's general condition. If the infection is younger than six weeks, the joint can be washed, and the head and inlay can be changed. If there is a mono-infection with excellent bony support, a unilateral prosthesis change can also be carried out.
A two-step change with temporary bone cement containing antibiotics can also be considered. A good prognosis always depends on the time of infection, the severity (species), and the patient's general state of health.
Revision Surgery for Hip Prosthesis Loosening
No hip prosthesis lasts a lifetime. Each prosthesis will have to be replaced sooner or later due to aseptic loosening of the prosthesis. Cemented prostheses have the best results in this respect with a service life of 25-30 years, whereas cementless prostheses can last up to 15 years. The prosthesis change in the case of aseptic loosening is usually unilateral.
Hip TEP Revision in Case of Prosthesis Instability
Instabilities in prostheses are usually led back to incorrectly positioned components, hip impingement syndrome (narrowing of the joint space), or certain soft-tissue laxities. Patients at increased risk for instability include those who have already undergone replacement surgery, patients with low compliance, alcoholics, and patients with neurological disorders and the type of access to the hip joint: rear entrance to the hip increases the risk of instability and dislocation.
In case of instability, the patient can try to correct it conservatively with the help of anti-luxation orthoses. Still, in about 30 percent of these patients, recurrent instability occurs, so that surgical intervention becomes necessary eventually. Within this surgery scope, it is attempted to restore the soft tissue tension and remove the impingement, i.e., the constriction. Besides, additional stability can be achieved by using covered inlays, and larger rod ends, modular shaft systems, and coupled inlays.
Periprosthetic Fractures
Periprosthetic fractures refer to fractures in the prosthesis area resulting from violent impact, aseptic loosening, bone resorption, or even directly during prosthesis surgery. Fractures that occur during a surgery most often involve cementless prostheses, whereby the fractures can occur at the acetabulum or in the upper part of the thigh. In almost four percent of cases, fractures occur during hip revision.
The primary goal in the case of a periprosthetic fracture is to restore the bone quality and the proper anatomical conditions. Prostheses that are still stable and firmly anchored despite fractures can be treated with the aid of so-called osteosynthesis plates. Prostheses that are no longer stable require revision, whereby the force effect is usually redirected distally of the fracture gap.
The Procedure of a Hip Revision
Typically, revision is based on the previously used accesses, whereby parallel incisions should always be avoided. The most important measure is to restore the layers in the hip joint. Fractures may occur in the junction area of the femoral body to the femoral neck during the surgery. Cortical perforations can also arise while preparing the femur, but these should be avoided as they can lead to a reduction in bone stability. Removal of the shaft is usually problematic during revision. If removal with conventional tools can no longer be guaranteed, high-speed milling and ultrasonic osteotomes must be used.
While the removal of the prosthesis socket usually turns out to be unproblematic - the bone defects that reduce the stability are more problematic - it can appear that, especially with cemented prostheses, the femur bone must first be "covered."
Long-lasting prosthesis loosening can also lead to so-called pelvic discontinuities, in which the pelvic bone is destroyed. Such defects must be treated with individual implants. The risk of dislocation during a revision is generally between five and 20 percent compared to primary treatment with implants.
Author:
PRIMO MEDICO Editorial Office | Created on 17 June 2017 | Last updated on 27 February 2020
Sources:
S3-Leitlinie Orthopädie: Koxarthrose, Leitlinie der DGOOC und BVO, AWMF
Leitlinie Unfallchirurgie: Endoprothese bei Koxarthrose