In most cases, increasing pain, greater difficulty in placing weight on the hip, and loss of mobility in the hip joint are early indications that revision surgery is necessary. The location of the pain may point to the part of the prosthesis that has been affected by osteolysis.
The pain is felt in both the hip area and the thigh when both parts of the prosthesis have become loose; if only the femoral component has been affected, the patient usually feels pain only in the thigh. As was mentioned earlier, however, some patients do not experience any discomfort even though their prosthesis is loosening or wearing against surrounding structures. In addition, a minority of patients who have had THR have always had pain from their artificial joints, and these patients may not consider their discomfort new or significant.
In general, diagnostic imaging that shows bone loss, loosening of the prosthesis, or wearing away of the joint tissues is an essential aspect of hip revision surgery—many orthopedic surgeons will not considerthe procedure unless the x-ray studies reveal one or more of these signs. X-ray studies are also used to diagnose fractures of the hip or dislocated prostheses. In some cases, the doctor may order a computed tomography (CT) scan to confirm the extent and location of suspected osteolysis; recent research indicates that CT scans can detect bone loss around a hip prosthesis at earlier stages than radiography.
Infections related to a hip prosthesis are a potentially serious matter. Estimated rates of infection following THR range between one in 300 operations and one in 100. Infections can develop at any time following THR, ranging from the immediate postoperative period to 10 or more years later. The symptoms of superficial infections include swelling, pain, and redness in the skin around the incision, but are usually treatable with antibiotics. With deep infections, antibiotics may not work and the new joint is likely to require revision surgery. One American specialist has said that the chances of salvaging an infected prosthesis are only 50/50.
Preoperative preparation Certain health conditions or disorders are considered contraindications for hip revision surgery. These include: • a current hip infection • dementia or other severe mental disorder • severe vascular disease • poor condition of the skin covering the hip • extreme obesity • paralysis of the quadriceps muscles • terminal illness
Patients who are considered appropriate candidates for hip revision surgery are asked to come to the hospitalabout a week before the operation. X rays and other diagnostic images of the hip are reviewed in order to select the new prosthesis. This review is called templating because the diagnostic images serve as a template for the new implant. The surgeon will also decide whether specialprocedures or instruments will be needed to remove the old prosthesis.
Aftercare Aftercare for hip revision surgery is essentially the same as for hip replacement surgery. The major difference is that some patients with very weak bones are asked to use canes or walkers all the time following revision surgery rather than trying to walk without assistive devices.
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