X-ray above shows hip replacement having now failed with gross pelvic destruction. Also previous revision of the left hip is seen.
Total Hip and Hip Resurfacing Replacements will with time unfortunately fail, as they become worn out, be it to varying degrees and at different rates for the different types used. This failure and the need for revision surgery may present in a number of ways.
The commonest cause for revision surgery of a hip replacement, or indeed any joint replacement, is aseptic loosening with osteolysis ie the artificial hip becoming loose with destruction of the surrounding bone. Also other causes for potential revision surgery are wear of the joint, instability / dislocation from the wear process, leg length changes, increasing bone destruction and the dreaded problem of infection.
The recurrence of pain and disability are usually what alerts the patient that all is not well. A clinical examination and X-ray will usually reveal the cause of the problem.
X-ray now showing reconstruction of the right hip using trabecular metal and bone grafting.
Bone destruction is a major problem in revision surgery, and indeed if there is major bone destruction without any pain present the surgeon may even recommend a major complex revision of the hip. If the bone left following the removal of the previous hip replacement is insufficient then bone grafting may be required. The use of large uncemented trabecular metal implants is now common practice in Bath for major revisions with massive bone loss. This allows for quicker operations with a reduced anaesthetic risk, as well as the reduced requirement for blood transfusion and a lower risk of infection, as compared to previous reconstructions with cement and cages which also themselves fail earlier. Also in cases of either massive bone loss or in cases of fracture or impending fracture cortical strut grafts may be used.
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