Hip revision surgery fundamentals
Hip revision surgery is performed to repair an artificial hip joint (prosthesis) that has been damaged over time due to an infection, or due to normal wear and tear of the prosthetic hip. Revision surgery helps to correct the problem so the hip can function normally again.
The use of artificial hip implants is extremely effective in improving hip joints that are damaged by injury or some form of arthritis. Artificial joints, including hip joints, do not last forever. The typical life of an artificial hip joint is 10-15 years, depending on the patient’s daily use of the joint. Patients with artificial hip joints are typically over the age of 55 and have developed severe arthritis in the hip. After a period of normal wear and tear of the hip joint, the prosthesis does not fit as securely and is not as effective. In these cases, hip revision surgery may be recommended by your doctor.
Revision surgery may also be recommended if an infection has developed in the tissue surrounding the joint. If infected, the muscle, tendon and ligament tissues in the hip joint will become weakened and damaged. The infection will also damage the hip bone.
What causes the hip pain?
The main reason for hip revision surgery is to repair an artificial hip implant that may be no longer securely attached to the bone, resulting in abnormal motion that causes pain for the patient. Hip revision surgery is an attempt to repair the hip and restore it to a condition where it can function normally.
What are the benefits of hip revision surgery?
Relief from pain is the main benefit of having hip revision surgery. Many patients may find that hip revision surgery improves mobility, strength and coordination of the torso and leg, in addition to improving the appearance of the hip and leg. Revision surgery may enable patients to return once again to normal activity with a pain-free hip. But keep in mind that successful hip revision surgery is also contingent on the patient’s diligence with his or her rehabilitation program following surgery.
What are the risks of hip revision surgery?
Keep in mind that hip revision surgery is a voluntary, but safe procedure. Unforeseen complications may develop that are associated with anesthesia, such as respiratory or cardiac malfunction. In addition, complications may arise with an infection, injury to nerves and blood vessels, fracture, weakness, stiffness or instability of the joint, pain, or the possibility of needing more hip surgeries.
How do I prepare for hip revision surgery?
In order to prepare for surgery, patients are requested to schedule a series of appointments prior to the surgery date to receive testing and clearance for surgery. The appointments are initiated at least a month prior to the surgery date. During these appointments, studies including lab testing, urine analysis, EKG, and X-rays, are conducted. Additional studies, such as bone scans, may also be recommended by your doctor. Based on the results of these tests and the patient’s health history clearance is initiated for the surgery. Depending on the patient’s condition, additional testing may be required prior to surgery.
Patients can also take steps at home to help ensure an easier recovery after surgery. Make a few simple changes around the house, and arrange for someone to help you during the few weeks following surgery. Discuss with your surgeon about whether you should donate your own blood for surgery, and schedule appointments to see your primary care doctor and your dentist. If you smoke, try to stop or cut down to lower your surgery risk and increase your recovery rate.
Try these tips at home prior to hip surgery:
- Remove any loose rugs, as they can be hazardous when you are walking in the house. Make sure you tape down all electrical cords.
- Store additional canned and frozen foods, and make sure all supplies are between waist and shoulder level.
- You will need to keep both legs elevated for the first 4 to 6 weeks following surgery. This is best accomplished in a recliner chair, or a chair with armrests and an ottoman for appropriate leg support.
- Prepare a sleeping room on the main floor, or ensure that you only have to climb the stairs once a day.
- Make sure you have a cordless phone for greater efficiency in answering any phone calls.
Special equipment will help to ensure an easier recovery following hip surgery. Your physical and occupational therapists will recommend equipment for you and will help you and your family in obtaining this equipment following surgery. Some of this equipment may include:
- Elevated toilet seats
- Shower seats
- Handrails and grab bars, especially when getting in and out of the bathtub
- Grasping device for putting on socks and shoes
Do not eat or drink anything after midnight the night before surgery.
Inform your surgeon about all of your medications, both over-the-counter and prescription. Some medications do not react well with anesthesia, and others such as aspirin, ibuprofen and blood thinners, increase bleeding. For these reasons, you may need to stop taking certain medications before hip replacement. If you are taking aspirin or aspirin-based medication for arthritis, you must discontinue these two weeks before your surgery. If you are taking medications for other medical problems, do not discontinue taking these without checking with your primary care physician. Make sure to bring a list of all medications, the dosages, and how often you take them. This includes all herbal supplements and vitamins. This is important information that will be documented in your hospital records.
Have your teeth cleaned and make sure you do not have any cavities that might need to be taken care of during the first few months following surgery. Since the blood supply to the hip is increased during healing time, it is better to have any routine dental work done either before surgery or three months after. In addition, any emergencies must be taken care of immediately. You will continue to use antibiotics prior to any dental work for the rest of your life once you have a total hip joint replacement.
Someone from Cleveland Clinic Anesthesia Department will meet with you before your hip replacement surgery. They will explain the various types of anesthesia available to you and the risks and benefits of the surgery. The spinal, or regional anesthetic block, is the most common and safe method used for orthopaedic procedures. You will also be asked to complete a health questionnaire from the Anesthesia Department for surgery clearance to ensure your safety.
An evaluation by Cleveland Clinic Physical Therapy Department is conducted on all patients prior to surgery. After surgery, you will have daily physical therapy.
It is possible for you to donate your own blood for surgery. You should notify your doctor or physician’s assistant if this is of interest to you.
What do I need to do the day of hip surgery?
On the day of surgery, patients are admitted at Desk P-20 (in the lobby of the P building) and typically spend an average of 4 to 5 days at the hospital. The physician’s assistant will advise you as to what time you will be admitted on the day of surgery. Parking is available in the E.90th Street Parking Garage adjacent to the P-20 Surgical Center.
What happens during surgery?
During hip replacement surgery, the diseased portions of the hip are cut away and replaced with an artificial hip joint. With hip revision surgery, the artificial hip joint is removed and replaced with a new one. Depending on the severity of the infection, more than one hip revision surgery may be required. In these more severe cases, the first surgery will be needed to remove the old prosthesis scar tissue and treat the joint with antibiotics for the infection. When the hip is cured of infection, surgery is performed to provide a new prosthetic.
What happens after surgery?
After surgery, medicines or therapy may be prescribed by your surgeon to prevent blood clots. To decrease your chances of having a Deep Vein Thrombosis (DVT) after surgery, you may be given medication, wear special stockings and do ankle pumps two to three days following surgery. You also may be given patient-controlled analgesia (PCA) which allows you to control your own pain medication through an IV and lasts for one or two days after surgery. You may have an appointment after surgery depending on the wound closure method preferred by your surgeon to have the sutures removed. You should call your surgeon before this appointment if you experience any of the following symptoms:
- Increased redness
- Pain or swelling
- Drainage at the incision
- Bumps or pimples
- Any other changes you question
How long is the recovery period after hip surgery?
Hip revision surgery requires a period of adjustment. It is important for patients to exercise their legs to reduce swelling, and elevate their legs above the heart when resting. After surgery, patients will use a walker. Patients should keep in mind that normal activities such as getting into a car or climbing stairs will be difficult. After approximately a month, the physician will take X-rays of the leg to monitor healing. After approximately 6 months, patients will be able to walk without a limp, and without pain in the hip.
What is the rehabilitation after surgery?
Rehabilitation and physical therapy is started immediately following replacement surgery and continues throughout your hospitalization and at home for one year after surgery. A physical therapist will provide goals and instructions for you to complete while in the hospital and at home. These goals and instructions may include limitations on weight-bearing activities following surgery and specific exercises that will help you in recovery.
On the first day after surgery, the physical therapist will meet with you in your hospital room for an assessment. On the second day, you will go to the Physical Therapy department by wheelchair for treatment. Your physical therapist will monitor the strength and flexibility in your leg and hip, as well as your ability to stand and sit.
Your doctor may determine that it is best for your recovery if you go to a rehabilitation center after discharge from the hospital. At the rehabilitation center, you will have concentrated time with a physical therapist and occupational therapist and will regain your strength, learn about all your hip exercises and the precautions that you’ll need to follow. Your length of stay at this facility is approximately 5 to 14 days. Your doctor’s physician assistant or nurse will discuss facilities available for your needs, and a Case Manager specializing in Discharge Planning will meet with you during your admission. The Case Manager handles all of the planning for your rehabilitation.
Positioning After Surgery
After surgery, your physical therapist will instruct you regarding hip movement precautions and any limitations you may have for range of motion. Keep in mind that your physical therapy and strengthening exercises will help you gain greater mobility and ensure an easier recovery following hip replacement. It is highly recommended that you continue therapy treatment for the recommended timeframe prescribed by your physical therapist.
There are several basic rules about positioning that you should be aware of following hip replacement surgery. Make sure that you do not bend forward more than 90 degrees, and do not lift your knee on the replacement side higher than your hip. Also, do not cross your legs or rotate your leg outward, or twist or pivot your operated hip. While sitting, make sure that you use a straight back chair with arm rests, and do not sit in chairs or sofas lower than knee height since they require excessive bending at the hips when sitting down and getting up. Do not sit on low soft sofas or on stools and remember not to lean forward or cross your legs. Since most toilet seats are lower than knee height, patients are recommended to use a toilet seat extension, which are available for purchase at the hospital or a medical supply store.
How can I manage at home during recovery from hip revision surgery?
The following are recommendations for home care activities following hip revision surgery:
When riding home from the hospital, make sure to stop every 45 to 60 minutes to get out of the car and do some walking. Also, do ankle pumps in the car while riding. If you are flying home, request an aisle seat and keep the operative leg extended in the aisle. You should request to be boarded last on the plane.
Resting and Sleeping
When resting or sleeping in bed, it is recommended that you lie on your non-operative side for the first four to six weeks following surgery. Make sure you have a pillow between your legs, and also a second pillow to support your foot and ankle. If you lie on your operative side, keep in mind that this may not be that comfortable in the initial weeks following surgery and is not recommended immediately following surgery. When you lie on your back, you must have a pillow between your legs.
For positioning during sexual relations, make sure to consult your physician or physician assistant. Intercourse may be resumed approximately 3 weeks after surgery, following the precautions outlined by your physician.
Reaching typically requires too much bending and is typically not comfortable for patients following hip surgery. It is recommended for the first 4 to 6 weeks after surgery you use long handled reachers that may be obtained from your occupational therapist or a medical supply store.
For dressing, to prevent lifting your knee higher than your hip on the surgery side, you may be given a long shoe horn and a dressing stick which will help you in putting on and taking off your shoes, socks and pants independently. Remember to always put your operative leg in the pants first. If you wear tie shoes, elastic shoelaces may be used to eliminate the need for tying.
Your physical therapist will teach you the correct way to go up and down stairs using handrails and/or crutches.
Remember to use your good leg first, followed by the crutches and the surgery leg. When going down stairs, the crutches and surgery leg go first, followed by the good leg.
For bathing, do not attempt to get into the bathtub to take a bath or to use an overhead shower. The excessive bending at the hips needed to get into and out of the bathtub should be avoided. Make sure not to use a walk-in type shower or take a sponge bath until 11 days following your surgery.
Remember not to bend too far or stoop when performing household chores. Chores that you should avoid that may involve excessive bending include cleaning the floor, taking out the rubbish, and making beds.
Following revision surgery, you will need to use a walker or crutches based on your condition, which your occupational or physical therapist will provide for you. Make sure to stay on your crutches or walker until your doctor or physical therapist advises that you use a cane. Your doctor will decide how much weight you can put on your surgery leg. In most cases, you will be able to put 100 percent of your weight on your surgery leg, unless otherwise notified. Your physical therapist will help you learn how to use your walker or crutches correctly and help you to obtain the appropriate equipment for use at home. A bag or basket attached to your walker will allow you to carry small items when walking.
Eating and Exercising
Eat well-balanced meals and make sure to complete the exercises that you have been taught in physical therapy three times a day. Keep in mind that it can take over a year for your muscles to become strong, so it is extremely important to do your exercises to help ensure a safe and effective recovery. Also remember to elevate both of your legs when sitting to minimize swelling.
It is recommended that you not drive for 8 weeks following surgery. You may go out in a car (as a passenger) approximately 3 weeks after you return home, but make sure to avoid sports cars and cars with bucket seats because of the low seat height. To get in and out of a car, park the car several feet away from the curb. Stand on the street and turn your back to the car and sit down. Slowly slide back on the seat, keeping your legs straight, not leaning forward. Get into the car by swinging your legs around to the front of the seat, keeping your legs straight.
How frequently should I schedule follow up appointments with my doctor following hip surgery?
Post-operative visits help your surgeon know that your hip is healing well. Make sure to schedule your first evaluation within the recommended timeframe indicated by your surgeon. This recommended timeframe is 4 to 6 weeks following your hip replacement surgery. Also request that any X-rays be sent to your orthopaedic surgeon’s office. Hip x-rays are typically taken the week of surgery, at 12 months and then yearly.
If you have a problem before you schedule your return appointment, make sure to call your doctor’s physician assistant immediately.
In addition to the first follow up appointment after discharge, this additional schedule is recommended:
- Three to six months following the date of surgery
- One year following the date of surgery
- Annually on the anniversary date of surgery
It is important to comply with this schedule and to see your doctor regularly for routine office visits to ensure safe and effective recovery from hip revision surgery.