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Hip Replacements

Hip Replacement Revision Surgery

When a hip implant fails, doctors perform another surgery called a revision surgery to replace the implant and correct any problems in the joint. This surgery is more complex than the original and can carry more risks.

More than 55,000 people a year in the United States – and thousands more worldwide – undergo repeat surgeries to replace hip implants that have become loose, painful, infected, dislocated or otherwise failed. Hip revision surgeries are complicated, painful and even dangerous in some cases — the mortality rate climbs to 2.5 percent from 1 percent for the original surgery. The goal for doctors is to relieve pain, restore mobility and remove damaged, worn-out or recalled implants.

Despite the potentially long-lasting complications and suffering for revision surgery patients, they often have little choice because they need their surgically repaired hip to function normally again. Revisions are often essential for joint-replacement patients because it is the only way for them to have a chance at active lives again.

Most orthopaedic surgeons prefer revision surgery as a last resort. The surgeries are difficult to perform correctly, require extensive preoperative planning and can make for an arduous recovery for a second-time recipient.

Multiple hip implant manufacturers find themselves under a microscope because of faulty designs or products that fail long before they should, making these revision surgeries a more pressing need and even more complicated. Those companies include DePuy Orthopaedics, Stryker Orthopaedics, Zimmer, Smith & Nephew, Biomet and Wright Medical.

The device companies face increased scrutiny from federal regulators, health care professionals and injured patients. Each of the companies has at least one hip implant component that can fail too soon and/or leach potentially deadly metals into an implant recipient.

Metal-on-metal ball-and-cup designs and other components that were favored by implant designers have proven to be riddled with problems. Devices often fail within a few years after being implanted. This has prompted worldwide recalls.

Complications Leading to Revision Surgery

Most patients who undergo surgery to replace faulty hip prosthetics tend to be elderly and more prone to serious complications. A number of factors lead to the need for revision surgery. In some cases, patients are too tough on their implant. They are either much more active than their implant is designed to handle or they failed to follow the proper rehabilitation regime from the original implant surgery.

In other cases, the implant failure is simple wear and tear over time. If a defective device was implanted the first time, revision surgery is often required. The most critical factor in determining the outcome of a successful revision surgery is the condition of the bone tissue in the femur. Damaged and defective bone does not easily allow for a new prosthesis.

A number of complications hasten the need for revision surgeries, including:
Loosening and deterioration Infection
Dislocation Metallosis

Revision Surgery Procedure

The first step in revision surgery is to dislocate the hip. Then, surgeons will work to remove the components of the failed implant that are creating problems. The implant attached to the acetabulum, the cup-shaped cavity in the pelvis, is removed first. Any cement is cleared out, and then the socket area is cleaned and filled with bone particles. Then a new liner is pressed into the acetabulum. Surgeons may use screws to secure additional bone grafts in place.

The more difficult part of the revision surgery comes when maneuvering the femur. Surgeons can remove a defective head and stem, as well as cement, using specialized extraction tools. They will add a new bone graft if the femur is defective. A new stem is then inserted into the femur, and the components are fitted together. Once the surgeon ensures the new implant moves freely, the surgical incisions are sewn shut.

Complications after Revision Surgery

The hope for most revision patients is that the surgery will correct the ongoing problems and pain. Often, this is not true. Many of the complications that led to the revision surgery are known to occur post-operatively as well, including the risk of fracture.

A couple of revision surgery complications can be serious:
Thrombophlebitis — Also called Deep Vein Thrombosis (DVT), this is more likely to follow any hip, pelvic or knee surgery. DVT occurs when clots form in the large veins of the leg. If the clot breaks off, it can travel to the lungs or heart and cause a serious, and possibly deadly, embolism.
Myositis ossification — Sometimes the bone can grow around and encapsulate the hip joint, leading to stiffness, pain and limited motion in the joint. Some physicians recommend radiation treatments immediately following revision surgery to offset the chance for this problem.

Revision Surgeries for Recalled Implants

Under normal circumstances, overall complications that lead to revision surgery can be physically and emotionally taxing for patients. For those who were implanted with devices that have been recalled or are under a federal watch, the toll can be greater.

Many of these patients are forced to undergo revision surgery within a few years of the initial surgery. For example, many patients who were implanted with the DePuy ASR XL Acetabular System total hip replacement or the ASR Hip Resurfacing System ended up under the knife again just a few years after the initial surgery. Researchers have found these two devices have higher-than-normal failure rates, can cause bone fractures near the implant site and can lead to metallosis.

Some patients who have had revision surgery to replace DePuy, Stryker, Zimmer or other faulty or recalled devices have even more complications. For example, the revision surgery makes patients more prone to infection.

In one case, a Texas woman needed to have the replacement DePuy hip removed and replaced with a temporary prosthesis so her hip infection could clear. She then required yet another surgery to have her permanent hip replacement implanted.

Faced with mounting medical bills and unending pain, more than 12,000 patients have filed lawsuits against hip implant manufacturers over their defective devices. In August 2012, DePuy settled the first three lawsuits over its ASR hip implants for $200,000 each. The first DePuy ASR trial began in January 2013.

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