REVISION TOTAL HIP ARTHROPLASTY

Revision total hip arthroplasty is contemplated when there is a failure of the primary arthroplasty procedure. The index procedure may fail due to the following reasons:
1) Aseptic loosening of one or both components, 2) progressive loss of bone, 3) fracture or mechanical failure of the implant, 4) recurrent or irreducible dislocation, 5) infection and 6) peri- prosthetic fracture.

Pain is the most common symptom necessitating revision arthroplasty. It is paramount to look for and treat other causes of hip/thigh pain such as lumbar disc disease, arthritis of the spine, spinal stenosis, metastatic or primary tumour, vascular occlusion, stress fracture or reflex sympathetic dystrophy.

Revision arthroplasty entails removal of the previously implanted components and bone cement if any as the first step. This may require extensive approaches and specialized instruments and techniques.

The next major step is to reconstruct deficiency of acetabular and/or femoral bone stock. Reconstruction of bone defects is done using autogenous or allograft cancellous bone or structural bone grafts depending upon the type of deficit.

The prosthesis used in revision arthroplasty come in various designs to suit the needs of the particular patient and may be implanted cementless or cemented.

Revision arthroplasty is a much more difficult procedure requiring more operative time and more blood loss and is fraught with complications such as infection thromboembolism, dislocation, nerve palsy, and penetration and fracture of the femur. Hence it is not to be taken lightly.