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Revision Total Hip Replacement

Dr Frank Connon

Dr Connon was awarded the Commonwealth Fellowship to the Royal National Orthopaedic Hospital after finishing his advanced orthopaedic surgery training in Australia.

There he spent 6 months treating a variety of patients referred from all over England and internationally with complex joint replacements requiring revision (“re-do”) total hip replacement.

If your hip replacement is painful or unstable after a previous total hip replacement, you may require review with Dr Connon to discuss your options.

Types of Revision Hip Replacements

There are different techniques for ways of performing a revision hip replacement.

Hip replacement

Dr Connon generally recommends the anterior approach for the majority of first time (“primary”) hip replacements. Unfortunately, many revision procedures require a larger incision to remove the existing implants that can only be achieved with a posterior approach, particularly if that was the approach used to implant the first total hip replacement.

If your first hip replacement was perform using the anterior approach, it possibility it can be revised anteriorly. However, the vast majority of hip replacements in Australia requiring revision procedures at this time were not implanted via the anterior approach.

With posterior hip replacements, the surgeon enters through the back of the hip (though the cut is on the side). Dr Connon can often use your previous surgical scar to minimise additional soft tissue trauma and pain.

The advantage of this surgical approach is that it provides a larger field of surgical view through a larger incision. This makes it useful for revision (“re-do”) surgery where more access is often required in order to remove existing implants and put new ones in, which sometimes cannot be done using the anterior approach.

Revision Hip Replacement Process

Revision Hip Replacement Surgery Recovery Timeline

Day of surgery

After your anaesthetic has worn off, you should be able to place full weight on your hip, with crutches or a frame to aid you. It is preferable that if your operation is done earlier in the day, you stand up on the same day as surgery to get used to being upright again.

Day after surgery (“Day 1 Post-op”):

We will try to get you walking, sometimes with a frame, sometimes with crutches as an aid.

3-5 days

When you are comfortable and once you are able to walk independently and tackle stairs, that’s when you are safe to head home. Everybody is a little different and this timeframe is tailored to you as an individual.

2-3 weeks

After 2-3 weeks, your wound will be checked (usually by a specialist wound nurse). Your surgeon will probably use dissolving suture and glue so no suture removal is likely to be required. After your wound review you should arrange to see your physiotherapist to begin post-operative exercises.

Between 2 and 6 weeks

Gradually disband first the crutch on the same side as your operation and eventually the other one when you feel comfortable. You will use this for longer walks and balance but can actually often get short distances around home without a gait aid. You will gradually disband this remaining crutch over the next few weeks depending on your stability. You should still observe posterior hip precautions if you have had a posterior approach.

After 6 weeks

From 6 weeks post-surgery, you should be able to return to normal activities. Some patients may be able to drive earlier, notably following a left hip replacement if you have an automatic car.

Surgical Risks

Every surgery has some risks. Whilst the probability of these risks has been shown to be lower in the hands of experienced specialist hip surgeons they are nevertheless a possibility.

Please note that certain risks such as infection and dislocation are unfortunately higher following revision hip replacement surgery than first-time “primary” hip replacement.

Dr Connon will always put your health first and will discuss the potential risks of surgery with you before you book in for any procedure. Before surgery, Dr Connon will assess any risks involved with your current medications, medical history, and require your skin to be healthy.

He will also organise a review by a perioperative doctor to optimise your general medical health and monitor you postoperatively.

Some risks present themselves only after surgery, such as infection and DVT. Please don’t hesitate to call Dr Connon’s rooms if you have any postoperative concerns.

Revision Hip Replacement Recovery and Exercises

Most patients feel better than they were preoperatively within a few weeks of surgery.

You should be able to do most normal activities after 6 weeks, if not before. Please note that time frames differ for each patient.

Physiotherapy is important to your recovery but you should avoid strenuous physio exercises for the first 2-4 weeks and stick mainly to gentle walking to allow the wound to settle first. You can then progress to more strenuous physiotherapy exercises to build your strength.

Most revision hip replacements require a posterior approach. Following Posterior Approach hip replacement, it is generally necessary to observe precautions: avoid bending your hip past 90 degrees/crossing your legs for the first 6 weeks in order to reduce your risk of dislocation. This means you may need a special toilet seat and a grasping device to pick up objects from the floor.

You can start driving once you regain full motor control of your leg and are no longer on prescription strength pain killers. You can often start driving after 4 weeks but sometimes less in patients who have had a left hip replacement and drive an automatic car.