Implant loosening is the most common cause/indication for revision hip surgery. Hip replacements have been carried out in the UK regularly since the 1960's and this, in combination with the increasing lifespan of the average person, means that there is an increasing need for revisions. Patients often present with dull pain in either their groin or thigh, depending on which part of the components are loose.
Figure 3: Post-operative image of a revision hip using a Restoration stem
All patients are examined and the appropriate investigations carried out to check for infection etc. During surgery the hip is exposed and scar tissue excised. The old implants are removed and the bone surfaces are prepared. Some patients will require bone grafting and this is done using donated bone from other patients who have undergone hip replacements. Once that is carried out, the new implants are inserted and the hip is checked for stability and leg length. At this point it is still possible to make the necessary adjustments to ensure the best possible result. During the operation, multiple samples are taken to check for infection. While these are being processed, the patient will remain on antibiotics for between 5 and 7 days.
The patient will begin to mobilise the next day. If bone graft has been used, then they will not be able to fully weight-bear for 3 months, until the bone has healed. Once patients are safe on their crutches and can mobilise normally, they are discharged home. Mr Fehily will usually review them at 6 weeks, 6 months and one year, with regular follow up after that.