Revision Hip Surgery

What is Revision Hip Surgery?

Revision hip surgery is a repeat hip surgery performed in certain patients to correct the problems or complications of previous hip surgery and overcome its limitations.

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. Stability of the hip joint is achieved by the labrum, ligaments, and tendons that encase the hip and support the hip movements. Any damage to these structures may warrant hip surgery.

Some of the hip conditions that may affect the hip joint structures necessitating hip surgery include:

• Rupture of the labrum
• Arthritis
• Hip dysplasia
• Avascular necrosis
• Hip impingement or femoroacetabular impingement (FAI)
• Hip bursitis
• Snapping hip syndrome

Indications for Revision Hip Surgery

Revision hip surgery may be recommended when previous hip surgeries such as debridement, hip labrum repair, hip labrum reconstruction, femoral osteoplasty, and periacetabular osteotomy have failed to resolve painful and debilitating hip symptoms associated with the hip conditions.

Preparation for Revision Hip Surgery

In general, preoperative preparation for revision hip surgery will involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a week before surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Revision Hip Surgery

Based on the hip condition and failure of the surgery to treat that condition, a patient may need to undergo revision hip surgery. The procedure is performed arthroscopically or as an open surgery under regional and general anesthesia. During an arthroscopic surgery, tiny incisions (portals), about a half-inch in length, are made around the joint area. Through one of the incisions, an arthroscope is passed. A camera attached to the arthroscope displays the images of the inside of the joint on a monitor, which allows your surgeon to view the damage and carry out the required repair. During an open surgery, a long incision of several centimeters is made over the hip joint to access the treatment area and carry out the required repair.

Some of the common revision hip surgeries include:

• Hip labrum repair: This is a surgery employed for the treatment of a torn hip labrum. A hip labral tear is an injury to the labrum, the cartilage that surrounds the outside rim of your hip joint socket. The labrum helps to deepen the socket and provide stability to the joint. It also acts as a cushion and enables smooth movement of the joint. During hip labrum repair surgery, your surgeon repairs the torn tissue by sewing it back together or removes the torn piece all together, depending upon the cause and extent of the tear.
• Hip labrum reconstruction: In some instances, where the hip labrum tear is severe and repair is not possible, your surgeon may perform a surgery called hip labrum reconstruction. In this surgery, a tissue graft is obtained from your own body (autograft) or a donor (allograft) and the graft is secured to the remaining part of the labrum utilizing durable stitching.
• Hip Capsule Repair and Reconstruction: Sometimes the hip capsule is damaged during previous hip surgeries. The hip capsule is a thick lining around the hip joint that contributes to hip stability. Patients with significant hip capsule damage can experience continued hip pain or hip instability. During revision surgery, the hip capsule can be repaired. If the hip capsule is too damaged to be repaired, it can be replaced with donor (allograft) tissue with a procedure called a hip capsule reconstruction.
• Surgery for snapping hip syndrome: Snapping hip syndrome is a condition in which you hear or feel a snapping sound in the hip when you swing your legs, run, walk or get up from a chair. The movement of muscles or tendons over a bony protrusion in the hip region or the presence of loose body fragments such as fragments of bone or cartilage in the joint space can give rise to the snapping sound. Common surgeries for snapping hip syndrome include:
  • Iliotibial band release: This procedure involves lengthening of the iliotibial band to decrease tension and hip snapping.
  • Iliopsoas tendon release: This procedure involves lengthening the iliopsoas tendon to decrease muscle tension and hip clicking.
  • Arthroscopic hip debridement: This procedure involves making small incisions at the hip joint cavity and removing bone or cartilage fragments.
• Femoral osteoplasty: This is a surgery to correct femoroacetabular impingement (FAI), a condition characterized by excessive friction in the hip joint from the presence of bony irregularities, which damages the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket). During femoral osteoplasty surgery, your surgeon removes excess bone from the femoral neck to make enough room for free motion of the hip joint, as well as repair any labral tears or cartilage damage caused by impingement.
• Periacetabular osteoplasty: This is a surgery to correct hip dysplasia. Hip dysplasia is a condition that is seen in infants and young children as a result of developmental problems in the hip joint. The femur (thigh bone) partially or completely slips out of the hip socket causing dislocation at the hip joint. During periacetabular osteoplasty surgery, your surgeon trims the hip socket (acetabulum) so that the femoral head can be repositioned in the pelvis, inserts metal screws into the bone to stabilize it in the new position, and smooths out any bone deformities that may be causing pain.
• Surgery for avascular necrosis: Avascular necrosis, also called osteonecrosis, is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Avascular necrosis can be treated by one of the following methods:
  • Core decompression: During this procedure, a portion of the inner layer of the bone is removed to relieve the pressure inside the bone. This decreases the pain and allows the growth of new blood vessels; thereby, stimulating new bone growth.
  • Bone transplant: Healthy bone harvested from another part of your body is grafted into the affected area.
  • Bone reshaping (osteotomy): This procedure is performed in advanced stages and involves reshaping of the bone which is done to decrease the stress placed over the affected bone.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after revision hip surgery will involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Revision hip surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Thromboembolism or blood clots
• Dislocations (rarely)
• Anesthetic/allergic reactions