Revision hip replacement can be either a partial procedure which replaces either the socket /stem or a total revision replacement, which replaces both the socket and stem. Revision hip arthroplasty may be done as a one or two stage revision.
A single stage revision is sufficient in aseptic cases. It consists of removal of the implants and replacement by a set of implants known as revision hip replacements. There may be bone loss which needs to be addressed by metal and bone graft.
In septic revisions, a two stage revision is the golden standard. The first stage consists of removal of the components and instillation of an antibiotic cement spacer. Intravenous antibiotics are administered for two months. My team will monitor you for subsidence of sepsis with blood tests.
When infection has been treated and a repeat hip aspiration shows no growth, it is safe to do the second stage. I have pioneered the concept of bio-composites for infected revisions. This paper was read at the Indian Orthopaedic association conference.
The challenges during hip revision are the following. It is better done by experienced surgeons who have access to bone graft, components and post op care.
Complications after revision are
During a revision, I ensure that explant devices, revision instruments, cables, plates, screws and range of implants are available. A variety of implant options, allograft, wedges, augments, cages, cup cage may be necessary. We have used Trabecular metal augments for focal contained acetabular defects. Bone allograft and synthetic bone substitutes are kept ready. Cables, trochanteric hooks, locking plates have also been used as shown in the post op x ray below.
I prefer cementless components for revision. Implants used by me are the mono block Wagner stem used in this case. Other femoral stems used by me are the SROM, Z VT and Link modular stems.
On the acetabular side, I have used Trilogy multi hole, Trabecular metal shell, revision, trabecular metal shells. I have used Ceramic and poly liners.
For a two stage infectious revision, I use antibiotic biocomposite pellets to deliver local antibiotics.