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Best Hip Replacement For Athletes 2018 | Orthopedic …
Revision hip replacement surgery is much different from that of performing primary hip replacement surgery as there are many variables that occur during surgery that, while anticipated, can change the course of the surgical procedure to one of increased difficulty and operative time. For instance, in almost all revision hip surgery procedures there will be bone loss around the implant. This occurs from either a biologic event such as osteolysis, where the bone is dissolved away through a complex series of biologic interactions between the plastic or cement debris and the cells of our bodies that clean up such things; or from infection, where the offending organism chews away at the bone; or from the resultant fracture of weakened bone in the removal of the implant.
From the patient’s perspective, the recovery from a revision hip replacement can take much longer than what the patient remembers from the original hip surgery. In fact, it can take up to a year after surgery before the patient finds routine daily activities easy to do. Some patients will require some form of walking assistance in the form of a cane or walker for the rest of their lives. The final maximum range of motion achieved is often less than what the patient remembers their first hip replacement had reached and in fact, stiffness is quite common with revision joints. In addition, leg length discrepancies are more common with revision hip replacement surgery than with primary hip replacements and patients may need a lift in a shoe or have many of their shoes fixed with lifts to compensate for a shorter or longer leg.
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Revision hip replacement surgery is significantly more challenging to perform and fraught with many more complicating events than is found with primary hip surgery. It is truly more art than science to successfully complete some of these very difficult revision surgeries and achieve a stable, flexible and functional hip in the end. Many surgeons who feel comfortable doing primary joint replacement surgery will not tackle revision surgery because of these added challenges and risks.
Dislocation is one of the most common complications that occurs after revision hip replacement surgery and is a result of many adverse forces at work. Sometimes weakened musculature fails to keep the hip together. Other times the position of the components is not optimal. Still other times, the patient does not follow the instructions given and puts the hip at repeated risk through early over activity. There are a variety of techniques known to the surgeon to improve the chances that the ball will stay in the socket after surgery, but dislocation is still a common event for the revision hip replacement patient.
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Once the implant is separated from the bone on both sides of the joint, samples of the biologic material that has developed in the defects of the bone may be sent off to the hospital lab for immediate analysis, especially if an infection is suspected. Sometimes, even when preoperative lab studies to assess for infection are negative, presentation at surgery may lead the surgeon to have concern that a low-grade infection is present. The material that is harvested from the area directly between the implant and the bone is often the best and only way that these occult infections can be found. If there is evidence that such a low-grade infection exists, the surgeon will not proceed with the re-implantation of a new, revision hip replacement at that time. Rather, an antibiotic spacer will be left in the hip temporarily, the operation ended and treatment will proceed to clear the infection.
A newer development in recent years has been the movement towards implants that have interchangeable, modular parts rather than a single piece design that comes in several sizes. Some modular designs allow different sized components for the femoral stem, the femoral neck, and the femoral head (ball) in order to achieve hundreds or even thousands of different combinations to try to achieve the best reconstruction possible. In this way, the surgeon can increase the offset without making the leg longer, change the angle that the device sits within the socket (anteversion or retroversion), or reconstruct a difficult and distorted joint such as a dysplastic hip. Smaller incisions can also often be used as the prosthesis is assembled in place, somewhat like a ship in a bottle.
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What Is The Best Hip Replacement Device 2018 | …
Once the hip is exposed, the very important step of removing the old hip replacement is begun. When the reason for the revision hip replacement surgery is mechanical loosening, otherwise known as aseptic loosening, with extensive osteolysis of the bone, one or all components are not well-fixed to the supporting bone and can be removed with relative ease. Unfortunately, when this is the case, there will be large cavitary bone defects that will need to be reconstructed in some manner to fill in these holes in the bone with either bone cement or bone graft.
What Is The Best Hip Replacement Device 2018
The approach into the hip is usually through the same incision used to put in the primary hip replacement. Often times the incision must be extended in one direction or the other to expose the hip joint adequately. Dense scar tissue is always found surrounding the old hip prosthesis and much time and care is devoted to the removal of as much of this deep scar tissue as is needed to allow the hip joint to be positioned in such a way as to allow access to the implants to be removed. There are several clever techniques that each experienced surgeon knows to gain maximum exposure while disrupting as little of the supporting bone, muscles and ligaments as possible.
Some Hip Prosthesis Loosening Symptoms Best …
Despite thorough preparation, the risks involved in revision hip replacement surgery are increased several fold from the level of risk of a primary hip replacement. The surgery is more difficult and time consuming, the soft tissues, nerves and blood vessels more difficult to mobilize and protect and the prostheses are more complex to implant properly into the supporting bone. The soft tissues become more difficult to stretch and the pain of revision hip replacement surgery can be an obstacle to full mobilization of the joint. Notably, it is important that patients realize that the revised hip frequently never reaches the same level of function as did the first hip replacement. Complications and chronic pain are far more common with revision hip replacement surgery than it is with primary hip replacement.
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Since each failed hip replacement has a different reason for its failure, preparing for the revision hip replacement is also going to be unique. Specialized CAT scans or MRI tests may be needed to evaluate bone loss around the current implant or position of the prosthesis relative to the normal anatomy. Various laboratory or nuclear scans to check for infection may be indicated such as CBC, CRP, Sed. Rate or Bone Scan. An aspiration of the hip joint may yield fluid that can be analyzed by cell count and culture. Finally, consultations with other medical or surgical specialists may be required to evaluate the medical condition or special circumstances of the patient prior to surgery to optimize the outcome.
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