REVISION HIP REPLACEMENT<\/h3>\n<\/div>\n
Total Hip Replacement (THR) is a very successful treatment for end-stage degeneration of the hip joint; over 55,000 THRs are performed in the UK each year. Despite technological advances and our increased understanding of hip replacement surgery, between 5-10% of hip replacements will fail and require revision within 10 years.<\/p>\n
CAUSES OF THR FAILURE<\/h3>\n<\/div>\n
The most common cause of hip replacement failure is aseptic loosening due to implant wear, although other factors such as infection, trauma and recurrent dislocation can all result in the need for revision surgery.<\/p>\n<\/div>
<\/i><\/i><\/span>ASEPTIC LOOSENING<\/span><\/a><\/h4><\/div>\nThe most widely used hip replacements consist of a metal ball articulating with a plastic (polyethylene) socket. Although these implants are designed to withstand the substantial forces that are transmitted across the hip joint during everyday activities (e.g. up to 6 times body weight when walking normally), the friction of the articulating surfaces results in wear of the plastic socket over time.<\/p>\n
As the socket wears, small particles of polyethylene are generated. These particles then activate the body\u2019s immune system, triggering an inflammatory response and causing the bone around the hip replacement to be reabsorbed. The result is that the hip replacement becomes loose and painful; this is known as aseptic loosening. As a consequence the hip replacement often needs to be revised.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>FACTORS CONTRIBUTING TO IMPLANT WEAR<\/span><\/a><\/h4><\/div>\nHip replacements are subjected to greater amounts of wear in patients who are young, active or overweight. The rate of failure is therefore higher in these patients.<\/p>\n
Wear will also be greater if the hip replacement is not correctly aligned and orientated, not appropriately sized, not securely fixed to the bone and not \u2018balanced\u2019 with the correct tension. All of these are factors are dependent upon good surgical technique. It is important therefore that hip replacements are undertaken by orthopaedic surgeons who specialise in this field.<\/p>\n
Current studies show that modern uncemented hip replacements systems are as reliable, in terms of long-term survival, as cemented systems.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TECHNOLOGICAL ADVANCES<\/span><\/a><\/h4><\/div>Technological advances have produced bearing surfaces with increased longevity which may therefore benefit patients who are young and physically active. Ceramic-on-ceramic bearing surfaces are extremely hard wearing and perform best in terms of laboratory results. Metal-on-metal bearing surfaces also perform well but concerns exist regarding the high level of metal ions released in to the blood by the articulation of these bearing surfaces. (See Hip Resurfacing section<\/a>.)<\/div><\/div><\/div><\/i><\/i><\/span>INFECTION<\/span><\/a><\/h4><\/div>\nA small percentage (about 0.5-1%) of hip replacements become infected. Patients who have had multiple operations on the hip are at higher risk of infection.<\/p>\n
If the infection is suspected quickly enough, surgery can be undertaken to wash out the infected hip replacement, change the femoral head (and acetabular liner if an uncemented hip has been used), and thereby clear the infection. High doses of intravenous antibiotics are then required for a period of generally 6-12 weeks to ensure that the infection doesn\u2019t recur.<\/p>\n
Occasionally the infection persists and the hip replacement must then be removed and a temporary \u2018spacer\u2019 inserted. Once the infection has cleared, revision surgery can be performed, usually at least 3 months later.<\/p>\n
The possibility of infection should be excluded by tests before any revision hip replacement surgery is performed. These tests include blood tests (inflammatory markers), x-rays, possibly a bone scan and often a biopsy of the tissues around the hip replacement.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TRAUMA<\/span><\/a><\/h4><\/div>
The most widely used hip replacements consist of a metal ball articulating with a plastic (polyethylene) socket. Although these implants are designed to withstand the substantial forces that are transmitted across the hip joint during everyday activities (e.g. up to 6 times body weight when walking normally), the friction of the articulating surfaces results in wear of the plastic socket over time.<\/p>\n
As the socket wears, small particles of polyethylene are generated. These particles then activate the body\u2019s immune system, triggering an inflammatory response and causing the bone around the hip replacement to be reabsorbed. The result is that the hip replacement becomes loose and painful; this is known as aseptic loosening. As a consequence the hip replacement often needs to be revised.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>FACTORS CONTRIBUTING TO IMPLANT WEAR<\/span><\/a><\/h4><\/div>\nHip replacements are subjected to greater amounts of wear in patients who are young, active or overweight. The rate of failure is therefore higher in these patients.<\/p>\n
Wear will also be greater if the hip replacement is not correctly aligned and orientated, not appropriately sized, not securely fixed to the bone and not \u2018balanced\u2019 with the correct tension. All of these are factors are dependent upon good surgical technique. It is important therefore that hip replacements are undertaken by orthopaedic surgeons who specialise in this field.<\/p>\n
Current studies show that modern uncemented hip replacements systems are as reliable, in terms of long-term survival, as cemented systems.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TECHNOLOGICAL ADVANCES<\/span><\/a><\/h4><\/div>Technological advances have produced bearing surfaces with increased longevity which may therefore benefit patients who are young and physically active. Ceramic-on-ceramic bearing surfaces are extremely hard wearing and perform best in terms of laboratory results. Metal-on-metal bearing surfaces also perform well but concerns exist regarding the high level of metal ions released in to the blood by the articulation of these bearing surfaces. (See Hip Resurfacing section<\/a>.)<\/div><\/div><\/div><\/i><\/i><\/span>INFECTION<\/span><\/a><\/h4><\/div>\nA small percentage (about 0.5-1%) of hip replacements become infected. Patients who have had multiple operations on the hip are at higher risk of infection.<\/p>\n
If the infection is suspected quickly enough, surgery can be undertaken to wash out the infected hip replacement, change the femoral head (and acetabular liner if an uncemented hip has been used), and thereby clear the infection. High doses of intravenous antibiotics are then required for a period of generally 6-12 weeks to ensure that the infection doesn\u2019t recur.<\/p>\n
Occasionally the infection persists and the hip replacement must then be removed and a temporary \u2018spacer\u2019 inserted. Once the infection has cleared, revision surgery can be performed, usually at least 3 months later.<\/p>\n
The possibility of infection should be excluded by tests before any revision hip replacement surgery is performed. These tests include blood tests (inflammatory markers), x-rays, possibly a bone scan and often a biopsy of the tissues around the hip replacement.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TRAUMA<\/span><\/a><\/h4><\/div>
Hip replacements are subjected to greater amounts of wear in patients who are young, active or overweight. The rate of failure is therefore higher in these patients.<\/p>\n
Wear will also be greater if the hip replacement is not correctly aligned and orientated, not appropriately sized, not securely fixed to the bone and not \u2018balanced\u2019 with the correct tension. All of these are factors are dependent upon good surgical technique. It is important therefore that hip replacements are undertaken by orthopaedic surgeons who specialise in this field.<\/p>\n
Current studies show that modern uncemented hip replacements systems are as reliable, in terms of long-term survival, as cemented systems.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TECHNOLOGICAL ADVANCES<\/span><\/a><\/h4><\/div>Technological advances have produced bearing surfaces with increased longevity which may therefore benefit patients who are young and physically active. Ceramic-on-ceramic bearing surfaces are extremely hard wearing and perform best in terms of laboratory results. Metal-on-metal bearing surfaces also perform well but concerns exist regarding the high level of metal ions released in to the blood by the articulation of these bearing surfaces. (See Hip Resurfacing section<\/a>.)<\/div><\/div><\/div><\/i><\/i><\/span>INFECTION<\/span><\/a><\/h4><\/div>\nA small percentage (about 0.5-1%) of hip replacements become infected. Patients who have had multiple operations on the hip are at higher risk of infection.<\/p>\n
If the infection is suspected quickly enough, surgery can be undertaken to wash out the infected hip replacement, change the femoral head (and acetabular liner if an uncemented hip has been used), and thereby clear the infection. High doses of intravenous antibiotics are then required for a period of generally 6-12 weeks to ensure that the infection doesn\u2019t recur.<\/p>\n
Occasionally the infection persists and the hip replacement must then be removed and a temporary \u2018spacer\u2019 inserted. Once the infection has cleared, revision surgery can be performed, usually at least 3 months later.<\/p>\n
The possibility of infection should be excluded by tests before any revision hip replacement surgery is performed. These tests include blood tests (inflammatory markers), x-rays, possibly a bone scan and often a biopsy of the tissues around the hip replacement.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TRAUMA<\/span><\/a><\/h4><\/div>
<\/i><\/i><\/span>INFECTION<\/span><\/a><\/h4><\/div>\nA small percentage (about 0.5-1%) of hip replacements become infected. Patients who have had multiple operations on the hip are at higher risk of infection.<\/p>\n
If the infection is suspected quickly enough, surgery can be undertaken to wash out the infected hip replacement, change the femoral head (and acetabular liner if an uncemented hip has been used), and thereby clear the infection. High doses of intravenous antibiotics are then required for a period of generally 6-12 weeks to ensure that the infection doesn\u2019t recur.<\/p>\n
Occasionally the infection persists and the hip replacement must then be removed and a temporary \u2018spacer\u2019 inserted. Once the infection has cleared, revision surgery can be performed, usually at least 3 months later.<\/p>\n
The possibility of infection should be excluded by tests before any revision hip replacement surgery is performed. These tests include blood tests (inflammatory markers), x-rays, possibly a bone scan and often a biopsy of the tissues around the hip replacement.<\/p>\n<\/div><\/div><\/div>
<\/i><\/i><\/span>TRAUMA<\/span><\/a><\/h4><\/div>
A small percentage (about 0.5-1%) of hip replacements become infected. Patients who have had multiple operations on the hip are at higher risk of infection.<\/p>\n
If the infection is suspected quickly enough, surgery can be undertaken to wash out the infected hip replacement, change the femoral head (and acetabular liner if an uncemented hip has been used), and thereby clear the infection. High doses of intravenous antibiotics are then required for a period of generally 6-12 weeks to ensure that the infection doesn\u2019t recur.<\/p>\n
Occasionally the infection persists and the hip replacement must then be removed and a temporary \u2018spacer\u2019 inserted. Once the infection has cleared, revision surgery can be performed, usually at least 3 months later.<\/p>\n
The possibility of infection should be excluded by tests before any revision hip replacement surgery is performed. These tests include blood tests (inflammatory markers), x-rays, possibly a bone scan and often a biopsy of the tissues around the hip replacement.<\/p>\n<\/div><\/div><\/div>
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