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.
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.
Controlled arthrography of the hip: A technique of fluoroscopic ..
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.
Shoulder and Elbow Coding - UW Faculty Web Server
Although this complex series of surgical events frequently can salvage an infected hip replacement, there is still a high re-infection rate, with some estimates giving a disappointing 10 -15% of hips revised for infection staying infected . Persistent infection in a hip joint presents difficult decisions for the patient and the surgeon and each circumstance will require unique and individualized consideration.
The Radiology Assistant : Hip - Arthroplasty
A fracture may occur to the tube-like femur bone within which is fixed the femoral prosthesis with either bone cement or biologic attachment, or to the supporting bone of the pelvis to which is fixed the acetabular prosthesis. There is a wide variety of fracture patterns which occur, each having many possible solutions. A patient’s age, activity level and overall health will be weighed along with the various options to repair a fracture around a hip replacement.
sonographic guided joint aspiration to ..
Once the decision is made that a hip is infected, the surgical plan is typically as follows involving a two-stage technique. An infected joint routinely requires the removal of all parts of the hip replacement from the bone so that the infection can be cleared. The space occupied by the removed hip prosthesis is filled with an antibiotic laden cement spacer shaped like a hip prosthesis. This spacer serves to keep the soft tissues stretched out to proper length and provides antibiotic which leaches out of the cement spacer directly to the infected area over time. In addition, 6-12 weeks of IV antibiotics are given, depending upon the infecting organism. Once this treatment is completed, it is commonly possible, through a second operation, to implant a new hip replacement into the now sterilized hip area.
Hip Joint Injection With Fluoroscopy - Technique and …
In assessing a hip for infection several steps may be needed as the diagnosis of an infection can be elusive. Plain X-ray studies can occasionally be helpful with observed changes at the interface of the bone and metal implant. Various studies including MRI, CT and bone scans may be needed in addition to plain X-rays to assess the character and integrity of the supporting bone. Laboratory studies are frequently collected from the blood and fluid taken from the hip joint in an attempt to validate or refute the diagnosis of a joint infection.