Total hip replacement revision
Why change a hip replacement ?
Total hip replacements (THR) sometimes need to be revised (replaced).
There are many reasons why a total hip prosthesis may require revision surgery, and each cause presents specific challenges that must be carefully anticipated.
A chronic infection of a hip prosthesis requires multidisciplinary management, including precise microbiological diagnosis, meticulous surgery to remove infected tissues and implants, and prolonged, targeted antibiotic therapy.
A fracture around an implant—whether femoral or acetabular (in the pelvis)—most often requires surgical treatment. This may involve either osteosynthesis (fixing the bone fragments without changing the implants) or replacing the prosthetic components. Sometimes, both procedures are necessary.
Wear of the implants can lead to loosening of the prosthesis (it no longer holds in the bone), requiring specific management with CT scans and 3D reconstructions to assess bone damage.
What exams are necessary before a hip revision ?
Revision hip replacement surgeries are complex procedures, and it is essential to anticipate difficulties through preoperative assessments:
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imaging studies (X-rays and 3D CT scans) to evaluate bone loss and plan the new prosthesis digitally. In the most complex cases, CT scans can be used to design custom-made implants,
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hip joint aspiration to check for chronic infection. If negative, only part of the prosthesis may need to be replaced, making the procedure less extensive,
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in some cases, nuclear medicine imaging such as SPECT-CT or FDG-PET scans may be required when diagnosis is difficult.
What happens during and after surgery ?
When possible, the surgeon will use the same surgical approach and incision, favoring minimally invasive techniques and methods that allow faster recovery. However, in cases requiring bone grafting or osteosynthesis, a period of non-weight-bearing on the operated limb may be necessary.
The procedure is most often performed under general anesthesia, and hospitalization typically lasts between 3 and 5 nights to ensure proper pain control and manage any potential anemia.
Even if a non-weight-bearing period is required, rehabilitation can begin immediately to maintain joint mobility and strengthen the hip muscles.
Preventive anticoagulant treatment is required for 5 weeks to reduce the risk of blood clots (phlebitis).
What are the risks ?
As with any surgical procedure, revision total hip replacement carries risks, which are slightly higher than for primary hip replacement:
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the most serious, though rare (less than 1%), is infection, which often requires additional surgery and prolonged antibiotic treatment. The risk is increased in active smokers. It is essential not to take antibiotics postoperatively—especially in case of wound healing issues—without your surgeon’s approval,
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the risk of dislocation (the joint coming out of place) is between 1% and 5% and depends on several factors. New technologies and anterior surgical approaches help reduce this risk. This is why certain movements must be avoided during recovery, while tissues heal and muscle strength returns. The risk is higher than in primary procedures because the tissues are operated on again,
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leg length discrepancy is a known complication, but modern 3D planning technologies and surgical experience significantly reduce this risk,
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postoperative bleeding and hematoma formation may cause pain but often resolve on their own without requiring further surgery,
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deep vein thrombosis (phlebitis) is another possible complication and can become serious if it leads to pulmonary embolism. Early mobilization, walking, and preventive anticoagulant treatment help minimize this risk.
New technologies ?
About 90% of patients achieve good or very good results after the procedure.
The development of new technologies is expected to further improve these outcomes.
The OPS technology, used for about two years, allows three-dimensional analysis of the hip prosthesis while taking into account pelvic movement when transitioning from sitting to standing. It is not used systematically before revision surgery but is a valuable tool in complex diagnostic situations, particularly in cases of prosthetic instability.
For this, patients undergo a CT scan of the lower limbs and dynamic X-rays (standing, sitting, and with the opposite leg flexed) about one month before surgery.
The CT scan enables 3D reconstruction of the pelvis and precise measurement of the femur and tibia.
Other new technologies, such as 3D printing, make it possible in the most complex cases with significant bone loss to design custom implants. The prosthesis is then planned directly on the patient’s anatomy in 3D. The positioning, orientation, length, and trajectory of the screws are optimized to ensure better fixation of the implant in the bone.