Although primary total hip replacement is one of the most successful procedures in the vast majority of cases, over time, a hip replacement can fail for a variety of reasons such as recurrent dislocation, implant wear and loosening. As a result, this might lead to severe hip pain and abnormal leg position which can largely disturb normal daily life. When second surgery is indicated in such a case, it is called “revision total hip replacement”. Its purpose is to remove some or all of the parts of the original prosthesis and replace them with new ones. Due to the advancements in orthopedic surgery, direct anterior hip replacement without detaching any tendons is a minimally invasive surgical technique used as an effective alternative for revision total hip replacement. Its benefits enable patients to live more active lives with a better quality of life.
Why is revision total hip replacement recommended?
Although most total hip replacements are very successful, problems can develop over time. Primary hip replacement can fail for a variety of reasons include:
- Implant wear and loosening
- Infection
- Recurrent dislocation
- Fracture
- Other factors such as certain medical conditions and daily activities , resulting in more hip pain and walking disability after primary surgery
Revision total hip replacement
Revision total hip replacement aims to remove some or all of the parts of the original prosthesis and replace them with new ones. There are different types of revision hip surgery. In some procedures, only some parts of the prosthesis need to be revised. In other cases, the entire prosthesis needs to be totally replaced and the bone around the hip needs to be rebuilt with augments or bone graft. Revision surgery significantly helps to relieve hip pain, extend the life span of new prosthesis as well as to improve patient’s function and quality of life.
Revision total hip replacement VS. Primary total hip replacement
Although both procedures share similar goals – to alleviate pain and enhance patient’s function and mobility, revision surgery is considerably different from primary procedure due to the reasons of:
- Longer operative time consumption
- More complex procedure
- Extensive surgical planning
- The use of specialized implants and tools
Revision total hip replacement with direct anterior approach
Traditional revision hip replacement surgery typically involves making an incision on the back of the hip (posterior approach) or on the side of the hip (lateral approach). Both techniques require the detachment of muscles and tendons from the hip in order to replace the joint. Detachment of these muscles might potentially result in increased pain after surgery and longer recovery time. These detached muscles might fail to heal after surgery, leading to increased risks of hip dislocation, defined as the separation of the ball and the socket. The hip stability is subsequently impaired with the extended length of the legs. It eventually becomes the cause of primary hip replacement failure.
“Direct anterior hip replacement” is an increasingly used technique for revision total hip surgery. It is a minimally invasive surgical approach that involves a 3 to 4 inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes. After removing the original implant, the bone surfaces are then prepared for the revision implants. The specialized revision implants will be placed accurately. Without detaching any muscles and tendons, this technique often results in less pain, fewer operative complications, lower infection rates, reduced chance of re-operation, faster recovery time and more normal function after hip replacement. This allows patients to return to their normal daily activities shortly after surgery with a reduced risk of hip dislocation.
Benefits of revision total hip replacement with direct anterior approach
n comparison to traditional techniques, direct anterior approach processes some major advantages include:
- Less pain
- Faster recovery time due to no muscle detachment
- Smaller surgical incision
- More accuracy in implant placement
- Reduced risk of hip dislocation
- During the procedure, X-ray image guidance and computer assisted navigation systems are used to identify the location of revision implant and enhance safety to surrounding areas.
- Length of each leg can be evaluated and adjusted immediately after surgery.
Who should consider revision total hip replacement with direct anterior approach?
Revision hip surgery with direct anterior approach is recommended in patients with:
- Implant degeneration
- Hip dislocation after primary surgery
- Leg-length inequality after primary surgery
- Implant wear or loosing
- Aggressive hip pain after primary surgery
- History of previous surgery with metal instrument before having primary hip replacement
Due to revision total hip replacement is longer and more complex than primary total hip replacement, there are some risks associated with revision total hip replacement. By using “direct anterior approach”, not only to improve the surgical outcomes, this advanced technique also helps to reduce pain with fewer complications. More importantly, lifespan of revision prosthesis can last 15-20 years. This surgical technique greatly enables the patients to continue their functions and daily activities with more confidence.