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1. Hip revision surgery
fundamentals
Hip revision surgery is performed to repair an artificial hip
joint (prosthesis) that has been damaged over time due to an
infection, or due to normal wear and tear of the prosthetic hip.
Revision surgery helps to correct the problem so the hip can
function normally again.
The use of artificial hip implants is extremely effective in
improving hip joints that are damaged by injury or some form of
arthritis. Artificial joints, including hip joints, do not last
forever. The typical life of an artificial hip joint is 10-15 years,
depending on the patient’s daily use of the joint. Patients with
artificial hip joints are typically over the age of 55 and have
developed severe arthritis in the hip. After a period of normal wear
and tear of the hip joint, the prosthesis does not fit as securely
and is not as effective. In these cases, hip revision surgery may be
recommended by your doctor.
Revision surgery may also be recommended if an infection has
developed in the tissue surrounding the joint. If infected, the
muscle, tendon and ligament tissues in the hip joint will become
weakened and damaged. The infection will also damage the hip bone.
2. What causes the hip pain?
The main reason for hip revision surgery is to repair an
artificial hip implant that may be no longer securely attached to
the bone, resulting in abnormal motion that causes pain for the
patient. Hip revision surgery is an attempt to repair the hip and
restore it to a condition where it can function normally.
3. What are the benefits of hip
revision surgery?
Relief from pain is the main benefit of having hip revision
surgery. Many patients may find that hip revision surgery improves
mobility, strength and coordination of the torso and leg, in
addition to improving the appearance of the hip and leg. Revision
surgery may enable patients to return once again to normal activity
with a pain-free hip. But keep in mind that successful hip revision
surgery is also contingent on the patient’s diligence with his or
her rehabilitation program following surgery.
4. What are the risks of hip
revision surgery? Is the treatment safe?
Keep in mind that hip revision surgery is a voluntary, but safe
procedure. Unforeseen complications may develop that are associated
with anesthesia, such as respiratory or cardiac malfunction. In
addition, complications may arise with an infection, injury to
nerves and blood vessels, fracture, weakness, stiffness or
instability of the joint, pain, or the possibility of needing more
hip surgeries.
5. How do I prepare for hip
revision surgery?
In order to prepare for surgery, patients are requested to
schedule a series of appointments prior to the surgery date to
receive testing and clearance for surgery. The appointments are
initiated at least a month prior to the surgery date. During these
appointments, studies including lab testing, urine analysis, EKG,
and X-rays, are conducted. Additional studies, such as bone scans,
may also be recommended by your doctor. Based on the results of
these tests and the patient’s health history clearance is initiated
for the surgery. Depending on the patient’s condition, additional
testing may be required prior to surgery.
Patients can also take steps at home to help ensure an easier
recovery after surgery. Make a few simple changes around the house,
and arrange for someone to help you during the few weeks following
surgery. Discuss with your surgeon about whether you should donate
your own blood for surgery, and schedule appointments to see your
primary care doctor and your dentist. If you smoke, try to stop or
cut down to lower your surgery risk and increase your recovery rate.
Try these tips at home prior to hip surgery:
• Remove any loose rugs, as they can be hazardous when you are
walking in the house. Make sure you tape down all electrical cords.
• Store additional canned and frozen foods, and make sure all
supplies are between waist and shoulder level.
• You will need to keep both legs elevated for the first four to six
weeks following surgery. This is best accomplished in a recliner
chair, or a chair with armrests and an ottoman for appropriate leg
support.
• Prepare a sleeping room on the main floor, or ensure that you only
have to climb the stairs once a day.
• Make sure you have a cordless phone for greater efficiency in
answering any phone calls.
Special equipment will help to ensure an easier recovery
following hip surgery. Your physical and occupational therapists
will recommend equipment for you and will help you and your family
in obtaining this equipment following surgery. Some of this
equipment may include:
• Elevated toilet seats
• Shower seats
• Handrails and grab bars, especially when getting in and out of the
bathtub
• Grasping device for putting on socks and shoes
Medications
Inform your surgeon about all of your medications, both
over-the-counter and prescription. Some medications do not react
well with anesthesia, and others such as aspirin, ibuprofen and
blood thinners, increase bleeding. For these reasons, you may need
to stop taking certain medications before hip replacement. If you
are taking aspirin or aspirin-based medication for arthritis, you
must discontinue these two weeks before your surgery. If you are
taking medications for other medical problems, do not discontinue
taking these without checking with your primary care physician. Make
sure to bring a list of all medications, the dosages, and how often
you take them. This includes all herbal supplements and vitamins.
This is important information that will be documented in your
hospital records.
Dental
Have your teeth cleaned and make sure you do not have any cavities
that might need to be taken care of during the first few months
following surgery. Since the blood supply to the hip is increased
during healing time, it is better to have any routine dental work
done either before surgery or three months after. In addition, any
emergencies must be taken care of immediately. You will continue to
use antibiotics prior to any dental work for the rest of your life
once you have a total hip joint replacement.
Anesthesia
Someone from Cleveland Clinic Anesthesia Department will meet with
you before your hip replacement surgery. They will explain the
various types of anesthesia available to you and the risks and
benefits of the surgery. The spinal, or regional anesthetic block,
is the most common and safe method used for orthopaedic procedures.
You will also be asked to complete a health questionnaire from the
Anesthesia Department for surgery clearance to ensure your safety.
Physical Therapy
An evaluation is
conducted on all patients prior to surgery. After surgery, you will
have daily physical therapy.
Blood Donation
It is possible for you to donate your own blood for surgery. You
should notify your doctor or physician’s assistant if this is of
interest to you.
6. What should I do the night
before surgery?
Do not eat or drink anything, including water, after midnight!
You will be informed by your doctor’s physician assistant, or a
nurse or secretary as to what time your surgery
is scheduled. You will need to bring a robe, good
supportive shoes, such as sneakers, and material for reading.
7. What do I need to do the day of
hip surgery?
On the day of surgery, patients are admitted to
the hospital and typically spend an average of four to five days at
the hospital.
8. What happens during surgery?
During hip replacement surgery, the diseased portions of the hip
are cut away and replaced with an artificial hip joint. With hip
revision surgery, the artificial hip joint is removed and replaced
with a new one. Depending on the severity of the infection, more
than one hip revision surgery may be required. In these more severe
cases, the first surgery will be needed to remove the old prosthesis
scar tissue and treat the joint with antibiotics for the infection.
When the hip is cured of infection, surgery is performed to provide
a new prosthetic.
9. What happens after surgery?
After surgery, medicines or therapy may be prescribed by your
surgeon to prevent blood clots. To decrease your chances of having a
Deep Vein Thrombosis (DVT) after surgery, you may be given
medication, wear special stockings and do ankle pumps two to three
days following surgery. You also may be given patient-controlled
analgesia (PCA) which allows you to control your own pain medication
through an IV and lasts for one or two days after surgery. You may
have an appointment after surgery depending on the wound closure
method preferred by your surgeon to have the sutures removed. You
should call your surgeon before this appointment if you experience
any of the following symptoms:
• Increased redness
• Pain or swelling
• Drainage at the incision
• Bumps or pimples
• Any other changes you question
10. How long is the recovery
period after hip surgery?
Hip revision surgery requires a period of adjustment. It is
important for patients to exercise their legs to reduce swelling,
and elevate their legs above the heart when resting. After surgery,
patients will use a walker. Patients should keep in mind that normal
activities such as getting into a car or climbing stairs will be
difficult. After approximately a month, the physician will take
X-rays of the leg to monitor healing. After approximately six
months, patients will be able to walk without a limp, and without
pain in the hip.
11. What is the rehabilitation
after surgery?
Rehabilitation and physical therapy is started immediately
following replacement surgery and continues throughout your
hospitalization and at home for one year after surgery. A physical
therapist will provide goals and instructions for you to complete
while in the hospital and at home. These goals and instructions may
include limitations on weight-bearing activities following surgery
and specific exercises that will help you in recovery.
On the first day after surgery, the physical therapist will meet
with you in your hospital room for an assessment. On the second day,
you will go to the Physical Therapy department by wheelchair for
treatment. Your physical therapist will monitor the strength and
flexibility in your leg and hip, as well as your ability to stand
and sit.
Your doctor may determine that it is best for
your recovery if you go to a rehabilitation center after discharge
from the hospital. At the rehabilitation center, you will have
concentrated time with a physical therapist and occupational
therapist and will regain your strength, learn about all your hip
exercises and the precautions that you’ll need to follow. Your
length of stay at this facility is approximately five to 14 days.
Positioning After Surgery
After surgery, your physical therapist will instruct you
regarding hip movement precautions and any limitations you may have
for range of motion. Keep in mind that your physical therapy and
strengthening exercises will help you gain greater mobility and
ensure an easier recovery following hip replacement. It is highly
recommended that you continue therapy treatment for the recommended
timeframe prescribed by your physical therapist.
There are several basic rules about positioning that you should
be aware of following hip replacement surgery. Make sure that you do
not bend forward more than 90 degrees, and do not lift your knee on
the replacement side higher than your hip. Also, do not cross your
legs or rotate your leg outward, or twist or pivot your operated
hip. While sitting, make sure that you use a straight back chair
with arm rests, and do not sit in chairs or sofas lower than knee
height since they require excessive bending at the hips when sitting
down and getting up. Do not sit on low soft sofas or on stools and
remember not to lean forward or cross your legs. Since most toilet
seats are lower than knee height, patients are recommended to use a
toilet seat extension, which are available for purchase at the
hospital or a medical supply store.
12. How can I manage at home
during recovery from hip revision surgery?
The following are recommendations for home care activities
following hip revision surgery:
Going Home
When riding home from the hospital, make sure to stop every 45 to
60 minutes to get out of the car and do some walking. Also, do ankle
pumps in the car while riding. If you are flying home, request an
aisle seat and keep the operative leg extended in the aisle. You
should request to be boarded last on the plane.
Resting and Sleeping
When resting or sleeping in bed, it is recommended that you lie
on your non-operative side for the first four to six weeks following
surgery. Make sure you have a pillow between your legs, and also a
second pillow to support your foot and ankle. If you lie on your
operative side, keep in mind that this may not be that comfortable
in the initial weeks following surgery and is not recommended
immediately following surgery. When you lie on your back, you must
have a pillow between your legs.
Sexual Activity
For positioning during sexual relations, make sure to consult
your physician or physician assistant. Intercourse may be resumed
approximately three weeks after surgery, following the precautions
outlined by your physician.
Reaching
Reaching typically requires too much bending and is typically not
comfortable for patients following hip surgery. It is recommended
for the first four to six weeks after surgery you use long handled
reachers that may be obtained from your occupational therapist or a
medical supply store.
Dressing
For dressing, to prevent lifting your knee higher than your hip
on the surgery side, you may be given a long shoe horn and a
dressing stick which will help you in putting on and taking off your
shoes, socks and pants independently. Remember to always put your
operative leg in the pants first. If you wear tie shoes, elastic
shoelaces may be used to eliminate the need for tying.
Stairs
Your physical therapist will teach you the correct way to go up
and down stairs using handrails and/or crutches. Remember to use
your good leg first, followed by the crutches and the surgery leg.
When going down stairs, the crutches and surgery leg go first,
followed by the good leg.
Bathing
For bathing, do not attempt to get into the bathtub to take a
bath or to use an overhead shower. The excessive bending at the hips
needed to get into and out of the bathtub should be avoided. Make
sure not to use a walk-in type shower or take a sponge bath until 11
days following your surgery.
Household Chores
Remember not to bend too far or stoop when performing household
chores. Chores that you should avoid that may involve excessive
bending include cleaning the floor, taking out the rubbish, and
making beds.
Walking
Following revision surgery, you will need to use a walker or
crutches based on your condition, which your occupational or
physical therapist will provide for you. Make sure to stay on your
crutches or walker until your doctor or physical therapist advises
that you use a cane. Your doctor will decide how much weight you can
put on your surgery leg. In most cases, you will be able to put 100
percent of your weight on your surgery leg, unless otherwise
notified. Your physical therapist will help you learn how to use
your walker or crutches correctly and help you to obtain the
appropriate equipment for use at home. A bag or basket attached to
your walker will allow you to carry small items when walking.
Eating and Exercising
Eat well-balanced meals and make sure to complete the exercises
that you have been taught in physical therapy three times a day.
Keep in mind that it can take over a year for your muscles to become
strong, so it is extremely important to do your exercises to help
ensure a safe and effective recovery. Also remember to elevate both
of your legs when sitting to minimize swelling.
Driving
It is recommended that you not drive for eight weeks following
surgery. You may go out in a car (as a passenger) approximately
three weeks after you return home, but make sure to avoid sports
cars and cars with bucket seats because of the low seat height. To
get in and out of a car, park the car several feet away from the
curb. Stand on the street and turn your back to the car and sit
down. Slowly slide back on the seat, keeping your legs straight, not
leaning forward. Get into the car by swinging your legs around to
the front of the seat, keeping your legs straight.
13. How frequently should I
schedule follow up appointments with my doctor following hip
surgery?
Post-operative visits help your surgeon know that your hip is
healing well. Make sure to schedule your first evaluation within the
recommended timeframe indicated by your surgeon. This recommended
timeframe is four to six weeks following your hip replacement
surgery. Also request that any X-rays be sent to your orthopaedic
surgeon’s office. Hip x-rays are typically taken the week of
surgery, at 12 months and then yearly.
If you have a problem before you schedule your return
appointment, make sure to call your doctor’s physician assistant
immediately.
In addition to the first follow up appointment after discharge,
this additional schedule is recommended:
• Three to six months following the date of surgery
• One year following the date of surgery
• Annually on the anniversary date of surgery
It is important to comply with this schedule and to see your
doctor regularly for routine office visits to ensure safe and
effective recovery from hip revision surgery.
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