Hip Revision Surgery – The Nebraska Medical Center


I think patients are frequently concerned
any time they have to have a repeat operation for an operation that was supposed to have
taken care of their problem initially. Often times, these patients are coming to doctor,
though, because they’re debilitated by pain. As these implants start to loosen or if there’s
an infection, they can have severe pain, which limits what they’re able to do on a daily
basis. While they are certainly concerned, usually they’re in quite a bit of discomfort,
which is what brought them to the doctor in the first place. We generally see a failure rate of hip replacement
about one percent per year. So you would say that at 10 years, 90 percent of people are
still doing well. And even at 20 years, 80 percent of people probably are still doing
well. But there are percentages that you either wait this out rapidly or you have another
complication we’ve talked about, either dislocation or infection or something else
requiring a revision. So it’s unlikely, but considering the number of artificial joints
being put in throughout the country and certainly even in this region, it leaves you with a
significant number that have to be revised. In the last decade, in particular, the materials
are much better. So we recently looked up this series of almost 150 patients who had
their joints replaced since 1999 and none of those patients over the 11-year period
had any problems with mechanical failure, which is much better than the decade before
it. It’s usually a more challenging surgery
to recover from and often times feels like a bigger operation to the patient, the second
time around. Which is also why it’s still important to do it right the first time, because
people that have revisions often will say this is a much bigger deal than their initial
surgery was. It’s just a tougher thing to recover from. You’re having to re-operate
on something that’s been operated before, so there’s more scarring around that site.
There’s been some bone removed because the first operation, so you have less to work
with to correct their problem. But if the problem is relevantly straightforward and
there is adequate bone and you can do a revision operation that may virtually last the rest
of their life. It’s important to identify the problem early and correct it; there’s
no time for procrastination. There’s an interesting statistic and that
is that 80 percent of the surgeons that do hip surgery do 10 or less hip replacements
a year. So that means that the majority of the hip replacements are done by the minority
of the orthopedic surgeons and at institutions like this, where there’s a large volume
of surgery being performed. Here we all have a specific interest in hip surgery and in
particular dealing with hip implants or previous hip replacements which were for whatever reason
failed. Because of that interest, we’re seeing more patients than most other centers
in the area, which allows us to take better care of those patients.

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