A hip replacement is a surgical procedure that involves removing a damaged or diseased hip joint and replacing it with an artificial implant. It is commonly performed to alleviate severe pain and improve mobility, often due to conditions like arthritis or significant injury. While successful in improving quality of life, the artificial joint may not last indefinitely.
Longevity of a Primary Hip Replacement
A primary hip replacement offers a long lifespan, with most implants lasting between 15 and 25 years, and some even for 30 years or more. The durability of the implant is influenced by several factors, including the patient’s age and activity level, the specific materials used in the implant, and the precision of the surgical technique.
Younger, more active individuals experience a reduced implant lifespan because their higher activity levels place increased stress on the artificial joint. Conversely, older patients, especially those over 70 with lower activity demands, may find their hip replacements last longer. Maintaining a healthy weight and avoiding high-impact activities like running or jumping can also help optimize the lifespan of the hip implant.
Understanding Revision Hip Surgery
Revision hip surgery replaces or repairs components of a previously implanted artificial hip joint. These surgeries are more complex than the original due to potential damage to surrounding bone and soft tissues.
The most common reasons for revision include aseptic loosening (implant detaching from bone without infection) and wear of components. These often occur many years after the initial surgery. Other causes can arise earlier, such as periprosthetic fractures, recurrent dislocations, or infection.
Infection can cause pain and lead to implant detachment, often requiring revision because antibiotics alone are insufficient to eliminate bacteria from the artificial joint. Dislocation, where the ball of the joint comes out of the socket, may also necessitate revision if it happens repeatedly. Sometimes, the body’s immune system can react to tiny particles worn off the implant, leading to bone deterioration around the implant, a condition called osteolysis, which can cause loosening and instability.
Factors Limiting Multiple Hip Replacements
While multiple hip replacement surgeries are possible, practical limitations and increasing risks restrict the number of times a hip can be replaced. Each subsequent revision surgery becomes progressively more challenging and carries a higher chance of complications due to cumulative damage to surrounding tissues and bone.
A limiting factor is bone loss. Every surgery can lead to further loss of natural bone, making it increasingly difficult to securely anchor future implants. Soft tissue damage to muscles and ligaments also accumulates with each procedure, potentially affecting joint stability and function.
The risk of complications (e.g., infection, blood clots, nerve damage, dislocation) increases with each revision. A patient’s overall health also plays a role, as individuals must be healthy enough to withstand the stress of major surgery multiple times. Finding suitable implants for severely compromised bone can also pose a challenge, as standard implants may not be appropriate.
Alternatives When Further Hip Replacement Is Not Possible
When additional hip revision surgery is no longer a safe option, several alternatives can help manage pain and improve quality of life. Non-surgical management includes pain relief medications, physical therapy to strengthen muscles and improve flexibility, and assistive devices like walkers or canes. Weight loss can also reduce strain on the hip.
For some patients, surgical fusion of the hip joint (arthrodesis) is an option, though less common for hip joints. Another option, particularly in cases of severe infection or significant bone loss, is a Girdlestone resection arthroplasty. This involves removing the artificial joint components and sometimes a portion of the bone, leaving a “flail” joint that provides pain relief but results in a shortened leg and altered mobility.