What happens in a revision hip surgery?

The purpose of this procedure is to remove your failed implants, and replace them with new ones, which will help make your hip strong, stable and flexible again. In a revision hip surgery, a new prosthesis is inserted after removing the previous prosthesis, the cement, the surrounding tissue and the dead bone.

Even though some revision cases are relatively straightforward, revision surgery is much more complex and technically much more difficult than first-time surgery. This is because there is often less bone for your orthopaedic surgeon to work with and morselized bone (bone in particle form) is sometimes needed to help improve the strength of the hip socket and secure the implant. Much depends on how difficult it is to remove the previous prosthesis, and on the quality and quantity of bone left behind after the implant has been removed. The trochanter bone may need to be cut to remove the implant. Wires may be needed to hold the parts together until the bone has healed. If defects need to be filled with bone, bone grafts from the pelvis and/or from a bone bank may be needed.

What are the implants used in a revision hip surgery?

In revision hip arthroplasty, compared with primary total hip arthroplasty, the environment of the hip joint is poor, and therefore, an implant appropriate for the purpose of the revision should be selected.

The total revision hip implant is comprised of four parts:
•  A metal hip stem that is inserted into the top of your thighbone
•  A metal cup which holds the cup liner
•  A cup liner which holds the femoral head
•  The femoral head or ball which is attached to the top of the hip stem and is inserted into the liner to form the ball-and-socket joint

Hip revision implants are not one-size-fits-all, therefore your surgeon will choose the right hip implant for your body. Depending on the type of revision surgery needed (e.g. acetabular cup revison), different implants and components may be used (e.g. special cup, augment, reinforcement). The revision stem  like the S-ROM is the most commonly used. Your surgeon will determine which of the four component’s design options will work best together to restore your accurate leg length, while minimizing the risks of post-operative dislocation and premature implant wear.

What are the wear-reducing materials available for revision hip surgery?

In recent years, advanced, wear-reducing materials have been introduced that may extend the life of hip replacements. These material options include OXINIUM Oxidized Zirconium balls on cross-linked polyethylene plastic liners, ceramic balls on ceramic liners and metal balls on metal liners.

OXINIUM Oxidized Zirconium
OXINIUM material is a metal alloy whose surface has been transformed into smooth, hard, black ceramic. This remarkable surface reduces wear like a ceramic but beneath the surface it is still solid metal and thus retains all of the metal component’s strength characteristics. The ceramic surface makes OXINIUM implants 4,900 times more abrasion resistant than standard cobalt chrome. It also reduces friction between the implant and the plastic or cartilage surfaces. The result is superior durability over time.

With an OXINIUM hip replacement, the ball is replaced with an OXINIUM femoral head and the socket is replaced with cross-linked plastic. This reduces wear by 98%1, 2 in laboratory testing when compared to traditional metal on plastic hip replacements. The OXINIUM surface also reduces the concern for metal wear particles that can occur from metal on metal hip replacements and brittle fractures which sometimes occur with ceramic on ceramic hip replacement. Talk with your orthopaedic surgeon to learn more about OXINIUM hip replacements and to find out if they are right for you.

Ceramic on ceramic
Another option for extending the life of your hip replacement is ceramic on ceramic. These implants reduce wear by 99%3 in laboratory testing when compared to traditional metal on plastic. With ceramic on ceramic hip replacements, both the ball and socket are replaced with ceramic. These implants have an excellent reputation for reducing wear, but have limited flexibility in design options due to manufacturing limitations of the ceramic material. Therefore these implants are not suited for all patients. Talk with your surgeon about this technology and if it is right for you.

Metal on metal
Metal on metal hip implants have shown to reduce wear by 97%3 in laboratory testing as compared with traditional metal on plastic. As with ceramic implants, metal sometimes limits flexibility in design. The metal on metal design also involves some potential health risks due to more metal wear particles (ions). Some studies have shown that ions in the body of patients with metal on metal hip replacements are up to 29 times the normal level.4 These levels were measured by testing the patient’s blood and urine ion levels before and after total hip replacement surgery (THR).  High ion levels can be especially harmful to women of child bearing age or persons with poor kidney function.

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