The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.

1. J K Laik
V.Chandra
Dept Of Joint replacement and
reconstruction

2. • Why hip
replacement?
• How? –Surgery!

3.  Trauma - Injury
 Osteonecrosis
 Rheumatoid arthritis
 Osteoarthritis
 Bone tumors that break down the hip joint.

4.  Generally acknowledged indications:
 Jointpain
 Functional limitation
 Radiographic evidence ofjoint damage

13. Removal of Old Component
Re-implantation of New Component

14. Break of Implant Loosening
Implant failure

15.  Complex
 Lengthy
 Challenging

16.  Most challenging
 CementRemovalFromFemur
 BoneGraftingandReconstruction
 SoftTissueBalancing

17.  Name – UF
 Age 68 yrs
 Previous THR in Chennai in 12 yrs back
 Admitted for pain and inability to walk

18. PRE OPERATIVE AP VIEW

19. PRE OPERATIVE LATERAL VIEW SHOWING EXTENDED FRACTURE
AND PERFORATION OF FEMORAL STEM

20. PROBLEMS SOLUTION
 Broken implant
 Cemented
 Perforated
 Removal of broken
implant
 Removal of cement
 Refixation with a new
implant

21. PRE OP XRAY SHOWING SUBLUXED JOINT

24. POST OPERATIVE XRAY AP VIEW

25. CASE SUMMARY
 G T wife of Mr. G
 She was operated elsewhere for Rheumatoid Arthritis of Right Hip on
3rd November, 11
 Cemented Total Hip Replacement was performed and patient was
ambulatory for about a month
 on evaluation was found to be having Mal-position of Replaced
Component resulting in Dislocation.

28. PROBLEMS
 Dislocated implant
 Shortening
 Cementing
SOLUTION
 Removal of cement
 Removal of implant
 Reconstruction with a
new implant

32.  Name – PS,48 yrs
 THR done in 2008
 Aseptic loosening of femoral component

42.  Name –RNS
 Age 68 yrs
 Infected implant

52.  Name – SG
 Age 55
 Initial surgery for neck of femur done
elsewhere
 Had prior shaft femur fracture (now healed)
 Surgery abandoned as there was perforation of
AMP
 Cement could not be taken out

54. PROBLEMS
 Cement inside
 Shortening
 Old fracture
SOLUTION
 Removal of cement
 Reconstruction with a
newer implant

55. WAGNER’S EXTENDED OSTEOTOMY WITH REMOVAL OF CEMENT

57. REAMING OF DISTAL DEFORMED FEMORAL CANAL ON A GUIDE WIRE

58. REPAIR OF OSTEOTOMY WITH PRESERVATION OF MUSCLE
ATTACHMENT AND PROSTHATIC IMPLANTATION

59. POST OPERATIVE PICTURE TOTAL HIP REPLACEMENT (WAGNER
UNCEMENTED STEM AND UNCEMENTED CUP)

60.  In our set up the most common cause of
revision is infected prosthesis followed by
malposition implants and periprosthetic
fractures
 Revision for aseptic loosening is less mainly
because most of the patients operated are late
in their life
 Proper planning and availability of implants
and instrumentation is a must before
attempting such type of surgery