Revisions are recommended for several reasons. If a prosthesis has been in place for a long time, the bearing surface may have worn, requiring a simple exchange. This is the easiest type of revision with the shortest recovery period, as the critical components are not changed. Loosening of the components (either the socket or stem) can occur independently or simultaneously, and require removal of one or both. Depending on the difficulty of the removal, the recovery can be short (six weeks) or long (six months). The hip components can dislocate. This may be remedied with a single “reduction” maneuver, but if this becomes chronic, revision surgery may be necessary. Finally, an infection around the prosthesis may require removal of the prosthesis. Once the infection has resolved, new components can be placed.
The components are very similar. This typically involves a larger diameter socket and a longer stem or rod. For enhanced fixation, screws are commonly used for increased contact with the native bone. Finally, augments, which are metallic bone substitutes, can be used to rebuild any prior bone loss.
Functional rehabilitation is similar in that often the “anterior approach” can be utilized enabling early and quick recovery. Specific hip limitations or precautions are sometimes needed to allow the soft tissues to heal. Usually, full weight-bearing is allowed, with the exception of revisions that necessitate osteotomies or bone cutting for implant removal. In these uncommon cases, a period (typically six weeks) of partial weight-bearing is required to allow the bone to heal properly. The usual time for resolution of most of the symptoms is three to six months.
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