What is a problematic total hip replacement?
There is no doubt a total hip replacement is the operation of the century. It is one of the top three interventions that can be performed in any branch of medicine including cataract surgery and renal transplantation surgery.
The problematic total hip replacement is one which continues to be painful or is unstable. Sometimes other issues such as a leg length inequality may be causing a problem.
The problem may be clinically silent and is sometimes only picked up on X-ray such as wear or osteolysis. Your surgeon will advise you if this is the case.
Patients can present with a vague non-specific pain in and around the hip. Alternatively, they can present with a more specific pain often related to the groin. Patients with instability or dislocation often present in a much more dramatic fashion by dislocating their hips and reduction is invariably required in hospital. Patients with leg length discrepancy often present early and may require a shoe raise to equalise their leg lengths. In rare situations, patients with an infection can become acutely unwell and require an urgent debridement of the hip.
What can cause problems?
The problematic total hip replacement can be divided into those extrinsic to the hip replacement, such as concomitant spinal issues leading to referred pain. Causes intrinsic to the hip replacement include:-
- Periprosthetic infection
- loosening, impingement
- squeaking, trochanteric bursitis
- leg length discrepancy
- septic or aseptic loosening
- recurrent dislocation
- prosthetic or periprosthetic fracture
- adverse reactions to wear
- debris such as osteolysis and metallosis.