Written by Dr. Ioannis Tsarouchas, MD, PhD, Orthopaedic Surgeon, Director of Joint Implant Orthopaedics Department, Athens Medical Center, Athens Medical Group
Total hip arthroplasty is one of the most successful surgical operations in orthopaedics. Nevertheless, a significant number of patients undergoes revision (second surgery/ reoperation/ revision).
Proper material placement during the initial operation, so that the patient surgical outcome to be perfect, requires significant surgical experience. In case of poor prosthesis positioning, mechanical problems arise, which together with the loosening or wear of the prosthesis, microbial infection and fractures around it, are the most common causes of revision. Regular postoperative monitoring is particularly important for the prevention and early treatment of these problems.
The main symptom of patients with problematic total hip arthroplasty is pain in the inguinal region and/ or thigh, so in case something like this is observed, it is necessary to visit the orthopaedic on time. The faster assessment and treatment of problematic arthroplasty is of particular importance, as it usually leads to avoidance of worst bone deterioration around the prosthesis, making its revision (revision) easier.
Total hip arthroplasty revision is a difficult and demanding procedure. Its success requires special knowledge and techniques, as well as great surgical experience, so it is better to be performed by experienced and fully trained surgeons in large centres.
Traditionally, hip revision surgeries require extensive accesses (large incisions, significant soft tissue injuries, great blood loss) accompanied by a higher rate of complications as compared to the first surgery. In cases where only one part of the prosthesis has a problem, individual replacement is preferrable, making the revision less time-consuming, with less need for blood and quicker recovery.
The minimally invasive ASI technique (Anterior Supine Intermuscular), apart from its great success in the initial total hip arthroplasty, is also used with excellent results in cases necessitating revision of the acetabular component, ensuring maximum advantages of old prosthesis’ partial repair. With the ASI method, needs for transfusion are practically minimised, recovery time is dramatically reduced, and complications accompanying the long recovery period following extensive access to the hip are avoided. The advantages of this method are due to minimal injury of soft tissue around the artificial joint (which is already injured by the previous operation) and the surgeon’s good visibility during the operation.
In the Major Joints Clinic of Athens Medical Centre, we have performed a large number of revisions with the ASI method combined, where appropriate, with the reliable acetabuloplasty techniques and the insertion of grafts in bone defects regions (impaction grafting, strut grafts, etc).
Acetabuloplasty, in particular, is a tested method for the management of incomplete acetabulum formation and great bone defects of the pelvic bones.
The selection of patients who may undergo revision surgery with the ASI method is made after a detailed preoperational check, to exclude the case of great damage of the femoral prosthesis. Furthermore, it is also necessary to exclude the case that the bone defects of the acetabulum are that large to require more extensive access.
Through the revision of the problematic total hip arthroplasty, patients ensure the multi-annual smooth functioning of their intention and maintain their quality of life high.