Revision Hip Replacement: Key Concerns and Insights

Revision of total hip arthroplasty

Hello, Doctor, thank you for your previous response regarding the materials used in artificial hip joints.
I later realized that you had addressed similar questions before, and I apologize for the repetition.
I am a patient with systemic lupus erythematosus (SLE) and had my right hip replaced with an artificial joint in 1994 (at a large medical center).
In 1995, due to a severe infection, I underwent a revision surgery (at a smaller hospital).
In October 2014, due to wear of the artificial joint, I had the "hip joint head" replaced at the original hospital (the doctor referred to it this way; due to my busy work schedule, I did not thoroughly research what the "hip joint head" is, and I assumed it was the part above the femoral stem).
The recovery was normal for the first few months after the surgery, but in recent months, the pain and limping have worsened significantly.
At the beginning of this month, I returned to the hospital for a check-up, and the doctor reviewed the X-rays, stating that the acetabular component was loose and that I would need another surgery.
I went to another large medical center, and the doctor also indicated that a revision was necessary, scheduling a "total hip arthroplasty revision" for the end of this month.
Recently, I noticed a lump resembling an abscess at the previous surgery site, and when I asked the doctor if it could be an infection, he said it was possible, but we would need to open it up to confirm.
The day before yesterday, I returned to the original hospital to request my previous blood test results, which showed an ESR of 45 and a CRP of 2.4.

I would like to ask you, based on these two numbers, can we determine if there is an infection? Given my past experience with the painful process of infection and hospitalization, I am very concerned.
If it is an infection, I need to make proper arrangements for many aspects of the surgery and hospitalization.
Another question is regarding the materials: does "total hip arthroplasty" include the entire set, which consists of the acetabulum, femoral head, and femoral stem, or does it only include the acetabulum and femoral head? If it is a complete revision, can a ceramic joint be used in combination with a titanium metal acetabular cup? (This question may be too specialized; I am unsure if "my question" is appropriate.) Could you provide me with some professional advice? (I would prefer not to face this issue the day before the surgery).
Thank you once again for your assistance.

Xiao Xiaomi, 60~69 year old female. Ask Date: 2016/03/08

Dr. Shi Guozheng reply Orthopedics

The test results indicate a high likelihood of infection.
The materials you mentioned are usable.
However, your hip joint may require a complete set, but the prerequisite is to effectively control the infection issue.

Reply Date: 2016/03/08

More Info

Understanding the complexities of revision hip replacement surgery can be daunting, especially for patients with a history of complications such as infections or material wear. Your concerns are valid, particularly given your medical history with systemic lupus erythematosus (SLE) and previous surgeries. Let's address your questions systematically.

Infection Concerns
Regarding your blood test results, an ESR (Erythrocyte Sedimentation Rate) of 45 mm/hr and a CRP (C-reactive protein) of 2.4 mg/dL can indicate inflammation in the body, but they are not definitive indicators of infection. ESR is a non-specific marker that can be elevated in various conditions, including infections, autoimmune diseases, and even after surgery. Similarly, CRP is a more sensitive marker for inflammation but can also be elevated for reasons other than infection.
In your case, the combination of these elevated markers, along with the presence of a lump that resembles an abscess, does warrant concern for a possible infection. The best course of action is to follow your surgeon's advice regarding further imaging or exploratory surgery to ascertain the cause of the lump and whether it is indeed an infection. Early intervention is crucial in managing infections, especially in the context of previous surgeries and your underlying health conditions.

Revision Surgery and Components
When discussing "artificial total hip replacement," it typically refers to the complete system, which includes the acetabular component (hip socket), femoral head (the ball), and the femoral stem (the part that goes into the thigh bone). In your case, if the surgeon is recommending a total hip revision, it generally implies that all components may need to be replaced, especially if there is evidence of loosening or wear.

Regarding the materials used in hip replacements, it is indeed possible to use a ceramic femoral head with a titanium alloy acetabular cup. This combination is often chosen for its durability and low wear rates. However, the specific choice of materials should be tailored to your individual needs, taking into account factors such as your activity level, age, and any allergies or sensitivities you may have.

Questions and Concerns
Your inquiries about the surgical process and materials are entirely appropriate. It is essential to have a clear understanding of what to expect from your surgery, including the types of materials that will be used and the rationale behind those choices. Open communication with your orthopedic surgeon is vital; they should be willing to explain the reasons for their recommendations and address any concerns you have about the procedure.

Preparing for Surgery
As you prepare for your upcoming surgery, consider the following steps:
1. Gather Information: Write down all your questions and concerns to discuss with your surgeon. This can include specifics about the surgery, recovery expectations, and any potential complications.

2. Plan for Recovery: Given your previous experiences, it may be beneficial to arrange for support during your recovery. This includes help with daily activities and transportation to follow-up appointments.

3. Monitor Symptoms: Keep an eye on any changes in your symptoms, especially regarding pain or swelling, and report these to your healthcare provider promptly.

4. Preoperative Assessment: Ensure that any preoperative assessments, including imaging and blood tests, are completed well in advance of your surgery date.

5. Mental Preparation: Consider discussing your anxiety regarding the surgery with a mental health professional or support group. This can help you cope with the stress of the upcoming procedure.

In conclusion, your concerns about revision hip replacement surgery are understandable, especially given your medical history. By maintaining open communication with your healthcare team and preparing adequately for your surgery, you can help ensure the best possible outcome. Remember, it is your right as a patient to seek clarity and understanding about your treatment options.

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