Alternatives to Repeat Hip Replacement

Q:  I am 68 and have had RA since the age of 19. Believe it or not, I have had six hip replacements! My most recent one, which I received in 1998, dislocates about every six months. My doctor is now recommending another hip replacement. I really don't want to go through that again. Are there any alternatives to more surgery?

A:  Six hip replacements! That's unusual. I suspect the cause for multiple hip revisions in your case is thinning of the bone associated with RA and loosening of the prosthesis associated with the wear of the lining of the implant. Recurrent dislocations are not common, but they can be a serious problem following total joint replacement, and they become more common after second and third surgeries on a given hip. 

Dislocations may occur because of lax muscle or fibrous tissue around the hip joint, positioning of the cup and stem (the metal portion of the prosthesis inserted into your thigh bone), impingement due to large outgrowths of bone, or other factors. Sometimes dislocations occur when patients repeatedly place the hip in an "unsafe position." That is, they bend the hip one way or the other too far, the ball is levered out of the socket, and the hip dislocates.

Some people who dislocate several times a week will find it necessary to have an early hip revision; however, if your hip is dislocating just every six months - still too often - the prospect of undergoing more surgery may be more troubling than the pain of and treatment for hip dislocation.

Recurrent dislocations may be solved without surgery by knowing the "safe range" for your own hip and not exceeding that range. It may be helpful to sometimes wear a brace with a stop lock on it to keep you in that range so you can learn how much bending your hip will take. 

If you and your doctor determine you need surgery, don't despair. Recurrent dislocations often can be solved by surgical revisions, including changing the plastic lining of the socket to give more coverage, changing the stem or head to provide more length, resetting the angles of either the cup or the stem or tightening up soft tissues that may have loosened. During revisions, sometimes the plastic liner can be changed without removing the metal backing for the cup or the stem. And sometimes the prosthetic components can be replaced without removing everything and starting all over. 

A special type of cup called a "constrained socket" is available to those with very difficult problems. Please discuss the matter thoroughly with your surgeon and see what his plan is to eliminate the recurrent dislocations. Unfortunately, nobody can guarantee that your next surgery will be free of complications.

JEFFREY NUGENT, MD
Orthopaedic Surgeon

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