Abstract
When is revision surgery contraindicated in the face of a failed total hip? Surgically indicated can be interpreted as a situation where the patient will benefit from a specific intervention, with sufficient likelihood, to warrant the risks of intervention. Contraindication connotes the opposite; the risks, or likelihood of the intervention's failure to achieve the desired results outweigh the expected extent and likelihood of benefit. Contraindicated actually represents the end point of a complex decision making process which must be carried out by the practitioner in conjunction with the patient and may require the full range of the surgeons analytical, technical and communication skills. Most commonly the term means that the surgeon's thinking has led to a belief that the patient will be better off without further surgery.
Deciding to forego another revision usually means leaving the patient with a resection arthroplasty. Relative indications for resection, or even avoiding revision of a failed arthroplasty, are most commonly biological. In a healthy host, with a sterile but anatomically deficient bed with adequate soft tissue coverage, mechanical reconstruction capabilities and massive bulk allograft may allow reconstruction of almost any amount of tissue loss. Severe osteomyelitis or soft tissue infection, unmanageable for reasons, including but not limited to: chronic immune-suppression, mixed or resistant organisms or a life threatening sensitivity to antibiotics which may be required to treat the sepsis. More subjective factors, such as adequacy of soft tissue and bone stock, comorbid medical conditions or a patient's desire to avoid additional surgery as well as costs must be considered. This decision may include dozens of other considerations, some of which may be considered pre-operatively and some which may only arise intra-operatively.
