Revision surgery means removing all or part of a replacement that has stopped working and reconstructing the joint. It is a different operation from the first, longer and more demanding: implants that are usually well fixed to bone have to be removed, the bone loss they leave has to be managed, and stability has to be achieved in territory that is no longer virgin.
The good news is that, well planned, revision restores function and removes pain. The condition is understanding exactly why it failed — because revising without knowing the cause is repeating the problem.
Why a replacement fails
Loosening. Over the years the implant can lose its bond with the bone. It usually shows as start-up pain in the thigh or buttock, easing as you warm up and returning with activity.
Wear of the bearing surface. The particles released can provoke a reaction that resorbs bone around the implant (osteolysis). It is often silent: it is picked up on a routine radiograph before it causes symptoms, which is precisely why a replacement should be checked periodically even when it does not hurt.
Periprosthetic infection. It can appear in the immediate postoperative period or years later, seeded from an infection elsewhere in the body. It is the cause that most changes the surgical plan, which is why it must always be ruled out.
Instability and repeated dislocations. When the hip dislocates more than once, there is a problem with component orientation, soft-tissue tension or a conflict with the lumbar spine that has to be corrected.
Periprosthetic fracture. The bone breaks around the implant, almost always after a fall. If the implant is loose, revision is part of the treatment.
Assessment: ruling out infection comes first
The plan is set before entering theatre. It combines serial radiographs — comparing with previous films is worth more than a single image — blood inflammatory markers and, very often, analysis of joint fluid obtained by aspiration, with cell count and cultures.
That step is not skipped. A painful replacement that turns out to be infected and is revised as if it were aseptic loosening ends in a second failure. In selected cases CT is added to assess bone loss and plan the reconstruction.
How it is resolved
If the problem is mechanical — loosening, wear, instability — the affected components are exchanged. Sometimes revising the cup or the bearing is enough; at other times the stem has to be revised as well. Where bone is missing, grafts or revision implants designed to seat on healthy bone are used.
If there is infection, treatment is different and longer. Depending on how long it has been present, the organism and the state of the tissues, options range from debridement with exchange of the modular components to a two-stage revision: removing the implant, placing an antibiotic spacer, treating the infection and reimplanting later. It is a long road and it has to be explained frankly from the outset.
What to expect
Recovery is slower than after a first replacement and the functional result is, on average, somewhat lower. Even so, most patients regain a pain-free, functional hip. Weight-bearing may need to be progressive depending on what was reconstructed, and rehabilitation is long.
What weighs most on the result is planning: having the right diagnosis, the right imaging, and the instruments and implants anticipated before starting.
Dr. Kushner’s approach: revision is reconstructive surgery, not just an exchange. It demands planning every detail — bone, stability and, where there is infection, eradicating it — to achieve a durable hip.
With a joint replacement in place, these are urgent
- Fever, redness, warmth or discharge from the wound — at any time, even years later.
- Pain that returns after a symptom-free period, or that changes in character.
- A sense that the hip is giving way or slipping when you bear weight.
- Inability to bear weight after a fall, even a minor one: this may be a fracture around the implant.
- Visible shortening of the leg or a change in the way you walk.
Frequently asked questions
Is every painful replacement infected?
No. Pain may be due to loosening, wear or instability; investigation distinguishes the cause, and ruling out infection is the priority.
Does infection always mean removing the implant?
Not always. Depending on the duration and the organism, strategies range from debridement with partial exchange to a two-stage revision.
Why does a replacement fail?
The commonest causes are loosening over time, wear of the bearing, infection, instability with repeated dislocations, and fractures around the implant.
How do you know if it is infected?
Through the combination of history, blood tests and, above all, analysis of joint fluid obtained by aspiration. It is a step not worth skipping: treatment changes completely if there is infection.
Is it harder than the first operation?
Yes. Implants have to be removed, bone loss managed and the joint reconstructed. It requires planning with specific imaging and having the right instruments available.
References
- Evans JT, et al. How long does a hip replacement last? Lancet. 2019;393(10172):647-654. DOI
Book your assessment
Book a consultation with Dr. Kushner at COMEDSA. Bring any previous imaging for a complete assessment.
Educational information reviewed by Dr. Michael Kushner Shrem. It does not replace an in-person medical assessment.