Revision Hip Replacement Explained

Modern hip replacement is one of the most successful procedures in orthopaedic surgery, helping hundreds of thousands of people worldwide regain mobility and enjoy a better quality of life.  The vast majority of hip replacements provide excellent pain relief and function for many years.

However, like any artificial joint, a hip replacement can occasionally develop problems over time.  In these situations, further surgery, known as a revision hip replacement, may be recommended to restore stability, relieve pain and improve function.

Revision hip replacement is often more complex than primary hip replacement and requires careful planning, specialised implants and an experienced multidisciplinary team.  This guide explains why revision surgery may be necessary, what it involves and what patients can expect during recovery.

At a Glance

This article covers:

• What revision hip replacement is

• Why some hip replacements require revision surgery

• The most common reasons for revision

• Symptoms that should not be ignored

• How revision surgery differs from primary hip replacement

• Recovery after revision surgery

• Frequently asked questions

A revision hip replacement involves removing one or more components of an existing hip replacement and replacing them with new implants.

Depending on the underlying problem, surgery may involve replacing:

• The acetabular (socket) component

• The femoral (stem) component

• The bearing surface (head and liner)

• Or the entire hip replacement

Revision surgery is tailored to each patient's individual circumstances and often requires specialised implants to address bone loss or instability.

Although modern hip replacements are designed to last many years, no implant lasts forever.  The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has shown that the majority of hip replacements continue to function well for many years, with excellent long-term survivorship.  However, a small proportion require revision surgery due to implant-related or patient-related factors.

The reason for revision often depends on:

• The age of the implant

• Patient activity level

• Bone quality

• Previous operations

• Medical conditions

• The underlying cause of the problem

Implant Loosening

Over time, the bond between the implant and bone can weaken.  This may lead to:

• Groin pain

• Thigh pain

• Difficulty walking

• Progressive loss of function

Loosening remains one of the most common reasons for revision surgery in long-term follow-up.

Infection

Although uncommon, infection is one of the most serious complications following hip replacement.  Symptoms may include:

• Increasing pain

• Swelling

• Redness

• Wound drainage

• Fever

Treatment depends on the timing and severity of the infection and may involve one-stage or two-stage revision surgery.

Dislocation or Instability

Some patients experience repeated dislocation of their hip replacement.

This may occur because of:

• Soft tissue weakness

• Component position

• Muscle damage

• Trauma

Modern implants, including dual mobility and constrained bearings in selected patients, have improved options for managing instability.

Polyethylene Wear

The plastic liner within the hip replacement gradually wears over many years.  Excessive wear may lead to:

• Bone loss

• Implant loosening

• Particle-related inflammation

Replacing the worn bearing surface before significant bone loss develops may simplify revision surgery.

Periprosthetic Fracture

A fall may cause a fracture around an existing hip replacement.  Treatment depends on:

• Fracture location

• Implant stability

• Bone quality

Some fractures require fixation, while others require revision of the implant.

Adverse Reactions to Implant Materials

Certain older implant designs, particularly some metal-on-metal hip replacements, may cause reactions in the surrounding soft tissues.  Fortunately, these implants are now used far less commonly than in the past.

You should seek specialist review if you develop:

• Increasing groin or thigh pain

• New pain after previously successful surgery

• Difficulty walking

• Recurrent dislocations

• Leg length changes

• Swelling

• Persistent clicking or instability

• Signs of infection

Early assessment often allows problems to be identified before they become more complex.

Revision surgery is generally more complex than a primary hip replacement.  It may involve:

• Removing well-fixed implants

• Managing bone loss

• Reconstructing damaged bone

• Using specialised revision implants

• Longer operating times

• More detailed pre-operative planning

Despite this complexity, modern revision techniques continue to produce excellent outcomes for appropriately selected patients.

Recovery varies depending on:

• The reason for revision

• The complexity of surgery

• Bone quality

• Overall health

Most patients begin walking soon after surgery with the assistance of physiotherapists and possibly a walking aid.  Compared with primary hip replacement, recovery is often:

• Slightly slower

• More individualised

• Dependent on bone healing where reconstruction has been required

Most patients continue improving throughout the first year after surgery.

Is revision hip replacement more difficult than the first operation?

Yes.  Revision surgery is generally more technically demanding because implants may need to be removed, bone loss managed and specialised implants used.

How long do revision hip replacements last?

Modern revision implants demonstrate excellent long-term results, although longevity depends on the underlying reason for revision, bone quality and patient factors.

Will recovery take longer?

In many cases, yes.  Recovery is often slower than after a primary hip replacement, particularly if extensive reconstruction has been required.

Can infection always be treated with one operation?

Not always.  Some infections can be treated with a single-stage revision, while others require a planned two-stage procedure.  The most appropriate treatment depends on the type of bacteria, the condition of the surrounding tissues and several patient-specific factors.

Can I return to normal activities afterwards?

Many patients return to walking, travel, golf and other low-impact recreational activities following successful revision surgery.  Your rehabilitation programme will be tailored to your individual situation.

If you have previously had a hip replacement, consider seeking specialist review if:

• Has my hip become progressively more painful?

• Has my walking distance reduced?

• Have I experienced repeated dislocations?

• Do I have increasing stiffness or instability?

• Has my quality of life changed significantly?

Early assessment often makes treatment simpler and may prevent further bone loss or complications.

Disclaimer: This article provides general information only and should not replace personalised advice from your orthopaedic surgeon, GP or physiotherapist.  Every revision hip replacement is different, and treatment recommendations should always be tailored to your individual circumstances.