Revision Hip Replacement

Revision hip replacement is a procedure performed when an existing hip replacement has failed, worn out, become loose, become infected, or is no longer functioning as intended. In revision surgery, part or all of the original hip prosthesis is removed and replaced with new components. Because it involves repeat surgery, altered anatomy, and sometimes bone loss or soft tissue damage, revision hip replacement is usually more complex than a primary total hip replacement.

What is revision hip replacement?

A primary hip replacement is designed to relieve pain and restore function by replacing the damaged ball-and-socket hip joint with prosthetic components. Over time, however, problems can develop that affect the performance or stability of the implant. Revision hip replacement is a secondary procedure used to address these issues. In some cases only one component needs to be exchanged, while in other cases the entire prosthesis must be removed and rebuilt using specialised implants, augments, bone graft, or reconstruction techniques.

Why might revision surgery be needed?

There are several reasons why a hip replacement may need to be revised. Common causes include implant wear, loosening of components, recurrent dislocation, infection, periprosthetic fracture, instability, leg length problems, or ongoing pain related to implant failure. Some revisions are required years after the original surgery due to gradual wear and loosening, while others occur earlier because of infection, instability, fracture, or technical issues affecting the original implant position.

Common reasons for revision hip replacement

• Aseptic loosening, where the implant loses fixation to bone over time.
• Wear of the bearing surfaces or liner.
• Infection around the hip replacement.
• Dislocation or recurrent instability.
• Periprosthetic fracture around the implant.
• Bone loss around the prosthesis.
• Persistent pain or failure of a component.

Pre-operative assessment and planning

Revision hip replacement requires meticulous planning before surgery. Patients commonly need imaging such as X-rays and CT scans to assess the position of the implants, the amount of bone loss, and the condition of the surrounding anatomy. Blood tests and other investigations may also be required, especially if infection is suspected. This planning helps the surgeon determine which implants, instruments, and reconstruction techniques may be needed during the operation.

How revision hip replacement is performed

Revision hip surgery is performed under anaesthesia. The surgeon accesses the hip joint through an incision, often using the previous surgical scar where possible, and removes the failed or problematic components. The bone and soft tissues are then assessed carefully, and the new prosthesis is inserted using the most appropriate reconstruction method. Depending on the reason for revision, surgery may involve replacement of the socket, the stem, the liner, the ball, or the entire hip prosthesis.

A typical revision hip replacement may include:

• Anaesthesia and surgical positioning.
• Exposure of the existing hip replacement through the previous incision or an extension of it.
• Removal of one or more failed components and any old cement if present.
• Assessment of bone loss, implant stability, and soft tissue condition.
• Reconstruction of the socket or femur using specialised revision implants.
• Use of augments, bone graft, cages, wires, or longer stems if needed.
• Insertion of the new components and assessment of hip stability, movement, and leg length.
• Closure of the wound and postoperative recovery planning.

Implants and reconstruction techniques

Revision surgery often requires specialised implants and tools that are different from those used in a primary hip replacement. If there is bone loss, the surgeon may use augments, longer stems, custom components, or bone graft to rebuild the joint and achieve secure fixation. In some cases only a liner or head exchange is needed, while in more complex cases major reconstruction of the socket or femur is required.

Benefits of revision surgery

The aim of revision hip replacement is to relieve pain, improve hip function, restore stability, and correct problems affecting the original prosthesis. For many patients, successful revision surgery can improve walking, reduce discomfort, and restore confidence in daily movement. Although outcomes can be very good, revision surgery is generally less predictable than primary hip replacement because of the added complexity involved.

Risks and complications

Revision hip replacement is major orthopaedic surgery and carries important risks. These may include infection, bleeding, blood clots, dislocation, nerve or blood vessel injury, fracture, leg length inequality, loosening of the new implant, ongoing pain, stiffness, heterotopic bone formation, and the possibility of further revision surgery in the future. The risk profile depends on the reason for revision, the complexity of reconstruction, the condition of the bone and soft tissues, and the patient’s general health.

Recovery after revision hip replacement

Recovery after revision surgery is often longer than after a first hip replacement. Hospital stay may be longer, walking aids may be needed for an extended period, and rehabilitation may progress more gradually depending on the stability of the reconstruction and the amount of bone or soft tissue repair required. Physiotherapy is an important part of recovery and helps improve movement, strength, balance, and confidence with walking.

A general recovery pathway may include:

• Early supervised mobilisation after surgery.
• Use of crutches or a walker during the initial recovery phase.
• Wound care, pain management, and monitoring for complications.
• Physiotherapy to restore movement, gait, and strength.
• Gradual return to daily activities over weeks to months, depending on the complexity of surgery.

Revision versus primary hip replacement

Revision hip replacement differs from a primary hip replacement because the surgeon is not operating on a normal joint for the first time. Instead, revision surgery must address an existing implant, possible scar tissue, bone deficiency, soft tissue compromise, or infection. For this reason, revision procedures are typically more technically demanding, take longer, and require more detailed pre-operative planning and specialised reconstructive options.

Is revision hip replacement right for you?

If you have a painful or failing hip replacement, an orthopaedic review can help determine the cause and whether revision surgery is appropriate. A careful assessment of your symptoms, imaging, implant status, bone quality, and overall health is needed before planning treatment. The goal is to address the source of failure and restore the best possible pain relief, mobility, and function.