Revision Hip Surgery

Why Revision Surgery May Be Required

Although modern hip implants are highly durable, no prosthesis lasts indefinitely. Over time, mechanical and biological factors may cause a previously well-functioning replacement to become painful or unstable. Early identification of the underlying cause is critical to planning a successful revision.

• Aseptic loosening — the most common reason for revision; gradual loss of the bond between the implant and bone, often related to particulate wear debris from the bearing surface
• Periprosthetic joint infection (PJI) — deep infection around the implant, which may present acutely or as a chronic low-grade process
• Instability and dislocation — recurrent dislocation of the hip joint requiring component revision or soft tissue reconstruction
• Periprosthetic fracture — fracture of the femur or pelvis around the implant, often following a fall
• Implant fracture or wear — mechanical failure of the prosthetic components
• Adverse local tissue reactions — particularly in metal-on-metal bearings, causing local tissue damage (pseudotumour)

Assessment & Planning

A thorough pre-operative evaluation is essential before revision surgery. This differs significantly from the workup for a primary replacement and must address the specific reason for failure.

• Detailed clinical history and examination including wound assessment and neurovascular status
• Plain radiographs to assess component position, bone stock, implant integrity, and the presence of osteolysis
• Advanced imaging (CT, MRI with metal artefact reduction) to characterise bone loss and soft tissue involvement
• Blood tests including inflammatory markers (ESR, CRP) to help exclude infection
• Hip aspiration for cell count, culture, and synovial fluid analysis when infection is suspected
• Nuclear medicine imaging when loosening or infection is uncertain

The Procedure & Recovery

Revision hip surgery is technically more demanding than primary replacement. Existing components must be carefully removed, often from well-fixed bone, and bone defects addressed using augments, structural allograft, or specialised revision implants. Operating time is longer, blood loss is greater, and hospital stay is extended.

Recovery following revision surgery is generally slower than after a primary replacement. Rehabilitation begins early but weight-bearing restrictions may be more conservative depending on bone quality and fixation achieved. Most patients can expect a gradual return to function over three to six months, though the final outcome is also influenced by the quality of the remaining bone and soft tissues.

Despite its complexity, revision hip surgery performed by an experienced specialist reliably improves pain and restores function in the majority of patients.