Revision Hip Replacement

Introduction

If you are reading this, you have most likely had a hip replacement in the past and your surgeon has raised the possibility of a second operation on the same hip. This second operation is called a revision hip replacement. It is the surgery that replaces an artificial hip joint that has loosened, worn out, become infected, dislocated repeatedly, or failed in some other way.

Revision hip replacement is more complex than the original (primary) hip replacement. The bone has already been operated on once, the soft tissues around the joint may be scarred, and the new implants often need to be larger or specially designed to fit. Because of this, the planning, the surgery itself, and the recovery all take longer.

This guide explains what revision hip replacement is, why it is done, the different surgical approaches your surgeon may consider, what happens during and after the operation, and what life looks like in the months and years that follow. It is written for patients who already know that their hip replacement is failing or who are working through the decision with their orthopaedic surgeon.

What Is Revision Hip Replacement?

A primary hip replacement (also called total hip arthroplasty) replaces a damaged hip joint with artificial parts. These parts usually include a metal stem that sits inside the thigh bone (femur), a ball that fits on top of the stem, and a cup that is fixed into the socket of the pelvis (acetabulum). The ball and cup may be made of metal, ceramic, or hard plastic (medical-grade polyethylene).

Over time or sometimes much sooner if there is a problem — one or more of these parts can fail. A revision hip replacement is the operation that removes the failed parts and puts in new ones. Sometimes only one component is replaced, for example just the plastic liner inside the cup. In other cases all of the original implant has to come out, along with any cement or scar tissue around it, and entirely new components are inserted.

The implants used in revision surgery are not the same as those used in a first-time hip replacement. They are often longer, wider, or modular (built in pieces) so that the surgeon can compensate for missing or damaged bone. Some revision systems also use metal augments, cages, or bone graft to rebuild areas where the pelvis or femur has been worn away.

Because so much of the surgery is shaped by what is already inside the hip, no two revision operations are exactly alike. Your surgeon’s plan will depend on the specific reason your original hip replacement failed, the condition of the bone that remains, and whether infection is involved.

Why Is Revision Hip Replacement Performed?

Hip replacements can fail for several different reasons. Understanding which one applies to you helps explain the type of operation being planned and what to expect afterwards.

Implant Loosening

Loosening is one of the most common reasons for revision. The implant can become loose at the interface between the bone and either the metal or the cement that holds it in place. You may notice pain in the groin, thigh, or buttock, especially when you stand up or take the first few steps after sitting.

Wear of the Bearing Surfaces

The ball and socket move against each other millions of times over the years. Even modern materials produce microscopic particles of wear debris. These particles can trigger an inflammatory response in the surrounding bone, leading to bone loss around the implant. This process is called osteolysis and it can loosen an implant that was originally well-fixed.

Infection (Periprosthetic Joint Infection)

Infection around an artificial joint is one of the most serious reasons for revision. It can occur soon after the original surgery or many years later, sometimes after bacteria spread to the joint from another infection in the body (for example, a dental abscess or urinary infection). Signs may include increasing pain, swelling, warmth, drainage from the wound, or fever. Infection usually requires a specific surgical strategy, often in two stages, which is described later in this article.

Recurrent Dislocation

Some hip replacements come out of place repeatedly. This may be due to the position of the components, weakness in the muscles around the hip, or wear of the plastic liner. When dislocations keep happening despite physiotherapy and activity changes, revision surgery may be considered to reposition the components or use a different design (such as a larger ball or a dual-mobility cup).

Periprosthetic Fracture

A fall or sometimes a minor injury can cause the bone around the implant to break. These fractures often destabilise the implant and require surgery to fix the bone and, in many cases, replace the implant with a longer stem that bypasses the fracture.

Component Breakage

Although uncommon with modern materials, the stem, ceramic head, or plastic liner can occasionally fracture. When this happens, the broken component is removed and replaced.

Other Reasons

Less common reasons include adverse reactions to metal debris from certain older metal-on-metal designs, leg length differences that significantly affect function, and stiffness or pain caused by soft-tissue problems around the joint.

Who Is a Candidate for Revision Hip Replacement?

Revision is considered when there is a clear, identifiable cause of failure and when the symptoms or risks are significant enough to justify another major operation. The decision is usually made together by you and your orthopaedic surgeon, after a full assessment.

Factors your surgeon will weigh include:

• The exact problem with the existing implant and whether non-surgical measures can manage it
• The severity of pain and how much it limits walking, sleep, and daily life
• The condition of the bone around the implant
• Whether infection is present or suspected
• Your overall health, including heart, lung, and kidney function
• Other medical conditions such as diabetes, obesity, or osteoporosis that affect surgical risk and healing
• Your age, activity level, and goals for mobility

In some patients, particularly those with significant medical risks or very limited symptoms, the safer choice may be to delay or avoid revision. In others, especially when infection or fracture is involved, surgery may be urgent.

Alternatives to Revision Surgery

Revision hip replacement is a major operation, and surgeons usually consider whether non-surgical options or smaller procedures can help before recommending it.

Non-Surgical Management

For patients with mild symptoms, slowly progressing wear, or significant surgical risk, non-surgical measures may relieve pain and maintain function for a time:

• Pain-relieving medications, including paracetamol and anti-inflammatory drugs where appropriate
• Activity modification — reducing high-impact movement and changing how household and work tasks are done
• Walking aids such as a cane, crutch, or walker to offload the hip
• Physiotherapy to strengthen the muscles around the hip and improve balance
• Weight loss, when relevant, to reduce load on the joint
• Antibiotic suppression in selected cases of chronic, low-grade infection where surgery is not possible

These steps do not fix a mechanical problem with the implant. They can, however, be useful while a decision about surgery is being made, or as a long-term plan for patients who are not suitable candidates for revision.

Smaller Surgical Procedures

In some cases, a limited operation may be enough. For example, an isolated worn plastic liner inside an otherwise well-fixed cup can sometimes be exchanged without removing the metal shell or the femoral stem. A single dislocation that has occurred only once may be treated with a closed reduction in the operating room rather than full revision. These “partial” revisions are not always possible, but they are worth discussing where the failure is limited to one component.

Living with the Existing Implant

Some patients choose to live with a known but stable problem if their pain is tolerable, function is acceptable, and the risks of surgery are high. This is a legitimate option that your surgeon can help you think through.

Surgical Approaches

The term “revision hip replacement” covers several different operations. The right one depends mainly on why the original implant failed.

Single-Stage Revision

In a single-stage revision, the failed components are removed and new ones are inserted in the same operation. This is the usual approach when there is no active infection — for example, in cases of loosening, wear, or recurrent dislocation. It is also used in selected, carefully chosen cases of infection where the bacteria are known to be sensitive to antibiotics and the soft tissues are healthy.

Two-Stage Revision for Infection

When infection is present and more severe, surgeons commonly use a two-stage approach.

• First stage: The infected implant, cement, and any infected tissue are removed. A temporary spacer made of bone cement mixed with antibiotics is placed in the hip. This spacer keeps the space open, releases antibiotics locally, and allows limited movement. Intravenous antibiotics are given for several weeks afterwards.
• Interval period: Over the following weeks to months, blood tests and sometimes joint fluid samples are used to confirm that the infection has cleared.
• Second stage: Once the infection is no longer detectable, a second operation removes the spacer and implants the definitive new revision components.

Two-stage revision is more demanding for the patient because it involves two operations and a long period of limited mobility in between. However, it is widely regarded by orthopaedic societies as the most reliable way to clear established periprosthetic joint infection.

Debridement, Antibiotics, and Implant Retention (DAIR)

When infection is identified very early after the original surgery and the implant is still well-fixed, surgeons may try a procedure called DAIR. The wound is reopened, the joint is cleaned thoroughly, the plastic liner is exchanged, but the main metal components are kept in place. This is followed by a long course of antibiotics. DAIR is less invasive than full revision but is only suitable in specific situations.

Component-Specific Revision

Sometimes only part of the original implant has failed. Examples include:

• Exchanging only the plastic liner in cases of wear without loosening
• Replacing only the femoral stem if it is loose while the cup remains well-fixed
• Replacing only the cup if it has worn out or loosened

These partial revisions are less invasive but still require careful planning to ensure the new and old components work well together.

Reconstruction for Bone Loss

When significant bone has been lost around the original implant, the surgery becomes more complex and may involve:

• Modular revision implants — stems and cups built from interlocking pieces that allow the surgeon to fit the implant to the remaining bone
• Bone grafting — using bone from a bone bank (allograft) or, less commonly, from another part of the patient’s body, to fill defects
• Metal augments and cages — specially shaped pieces of metal that bridge gaps in the pelvis or femur
• Longer femoral stems — that extend further down the thigh bone to gain stability below an area of weakened bone

Surgical Incision and Approach

Most revision hip replacements are performed through a posterior or lateral approach, often using the same scar as the original surgery, extended as needed. The choice of approach depends on the surgeon’s training, the type of failure, and what needs to be done to remove the existing components safely.

Preparing for Revision Hip Replacement

Because revision surgery is more complex than primary hip replacement, the preparation is usually more detailed.

Clinical Assessment

Before surgery, your surgeon will gather a full picture of the problem, typically including:

• A detailed history of your original hip replacement and how symptoms developed
• A physical examination of the hip, leg length, gait, and strength
• X-rays of the hip and sometimes the whole pelvis and femur
• A CT scan to assess the position of the implant and the extent of bone loss
• MRI with metal-artifact-reduction techniques in selected cases
• Blood tests, including inflammatory markers (ESR and CRP), if infection is being ruled out
• Joint aspiration — a needle sample of fluid from inside the hip — if infection is suspected

Identifying or ruling out infection is one of the most important parts of the work-up, because it changes the entire surgical plan.

Medical Optimisation

The team will also work to make sure that your overall health is as good as it can be before surgery. This may include:

• Reviewing and adjusting medications, particularly blood thinners
• Improving control of diabetes, blood pressure, and other chronic conditions
• Treating anaemia, where present
• Addressing dental, urinary, or skin infections that could spread to the joint
• Stopping smoking, which significantly improves wound healing and implant fixation
• Nutritional advice, especially for patients who are underweight or have low protein levels

Practical Preparation

You will be asked to prepare for a longer recovery than after primary hip replacement. Helpful steps include arranging help at home, setting up a ground-floor bed if stairs are difficult, removing trip hazards, and obtaining equipment such as a raised toilet seat, grab bars, and a walking aid.

What Happens During Revision Hip Replacement

On the day of surgery, you will meet the anaesthetist, who will discuss whether your operation will be done under general anaesthesia (you are fully asleep) or under spinal anaesthesia (numb from the waist down, often with sedation). Both are routinely used for hip surgery.

The operation itself usually takes between two and four hours, sometimes longer for complex reconstructions or two-stage cases. The broad steps are:

1. An incision is made over the hip, usually along the line of the previous scar
2. The muscles and tissues around the joint are carefully moved aside
3. The existing components are exposed and tested for looseness
4. The failed implant, along with any cement, scar tissue, or infected material, is removed. This is often the most technically challenging part, especially when components are still well-fixed
5. Bone defects are assessed and reconstructed if needed, using grafts, augments, or longer stems
6. The new revision components are trial-fitted, then implanted
7. Stability, leg length, and movement are checked
8. The wound is closed in layers, often with a drain in place for the first day or two

Blood loss in revision surgery can be greater than in primary replacement, and a blood transfusion is sometimes needed. Tissue samples are usually sent to the laboratory during surgery to check for infection, even when none was suspected beforehand.

Recovery and Healing

Recovery from revision hip replacement is typically slower than after a first-time hip replacement. The exact timeline depends on what was done during surgery, the condition of the bone, and your overall health.

Hospital Stay

Most patients stay in hospital for around five to seven days, although this varies. During this time the focus is on pain control, wound care, prevention of blood clots, and starting to move safely.

The First Six Weeks

Early recovery centres on protecting the new implant while allowing the bone and soft tissues to heal. Typical features include:

• Walking with a frame, crutches, or a cane, with the amount of weight you are allowed to put on the leg decided by your surgeon
• Daily physiotherapy exercises to maintain muscle strength and joint movement
• Precautions against dislocation, such as avoiding certain hip positions
• Wound checks and removal of staples or sutures
• Blood-thinning medication to reduce the risk of clots

Six Weeks to Three Months

As healing progresses, weight bearing usually increases, walking aids are gradually reduced, and physiotherapy focuses on strength, balance, and gait. Many people are able to walk around the house without aids by the end of this period, although outdoor walking may still need a cane.

Three to Six Months

Most patients return to routine daily activities during this phase. Driving, light housework, gentle gardening, and a return to office-based work are often possible, depending on the individual case and the surgeon’s advice.

Six to Twelve Months

Full recovery from revision hip replacement can take up to a year. Muscle strength, endurance, and confidence continue to improve over this period. Some patients, particularly after complex reconstructions, may notice ongoing improvement even beyond twelve months.

Rehabilitation

Structured physiotherapy is a central part of recovery. Your physiotherapist will guide a programme that gradually progresses from gentle movements to strengthening and functional exercises. Sticking to this programme has a strong influence on how well the hip works in the long term.

Risks and Complications

Revision hip replacement carries a higher risk of complications than primary hip replacement. This is because the bone and soft tissues have already been operated on, the operation is longer, and the patient population is often older with more medical conditions. It is important to weigh these risks honestly with your surgeon.

Infection

Infection is the most serious complication. It can occur at the wound, in the deeper tissues, or around the new implant. Periprosthetic joint infection after revision sometimes requires further surgery.

Dislocation

The new hip can dislocate, especially in the first few months while the soft tissues are healing. Surgeons often use larger heads, dual-mobility components, or constrained liners in revision surgery to reduce this risk.

Blood Clots

Deep vein thrombosis (a clot in a leg vein) and pulmonary embolism (a clot that travels to the lungs) are recognised risks after any major hip surgery. Blood-thinning medication, compression stockings, and early movement are used to lower this risk.

Nerve and Blood Vessel Injury

The sciatic and femoral nerves run close to the hip joint. They can occasionally be stretched or injured during revision surgery, leading to weakness or numbness in the leg. Most nerve injuries recover, but some may be permanent.

Bone Fracture

The femur or pelvis can crack during removal of old components or insertion of new ones. These intra-operative fractures are usually identified at the time and treated with wires, plates, or additional implants.

Leg Length Difference

It is not always possible to match leg length exactly, particularly when there is significant bone loss or when restoring stability requires a longer stem. Small differences are common and can often be managed with a shoe lift.

Implant Loosening or Failure

Revision implants can themselves loosen, wear, or fail over time. The risk of a further revision is higher after a first revision than after a primary replacement.

Medical Complications

As with any major operation, there are general risks such as reactions to anaesthesia, heart problems, chest infections, urinary infections, and pressure sores. These risks are higher in older patients and those with other medical conditions.

Life After Revision Hip Replacement

For most patients, a well-performed revision hip replacement provides meaningful pain relief and improved function. However, it is realistic to expect that the result may not be identical to that of a successful primary hip replacement. Strength, range of motion, and endurance can take longer to return, and some patients are left with a limp or a feeling of mild instability.

Activities

Once recovery is complete, many patients are able to return to:

• Walking independently, including longer distances
• Driving
• Light household tasks and gardening
• Low-impact exercise such as swimming, stationary cycling, and walking
• Office-based work and many forms of light manual work

High-impact activities such as running, jumping, and contact sports are generally discouraged after revision surgery, as they increase wear and the risk of further loosening or fracture.

Long-Term Joint Care

Protecting the new implant over the long term involves a few consistent habits:

• Maintaining a healthy body weight
• Continuing the strengthening exercises learned in rehabilitation
• Managing chronic conditions such as diabetes and osteoporosis
• Attending regular follow-up appointments and X-rays, even when the hip feels well
• Taking any dental or urinary infection seriously and seeking prompt treatment, as bacteria can occasionally spread to the joint
• Reporting new pain, swelling, warmth, or change in walking pattern to your surgeon

How Long Do Revision Implants Last?

Modern revision implants can function well for many years — often a decade or more — but they do not last forever, and the long-term survival of a revision is generally lower than that of a primary hip replacement. Younger and more active patients are more likely to need a further revision in their lifetime. Your surgeon can give you a more individual estimate based on your reconstruction, bone quality, and activity level.

Frequently Asked Questions

How is revision hip replacement different from my original hip replacement?

The basic goal is the same — a working, pain-free hip joint — but the operation is more complex. The surgeon has to remove the existing implant, deal with any bone loss or infection, and put in new components that often have to be larger or specially shaped. Surgery typically takes longer, blood loss can be greater, recovery is slower, and complication rates are higher than for primary hip replacement.

How do I know if my hip replacement has failed?

Common warning signs include new or increasing hip, groin, thigh, or buttock pain; pain when starting to walk after sitting; a feeling of instability or that the hip is “giving way”; repeated dislocations; a new limp; swelling, warmth, or drainage around the scar; or fever. Any of these, especially when persistent, should be assessed by an orthopaedic surgeon. Not every problem after hip replacement means the implant has failed, but it does need to be investigated.

Will I be able to walk normally again?

Many patients walk well after a successful revision, although a slight limp is not unusual, particularly after complex reconstructions. Adherence to physiotherapy, the condition of the muscles before surgery, and the extent of bone loss all influence the final result.

Will I need crutches or a walker for life?

Most patients move from a walker or crutches to a cane within several weeks, and many no longer need any walking aid indoors by three to six months. Some choose to use a cane for outdoor walking or long distances for added confidence.

How long will the new implant last?

Revision implants can last many years, but the survival rate is generally lower than that of primary implants. The exact lifespan depends on factors such as the type of implant used, the quality of the surrounding bone, your weight and activity level, and the original reason for failure.

Can I have more than one revision on the same hip?

Yes. Some patients undergo more than one revision over a lifetime. Each subsequent operation is usually more complex because there is less healthy bone and more scar tissue. Surgeons aim to make each revision as durable as possible to reduce the chance of needing another.

What happens if I do not have the revision?

The answer depends on the cause. A worn-out plastic liner may continue to cause slowly progressing pain and bone loss. A loose implant tends to cause increasing pain and limit walking. An infected joint, however, can become dangerous if left untreated and may spread infection through the body. Your surgeon will explain what to expect in your specific situation if revision is delayed or declined.

Is revision hip replacement painful?

There is pain after the surgery, as with any major operation, but it is managed with a combination of medications, including nerve blocks, oral pain relief, and sometimes patient-controlled anaesthesia in the first day or two. Most patients find the post-operative pain steadily improves over the first few weeks, and the long-term result is usually much less painful than the failing hip was before surgery.

How soon can I travel after revision hip replacement?

Short local trips are usually fine within a few weeks, but long-distance travel — especially flights — is generally delayed for at least six to twelve weeks because of the risk of blood clots and the need for follow-up. Your surgeon will give you specific guidance based on your case.

Conclusion

Revision hip replacement is a demanding operation, but it can offer real and lasting improvement for patients whose original hip replacement has failed. By removing the failed implant, addressing infection, fracture, or bone loss, and putting in new, specialised components, surgery aims to relieve pain, restore stability, and bring back walking and daily function.

Because every failed hip replacement has its own pattern, the path through diagnosis, surgery, and recovery looks different for each patient. A thorough assessment, a clear understanding of the reason for failure, and an open conversation with an experienced orthopaedic surgeon are the foundations of a good outcome. With careful planning, modern revision techniques, and a committed rehabilitation programme, many patients regain a level of comfort and mobility that they had not expected to see again.