Revision hip replacement: when it's needed, what's involved and the risks

Hip replacement surgery has become a common and highly successful procedure for people with hip pain and mobility issues due to various conditions, such as osteoarthritis, rheumatoid arthritis or hip fractures. However, in some cases, the original hip replacement may fail or wear out over time, leading to the need for revision hip replacement surgery. 

Here, we’ll explore when revision hip replacement surgery is needed, what the procedure involves and the associated risks.

When is revision hip replacement needed?

Revision hip replacement, also known as secondary hip replacement, is needed when your original hip replacement implant fails or causes complications. 

Several reasons may lead to the need for revision surgery:

Implant wear and tear

Over time, your artificial hip joint may wear out, causing pain, instability and reduced mobility. This can result from normal wear and tear. It is especially common in individuals who have had their hip replacements for many years.

Infection

Infection can occur in your hip joint, leading to the need for revision surgery. In some cases, this may involve removing the infected implant and replacing it once the infection is under control.

Implant loosening

Your artificial hip components may become loose or dislodged from the bone, causing pain and instability. This can result from various factors, including bone loss or poor implant placement.

Fracture

Fractures around your implant site can result in the need for revision surgery. These fractures may occur due to a fall, trauma or stress on the hip joint.

Component malposition and recurrent dislocation 

Incorrect positioning of the hip implant components during your initial surgery can lead to discomfort, limited range of motion, dislocation and the need for revision surgery.

Implant recalls

In rare cases, hip implants are recalled due to manufacturing defects or safety concerns. In these cases, revision surgery is needed to replace the defective implant.

What is involved in revision hip replacement?

Revision hip replacement surgery is a more complex procedure than the initial hip replacement. It typically involves the following steps:

Preoperative assessment

Before surgery, your surgeon will conduct a thorough evaluation, which may include imaging tests, blood tests and a review of your medical history. This assessment helps determine the extent of the problem and helps plan the surgery.

Anaesthesia

Revision hip replacement is performed under general or spinal anaesthesia to ensure you’re comfortable and pain-free during the procedure.

Removal of the failed implant

Your surgeon will make a cut (incision), usually along the same scar as your original surgery, to access your hip joint. The failed implant components, including the stem, cup and any damaged bone, will be carefully removed.

Bone preparation

In cases of bone loss or damage, your surgeon may need to rebuild or reinforce your bone using grafts or special implants.

New implant placement

Your surgeon will insert new hip implant components, which may include a new stem, socket and possibly a liner. These components are selected based on your specific needs.

Closure and recovery

After implant placement, your incision will be closed and you will be carefully monitored during your recovery process. Physiotherapy and rehabilitation are crucial to help regain the strength and mobility of your hip.

Risks associated with revision hip replacement

While revision hip replacement can improve your quality of life, it is not without risks. Some potential complications and risks include:

Infection

The risk of infection is always present with any surgical procedure. In revision hip replacement, the risk may be higher, especially if infection was the reason for the revision.

Blood clots

The risk of blood clots forming in your legs (deep vein thrombosis) or travelling to your lungs (pulmonary embolism) is a concern after any major surgery.

Nerve damage

Nerves around the hip joint can be injured during surgery, leading to numbness or weakness in your leg.

Dislocation

There is a risk of your hip joint dislocating or becoming unstable after revision surgery, especially if there is a significant amount of bone loss.

Implant failure

New hip implants can also fail or wear out over time, potentially leading to further revisions in the future.

Longer recovery

Recovery from revision hip replacement surgery is often longer and more challenging than the initial hip replacement, and you may not achieve the same level of function as before.

Is revision hip replacement surgery right for you?

It is essential to work closely with your healthcare team to understand the potential risks and benefits of having revision hip replacement surgery in your particular circumstances. This will help determine the appropriate course of action. 

While revision surgery can provide you with relief from hip pain and improve your mobility, it’s not without its challenges and risks. You should carefully consider all your options and consult with your orthopaedic surgeon to make an informed decision about your hip health and quality of life.