Revision Hip Replacement

What is revision hip replacement?

A revision hip replacement is the redo or modification of a previous hip replacement. While most primary hip replacements last more than 15–20 years, some patients eventually experience problems that require further surgery. Revision is more complex than primary surgery and typically takes longer. The goal is always to restore pain-free function, mechanical stability, and quality of life.

Why might you need revision surgery?

• Aseptic loosening — gradual loosening from the bone (most common reason)
• Periprosthetic joint infection (PJI)
• Recurrent dislocation that cannot be managed conservatively
• Bearing surface wear with potential bone loss (osteolysis)
• Periprosthetic fracture
• Component malposition causing pain or mechanical symptoms

What is done — depending on the mode of failure

• Head and liner exchange — when stem and cup are well-fixed and correctly positioned
• Acetabular revision — with bone graft or metal augments where bone loss is present
• Femoral revision — longer stems used to bypass areas of poor bone quality
• Full revision — replacement of all components when both cup and stem are affected

Infection management

• DAIR (Debridement, Antibiotics, Irrigation, Retention): early infections with well-fixed implants — wash-out and liner exchange plus prolonged antibiotics.
• One-stage revision: all components removed, joint debrided, and new implants inserted in a single operation with antibiotic-loaded cement.
• Two-stage revision: gold standard for complex/chronic infections — cement spacer and 6–12 weeks of IV antibiotics, then re-implantation once infection is eradicated.
• Suppressive antibiotics for patients unfit for surgery.

Who is this for?

• Patients with a painful or failing hip replacement
• Patients with confirmed periprosthetic infection
• Patients whose hip replacement has reached the end of its functional lifespan

My approach

• Thorough pre-operative assessment: X-rays, CT, blood tests and joint aspiration as required
• Implant choice tailored to the degree of bone loss
• Antibiotic protocol for infected cases — in collaboration with microbiology and infectious diseases
• Non-infected revision: Meriden Nuffield and UHCW
• Complex or infected revision: UHCW only

Risks

• Higher infection, dislocation and nerve injury risk than primary surgery
• Significant blood loss — transfusion may be required
• Leg length discrepancy is harder to control than in primary surgery
• Risk of fracture around the implant
• Re-revision may be required in the longer term

Recovery

Recovery is generally longer than primary surgery. Hospital stay may be 4–7 days or longer in complex cases. Mobilisation may be more gradual depending on the extent of bone reconstruction. Full recovery may take 6–12 months.