A total hip replacement is one of the most successful operations in medicine, but no implant lasts forever. Revision hip replacement is the operation in which part or all of a previous hip prosthesis is removed and replaced. It is technically more demanding than a primary replacement and should be carried out by a surgeon who performs it regularly.
Aseptic loosening and wear. Microscopic particles released from the bearing surface provoke a biological reaction that resorbs the bone around the implant. Over years this leads to loosening and bone loss. This remains the most common reason for revision.
Recurrent dislocation. Instability may follow component malposition, soft-tissue deficiency, abductor damage from the original approach, or a change in the patient’s spinal mechanics.
Periprosthetic infection. Infection may appear early after surgery or years later through bloodstream seeding. It is the most serious cause of failure and requires a specific treatment strategy.
Periprosthetic fracture. A fracture of the femur around the stem, usually after a fall, may require revision if the implant is loose.
New or increasing groin or thigh pain, pain on starting to walk, a sensation of the hip giving way, a change in leg length, recurrent dislocations, swelling, redness or a discharging wound, and fever. Pain that appears after a period of a well-functioning hip is never normal and should be assessed promptly.
Assessment combines clinical examination with serial radiographs looking for radiolucent lines, implant migration and osteolysis. Blood inflammatory markers (CRP and ESR) are measured, and joint aspiration with culture and synovial fluid cell count is performed whenever infection is suspected. CT is used to quantify bone loss and plan reconstruction; nuclear medicine studies are added in selected cases.
In aseptic loosening the loose components are removed, the bone defect is reconstructed — with bone graft, augments, or acetabular cages and revision stems that gain fixation in healthy bone distally — and new implants are inserted. In septic loosening the standard approach is a two-stage revision: removal of all implants and cement, thorough debridement, insertion of an antibiotic-loaded spacer and targeted intravenous antibiotics, followed by reimplantation once the infection has been eradicated. In selected cases a single-stage revision is possible.
Recovery after revision surgery is slower than after a primary replacement and depends on the amount of bone loss and the quality of fixation achieved. Weight-bearing may be restricted for several weeks, hospital stay is longer, and rehabilitation typically continues for six to twelve months. Results are good when the problem is identified early, before extensive bone loss develops — which is the strongest argument for regular follow-up of every hip replacement.
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