What Is The Difference Between A Hip Replacement And A Hip Revision?

If you’ve been experiencing problems with an existing hip replacement your consultant may have spoken to you about needing hip revision surgery. If this is the case, you may be wondering about the differences between hip replacement and hip revision surgery. Read on and we break it down.

Differences between hip replacement and hip revision surgery

Hip replacement and hip revision are associated but different operations. 

What is hip replacement surgery?

Hip replacement (also known as total hip arthroplasty) is the original procedure. You get a hip replacement when your joint has degenerated, creating severe pain, stiffness and mobility problems. In most hip replacement patients, the joint degeneration is caused by osteoarthritis. But it can also be down to other problems including rheumatoid arthritis, avascular necrosis (death of bone tissue because of loss of blood supply), or fracture. Usually, other interventions will have been exhausted by the time you get a hip replacement. 

What is hip revision surgery?

Hip revision surgery is a subsequent procedure conducted when your original (or previous) artificial hip needs to be repaired or replaced.

Hip revision surgery is conducted when your hip replacement fails or creates problems. 

Why might you need hip revision surgery?

Hip revision is typically needed because of problems like:

  • Aseptic loosening – when the hip implant gradually comes loose from the bone (this is the leading cause of hip revision surgery)
  • Infection
  • Fracture surrounding the implant
  • Instability or dislocation – the joint consistently dislocates due to inadequate positioning of the original implant parts or because of weakened muscles 
  • Component failure because of wear, or the implant breaks 
  • Osteolysis – when miniscule particles have worn off from the implant (usually plastic or metal components), causing an immune reaction which attacks the bone around the implant. 

Differences between hip replacement and hip revision surgery: What the procedures involve 

What does hip replacement surgery involve?

Hip replacement surgery is a shorter and more routine surgery – among the most common elective operations in the UK. 

In a hip replacement procedure, the surgeon removes the impaired hip ball-and-socket and fits an artificial implant (usually ceramic or metal) into the thigh bone, with a cup placed into the pelvis. 

Hip replacement usually takes 1-2 hours.

Most patients can walk with crutches by the next day. Recovery to most routine activities normally takes 2-3 months. Full recovery (recovered joint flexibility, full strength and total muscle healing) takes 6-12 months.

What does hip revision surgery involve?

A key difference between hip replacement and hip revision surgery is in complexity. A hip revision procedure is significantly more complex than a hip replacement.

The surgeon needs to carefully take out the original implant (which was well-fixed in place during the initial surgery) without damaging the remaining healthy bone.  

New components then need to be fitted. If the bone has fractured or degenerated, the surgeon might restore it with the use of bone grafts or longer implants. 

Hip revision usually takes 2-3 hours, and in very complex cases can take 4-5 hours. 

What surgical approaches might be used for hip revision surgery? 

Common surgical approaches to hip revision include:

  • Posterior approach (Posterolateral): The hip joint is accessed from the back via the gluteal muscles, without fully separating them from the bone. It offers exceptional visualisation and is a very common approach for hip revision.
  • Direct Lateral (Transgluteal) approach: The hip joint is accessed from the side, with the surgeon detaching or splitting a part of the hip abductor muscle to get to the bone. It is often used for hip revisions when the original hip replacement approach was anterior (from the front), or if a key revision priority is avoiding future posterior dislocations. 
  • Extended Posterior approach: If a patient has deeply-fixed implants or substantial bone loss, a surgeon may create a larger incision to provide better visibility and access – in order to then perform intricate revisions and reconstruction, such as repairing damaged bone. 

Mr Jerome Davidson, internationally renowned consultant orthopaedic hip surgeon says: “These days, we have lots of leading-edge techniques and technology at our disposal when it comes to hip replacement and hip revision surgery.

“For example, robot-assisted surgery offers us in-theatre precision imaging, allowing us to pinpoint exactly where the implants need to be placed. Custom-design hip replacement enables us to create an implant tailored specifically to a patient’s unique anatomy, rather than the standard approach of picking from a collection of pre-made implants. This can be particularly helpful for people with an unusual hip structure or significant bone loss. We also now have ceramic hip implants, which are significantly more durable than the traditional metal-on-plastic ones – and this often makes them particularly relevant for younger or highly active patients, whose hips will undergo more wear and tear.” 

How many times can you have a hip revision?

There is no set maximum number for hip revisions. Indeed, there are people who have had multiple revisions. However, generally with every revision procedure, more bone is lost and the surgery becomes more complicated.

So the question of whether another surgery is realistic depends in large part on how much healthy bone is left and the strength of the tissue surrounding it. This is another reason why Mr Davidson’s approach is as minimally invasive and precise as it can be, always preserving as much of your bone and tissue as possible. 

Risks and complications of hip revision 

While hip revision is a generally safe and effective procedure, it carries longer recovery times than hip replacement and higher risks of complications including implant loosening, bone fractures, infection and joint dislocation. 

With this in mind, it is imperative that hip revision is done by a highly skilled surgeon. 

Mr Davidson is a fellowship trained surgeon. This means he has spent extra time specialising, in addition to his orthopaedic training. Research shows that hip revision surgery performed by fellowship trained surgeons results in higher success rates and lower complication rates. 

Mr Jerome Davidson, has received specialist training from some of the most eminent surgeons in the world at dedicated centres globally including The Royal National Orthopaedic Hospital (UK) and The Royal Adelaide Hospital (Australia). His NHS practice is based in a specialist centre where he conducts hip revision surgery. He has performed numerous successful hip revisions, frequently for complex cases. 

Simply put, Mr Jermone Davidson is one of the UK’s foremost hip surgeons. If you’re considering hip revision surgery, you’re in safe hands.

To arrange a consultation or talk through your hip concerns, contact Mr Davidson’s secretary at 020 8168 0111 or simply book a consultation online.