What is revision hip surgery and why might I need it?

What Is Revision Hip Surgery And Why Might I Need It?

Hip revision surgery is a surgical procedure that involves repairing or replacing a hip replacement implant that is not functioning as it should. The aim is to restore function and mobility, and reduce pain.

While hip replacements are designed to last for many years (according to a systematic review, a hip replacement can be expected to last 25 years in around 58% of patients), some implants eventually fail. This can happen for a number of reasons, including wear and tear, infection, dislocation or fracture. 

In some cases, such as after a fall, the need for revision surgery cannot be avoided. However, closely following post-surgery advice can help reduce the risk of complications and prolong the lifespan of an implant.

This article explains what hip revision surgery involves, why it might be needed, and steps that can be taken to help prevent the need for hip revision surgery.

What hip revision surgery involves

Hip revision surgery is a complex procedure carried out to replace or repair a worn or damaged hip implant. The operation typically takes longer than an initial hip replacement because the surgeon must first remove the old implant and any damaged tissue or bone before inserting the new components.

Depending on the extent of the damage, your surgeon may also need to reconstruct some of the bone in the hip using grafts or specialised implants to restore stability and function. Revision surgery is usually performed under general or spinal anaesthetic, and patients often stay in hospital for between two and five days afterwards for observation and pain management.

Recovery times can vary depending on the complexity of the procedure and the patient’s overall health. Physiotherapy is usually recommended to help restore strength and mobility, and it can take several months to return to normal activities.

Why you might need hip revision surgery

There are several reasons why a hip replacement may fail and require revision surgery:

Loosening

Loosening is one of the most common reasons for revision surgery, particularly in long-standing hip replacements. A study of more than 5,000 total hip replacement patients found that loosening was more likely to occur in those with a higher BMI, of a younger age, and in men.

Wear and tear

Over time, the surface of the implant can gradually wear and the surrounding bone subsequently weakens. This is known as osteolysis, and it is the most common cause of implant loosening, leading to pain, stiffness and reduced mobility. Mr Jerome Davidson favours ceramic hip replacements for their excellent durability and long-lasting performance. 

Infection

Infection can occur shortly after surgery or even years later. When bacteria attach to the implant, they can form a biofilm that makes it difficult for antibiotics to work effectively. In such cases, the infected implant must often be removed and replaced.

Dislocation

If the artificial joint becomes unstable or dislocates repeatedly, revision surgery may be needed to correct the position of the implant or replace components with more stable designs.

Fracture

A fracture around the implant, known as a periprosthetic fracture, can occur following a fall or trauma, or with repeated stress on the hip joint. Depending on the severity and location of the fracture, revision surgery may be required to repair the fracture and secure the implant.

Instability

Some patients may experience a feeling that the joint is giving way or slipping, even without full dislocation. Instability can cause pain, limit movement, and increase the risk of future dislocations.

Component malposition

If the original implant was not positioned correctly, it may lead to uneven wear, pain and limited function. Revision surgery allows the surgeon to correct alignment issues and restore proper joint movement. Mr Jerome Davidson uses robot-assisted technology to increase the accuracy of hip replacement to prevent such issues from occurring and reduce the risk of complications.

What can be done to prevent the need for hip revision surgery?

While not all cases of implant failure can be avoided, there are steps patients can take to help reduce the risk of needing revision surgery. These include:

  • Follow post-surgery instructions carefully. Adhering to your surgeon’s recovery plan, including restrictions on movement and activity, can prevent early complications.
  • Maintain a healthy weight. Excess weight puts added pressure on the hip joint, which can speed up wear and tear.
  • Stay active, but safely. Regular exercise helps strengthen muscles around the hip and maintain flexibility. Mr Davidson generally does not recommend patients return to contact martial arts after hip replacements, as there is a higher risk of damaging the implant.
  • Attend all follow-up appointments. Routine check-ups allow your surgeon to monitor how the implant is performing and identify potential issues early.
  • Prevent falls. Taking precautions around the home, such as removing trip hazards and using supportive footwear, can reduce the risk of injury.
  • Address infections promptly. If you develop an infection anywhere in your body, seek medical advice quickly, as bacteria can spread to the implant through the bloodstream.

By taking these measures, patients can help extend the lifespan of their hip replacement and reduce the likelihood of needing further surgery.

When will I know if I need hip revision surgery?

If you’ve had a hip replacement and start to experience new or worsening symptoms such as pain, stiffness, instability or difficulty walking, it may be a sign that your implant is no longer functioning as it should. Other indicators can include swelling, warmth around the joint or a noticeable change in alignment.

If you have any concerns, it’s important to consult an orthopaedic hip surgeon promptly. They can assess your hip with imaging and a physical examination to determine whether revision surgery is necessary. Early evaluation and intervention can help prevent further complications and support a smoother recovery.

Looking for a hip surgeon? Mr Jerome Davidson is a consultant trauma and orthopaedic hip surgeon who specialises in minimally invasive hip surgery, as well as primary and revision hip replacements. To arrange a consultation, please call 020 8168 011 or book online.