Hip replacement revision

Modern prostheses have good survivorship, but over the years they can loosen, wear, dislocate or become infected. When that happens and causes pain or loss of function, a revision may be indicated.

Before operating it is essential to understand why the prosthesis is failing. Radiographs —sometimes compared with previous ones—, blood tests and, when in doubt, a joint aspiration are reviewed, because the first step is always to rule out infection: if the cause is infectious, the treatment is different (see two-stage revision).

A prosthesis that is painful but well fixed and not infected obliges us to look for other causes —the spine, the tendons around the hip, a hernia— before recommending a revision, so that we do not reoperate without a clear reason.

This workup defines which components are changed and which implants and grafts must be available on the day of surgery.

The failed components are removed carefully, preserving as much bone as possible, and the remaining bone is assessed. Often bone defects must be reconstructed with grafts or metal augments, using revision implants such as longer stems that anchor further down the femur or special cups and meshes for the pelvis.

Planning ahead with imaging is essential to anticipate the defect and have the right implants available; for large defects, custom solutions are used.

Recovery is usually slower than after a primary replacement and sometimes requires protecting weight-bearing for several weeks while the bone and grafts integrate. Rehabilitation is tailored to the reconstruction performed.

The decision to operate is made together: we discuss your symptoms, their impact on daily life, the expected benefits, the risks and the alternatives. Surgery does not guarantee an outcome; it aims to improve pain and function in selected patients.