The previous incision is reopened (or a new approach used). The old components are carefully removed — this may require specialised instruments, osteotomies (controlled bone cuts), and significant time if the implants are well-fixed or cemented. Bone defects are assessed and reconstructed using bone graft, metal augments, trabecular metal components, or cages. New revision components with longer stems and larger cups are implanted. The operation takes two to five hours depending on complexity.
Revision is needed for aseptic loosening (the implant has become loose), periprosthetic infection (after failed DAIR), recurrent dislocation, periprosthetic fracture, wear or failure of bearing surfaces, and adverse reaction to metal debris.
For loosening: observation if asymptomatic and minimally progressive. For infection: long-term antibiotic suppression (accepting persistent infection). For dislocation: constrained liner or bracing. These are rarely definitive solutions.
CT scan with metal artefact reduction for bone stock assessment. Blood tests including metal ions and inflammatory markers. If infection is suspected, joint aspiration. Identification of the existing implant type. Blood available for transfusion. Specialist revision centre.
Restoration of hip function and pain relief. Revision hip replacement outcomes are generally good but less predictable than primary surgery. Dislocation, infection, and re-revision rates are higher than primary.
Longer recoveryExpected
Recovery is slower than primary hip replacement.
Blood lossCommon
Significant. Transfusion commonly needed.
Leg length discrepancyCommon
More common than in primary surgery.
DislocationCommon
Risk approximately 5–10%, higher than primary.
Intra-operative fractureCommon
The weakened bone may fracture during component removal or insertion.
Nerve injuryUncommon
Sciatic nerve at increased risk due to scar tissue.
InfectionUncommon
Risk approximately 5–10%, much higher than primary surgery.
Re-revisionLong-term
Further revision may be needed over time.
Bone graft failureUncommon
Allografts may not incorporate.
Medical complicationsCommon
Many revision patients are elderly with comorbidities.
General or spinal anaesthesia. Prolonged operating time. Cell salvage and transfusion capability essential.
Hospital stay three to seven days. Weight-bearing may be restricted depending on bone quality and reconstruction. Crutches for six to twelve weeks. Hip precautions for six to twelve weeks. Physiotherapy for hip strengthening. Full recovery six to eighteen months.
Regular X-rays at six weeks, three months, one year, and then annually. Long-term surveillance of the reconstruction.
Why is revision more complex than primary?
Bone loss, scar tissue, cement removal, altered anatomy, and compromised soft tissues make revision surgery significantly more challenging. It requires specialist training and equipment.
How long will a revision hip last?
Revision implants generally have shorter survival than primary implants. Modern revision constructs have approximately 80–90% survival at ten years, but this depends on the patient, the indication, and the quality of remaining bone.