Revision Hip Replacement Surgery – Brisbane & Hamilton

What is Revision Hip Replacement Surgery?

Revision surgery replaces one or more parts of an existing hip replacement.

A revision hip replacement, also called revision total hip arthroplasty (revision THA), is an operation performed when an existing hip replacement develops a problem that requires further surgery.

A hip replacement usually consists of:

• a metal socket fixed into the pelvis
• a plastic or ceramic liner
• a metal stem inserted into the femur
• a ceramic or metal ball attached to the stem

Revision surgery does not necessarily mean replacing the entire hip replacement. Depending on the problem, surgery may involve changing:

• the ball or liner
• the acetabular component (socket)
• the femoral component (stem)
• several or all of the components

Revision hip replacement is generally more complex than a first hip replacement because there may be scar tissue, bone loss, infection, muscle damage, fracture or difficulty removing existing implants.

Specialised revision implants, bone graft or other reconstruction techniques may therefore be required.

Why is Revision Hip Replacement Surgery Done?

Surgery is considered when a hip replacement has a correctable mechanical or biological problem.

Modern hip replacements can function successfully for many years, but problems can occasionally develop.

Common reasons for revision include:

• aseptic loosening – an implant becomes loose without infection
• infection around the hip replacement
• recurrent dislocation or instability
• fracture around the hip replacement
• wear of the bearing surfaces
• bone loss around the implants
• implant breakage or mechanical failure
• adverse reactions to wear debris or particular implant materials

A 2024 analysis of national joint replacement registries from multiple countries found that the most frequently reported reasons for revision hip replacement were aseptic loosening, infection, dislocation or instability, and periprosthetic fracture.

Importantly, pain after hip replacement does not automatically mean that revision surgery is required.

Pain can arise from the replacement itself, but can also come from muscles, tendons, the lower back, nerves or other structures.

For example, a systematic review of iliopsoas impingement after hip replacement found that selected patients can be treated with non-operative management or iliopsoas tendon surgery rather than revision of the hip replacement.

The first objective is therefore to establish why the hip is painful or failing and whether revision surgery is likely to correct that problem.

How is Revision Hip Replacement Surgery Performed?

The operation is individually planned around the implants, bone loss and reason for failure.

Every revision hip replacement is different.

Planning commonly involves X-rays and may also include CT scans, blood tests, joint aspiration or other investigations.

Anaesthetic

A spinal or general anaesthetic may be used, together with additional methods of pain relief.

Accessing and assessing the hip

The existing hip replacement is exposed and carefully assessed.

The operation may involve examining:

• fixation of the socket
• fixation of the femoral stem
• implant position
• bone loss
• hip stability
• muscles and tendons
• bearing-surface wear
• possible infection

Removing existing implants

Sometimes only the ball and liner need to be changed.

If the socket or stem is loose, it can usually be removed relatively easily. Removing a well-fixed implant can be considerably more difficult.

Specialised instruments may be required to remove the component while preserving as much healthy bone as possible.

Occasionally, the femur needs to be carefully opened to remove a well-fixed stem and then reconstructed around the new implant.

Reconstructing the hip socket

Revision surgery may reveal areas where bone has been lost around the socket.

Depending on the amount and location of remaining bone, reconstruction may involve:

• a larger acetabular component
• additional screws
• bone graft
• porous metal augments
• specialised revision cups
• more complex reconstruction systems for major bone loss

A 2024 review of acetabular bone loss in revision hip replacement describes how the amount and pattern of remaining pelvic bone guide the reconstruction required.

Reconstructing the femur

If the femoral component needs revision, a specialised stem may be required.

Revision stems are often longer than standard hip replacement stems, allowing fixation in healthy bone further down the femur.

Metal cables or other fixation may sometimes be required around the femur, particularly where bone is thin, damaged or fractured.

Improving hip stability

Instability can be an important problem following revision hip replacement.

Treatment can involve correcting implant position, restoring appropriate muscle tension, changing femoral head size or using specialised bearing surfaces.

One option in selected patients is a dual-mobility bearing, which is designed to increase the effective range before the hip can dislocate.

A 2024 systematic review and meta-analysis comparing dual-mobility and fixed-bearing implants found lower rates of revision for dislocation with dual-mobility constructs, including in revision hip replacement. Longer-term comparative evidence is still developing.

Closing the hip

Once the reconstruction is complete, the deeper tissues are carefully repaired and the incision is closed in layers before a dressing is applied.

How is an Infected Hip Replacement Treated?

Infection may require implant removal, antibiotics and one-stage or staged reconstruction.

Periprosthetic joint infection is an important reason for revision hip replacement.

Investigation can include:

• blood tests
• aspiration of fluid from the hip
• microbiological cultures
• tissue samples taken during surgery

Treatment depends on how long the infection has been present, the organism involved, implant fixation, bone and soft-tissue condition and the patient's overall health.

One-stage revision

In selected circumstances, the infected implants are removed, the hip is thoroughly cleaned and a new hip replacement is inserted during the same operation.

Two-stage revision

In other situations, treatment is performed in stages.

The infected implants are removed and the hip is thoroughly cleaned. A temporary antibiotic-containing spacer may be inserted and antibiotics are given.

The definitive hip replacement is then inserted during a later operation.

An updated systematic review and meta-analysis comparing one-stage and two-stage revision for hip replacement infection found no significant difference in reinfection, mortality, aseptic loosening or overall revision rates between the strategies in the available comparative studies.

This does not mean that both approaches are equally appropriate for every infection. Treatment is individualised according to the organism, implants, bone, soft tissues and patient.

Preparing for Revision Hip Replacement

Optimising your health and home is particularly important before complex revision surgery.

Health preparation

Before surgery:

• stop smoking or vaping if possible
• optimise diabetes and blood sugar control
• improve general fitness where appropriate
• maintain good nutrition
• provide a complete list of medications and supplements
• tell us about blood-thinning medications
• tell us about previous infections or wound problems
• tell us about previous blood clots, heart or lung conditions and sleep apnoea

If infection is suspected, additional investigations will usually be required.

Prehabilitation

The amount of exercise possible depends on the problem with your existing hip replacement.

Maintaining general fitness, upper-body strength and strength in the unaffected leg can be particularly useful if crutches or a walking frame will be required after surgery.

Preparing your home

Revision hip replacement recovery may take longer than recovery from a first hip replacement.

Arrange help with meals, shopping and transport. Remove loose rugs and other trip hazards and consider how you will manage stairs, showering and everyday activities.

Because Brisbane has a warm and humid climate, particularly during summer, consider making sure you have access to a cool, comfortable and preferably air-conditioned environment during early recovery. Apart from making recovery more comfortable, published research has found an association between warmer weather and higher rates of surgical-site infection.

Keeping yourself comfortable and your surgical dressing clean and dry is therefore particularly important during Brisbane's warmer months.

What Should I Expect After Revision Hip Replacement?

Recovery varies greatly according to how much reconstruction was required.

In hospital

You can expect:

• several different forms of pain relief
• physiotherapy and mobilisation when appropriate
• measures to reduce blood-clot risk
• antibiotics when required
• crutches or a walking frame

Some patients can place full weight through the operated leg relatively early.

Others require restricted or protected weight-bearing while bone graft, fractures or more complex reconstruction heals.

First 2–6 weeks

Walking aids are used as instructed and swelling around the hip and leg is common.

Your early review focuses on wound healing, pain, walking and overall progress.

6 weeks–3 months

Walking, strength and confidence should progressively improve.

Rehabilitation is tailored to the reconstruction performed. Someone having a relatively straightforward ball-and-liner exchange will have a very different recovery from someone requiring extensive reconstruction of the pelvis and femur.

Driving and work should resume according to safe function, medication use and the individual operation rather than a fixed date.

3–12 months

Improvement in strength, walking, pain and confidence can continue for 12 months or longer.

Revision hip replacement often requires more patience than a first hip replacement.

What Are the Long-Term Outcomes After Revision Hip Surgery?

Revision may improve pain and function, but outcomes vary between patients.

Revision hip replacement can provide meaningful improvements when the underlying problem can be identified and corrected.

A study comparing patient-reported outcomes after revision and primary hip replacement found significant improvements in pain, function, activity and quality of life following revision surgery. However, the magnitude of improvement and final outcome scores were lower than after primary hip replacement.

More recent prospective patient-reported outcome research after aseptic revision hip replacement similarly found overall improvements in pain and function at one year, while demonstrating considerable variation between individual patients.

This makes realistic expectations particularly important. A 2024 review of patient expectations surrounding revision hip replacement found that patients commonly had high expectations regarding walking ability, pain relief and implant longevity compared with their eventual outcomes.

How long does a revision hip replacement last?

There is no single lifespan for a revision hip replacement.

Durability depends on:

• the reason for revision
• amount and quality of remaining bone
• infection
• muscle and soft-tissue condition
• implants required
• age and activity
• previous operations

A registry study of 629 aseptic revision hip replacements reported approximately 87% implant survival without further revision at five years.

These figures describe a group of patients and cannot predict how long an individual revision hip replacement will last.

What Should I Look Out for After Revision Hip Replacement?

Wound problems, severe pain, dislocation or breathing symptoms require prompt assessment.

Contact our office, your GP or seek medical attention if you develop:

Possible infection

• increasing redness or warmth around the incision
• worsening pain after initially improving
• persistent wound leakage or pus
• fever, chills or feeling significantly unwell

Possible blood clot

Seek medical attention for new calf pain or significant one-sided leg swelling.

Sudden shortness of breath, chest pain or coughing blood requires emergency assessment.

Hip dislocation

Sudden severe hip pain, inability to move the leg or a leg appearing shortened or abnormally rotated requires urgent assessment.

Wound problems

Persistent leakage, wound opening or rapidly increasing swelling should be assessed promptly.

Fracture or sudden change in function

Sudden severe pain or inability to put weight through the leg after a fall or unexpected movement should be assessed.

Nerve or circulation problems

Increasing weakness or numbness, a cold or pale foot, or severe escalating pain requires urgent medical assessment.

Revision Hip Replacement Surgery

Dr Alexey Borshch is a specialist orthopaedic surgeon in Brisbane with a particular clinical focus on surgery of the hip, knee and lower limb.

His practice as a Brisbane orthopaedic surgeon includes primary and revision hip replacement surgery, as well as the assessment of painful or problematic existing hip replacements.

Revision hip replacement can range from changing one component of an existing replacement to complex reconstruction involving the socket, femur, bone graft, specialised revision implants or treatment of infection.

Dr. Borshch completed his medical degree at the University of Queensland before undertaking specialist orthopaedic training in Queensland. He completed the Australian Orthopaedic Association training program and the Royal Australasian College of Surgeons Fellowship Examination in Orthopaedic Surgery. He obtained specialist registration in Orthopaedic Surgery in 2022 and is a Fellow of the Australian Orthopaedic Association.

He offers consultations in Hamilton, Brisbane, and conducts private orthopaedic surgery at Brisbane Private Hospital.