Revision Total Hip Replacement

During primary total hip replacement surgery, the hip joint is replaced with an implant or prosthesis made of metal, plastic, and/or ceramic components. Although most total hip replacements are very successful, problems can develop over time. These problems may require a revision procedure to replace the original components.

There are different types of revision surgery. In some cases, only some components of the prosthesis need to be revised. In other cases, the whole prosthesis needs to be removed or replaced and the bone around the hip needs to be rebuilt with augments (metal pieces that substitute for missing bone) or bone graft.

Damage to bone and soft tissue around the hip may make it difficult for the doctor to use standard primary hip implants for revision hip replacement. In most revisions, the doctor will use specialized implants that are designed to compensate for the damaged bone and soft tissue.

In order for a total hip replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, the hip replacement components were either cemented into place or were “press fit” into the bone to allow bone to grow onto them. Sometimes, however, bone may fail to grow onto press-fit components. In addition, cemented or press-fit components that were once firmly fixed to the bone can eventually loosen, resulting in a painful hip.

The cause of loosening is not always clear, but repetitive high-impact activities, excessive body weight, and wear of the plastic liner between the ball and the metal cup are all factors that may contribute.

In addition, patients who are younger when they undergo the initial hip replacement may “outlive” the life expectancy of their artificial hip. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear.