Revision hip replacement is a specialised orthopedic surgical procedure designed to correct a failed primary hip implant. While primary total hip replacement exhibits high long-term success, mechanical components can wear down, loosen from the bone, or fail due to infection or fracture over time. The primary objective of revision surgery is to remove the compromised original hardware, reconstruct lost bone stock, and securely fix new prosthetic components. According to the American Academy of Orthopaedic Surgeons (AAOS 2021), revision surgery aims to restore pain-free walking mechanics, joint stability, and structural leg length alignment.

Unlike primary hip replacement, which replaces native bone and cartilage, revision procedures must address altered joint anatomy, scar tissue formation, and bone loss. Surgeons utilise specialized revision hardware, including modular stems, porous metal augments, acetabular cages, and bone grafts to achieve stable fixation in compromised tissue.

Revision hip replacement begins with general or regional spinal anesthesia. The surgeon opens the previous surgical scar to expose the hip joint. Soft tissue capsule and scar tissue are meticulously dissected to reach the prosthesis. The stability of both the acetabular cup and femoral stem is evaluated. Loose or damaged hardware is extracted using specialised instruments designed to conserve remaining bone. Soft tissue and inflammatory membranes (pannus) are radically cleaned. Bone defects in the socket or femur are reconstructed using porous titanium metal augments, structural bone grafts, or custom 3D-printed implants. Trial components are placed to verify joint stability, leg length, and range of motion. Final modular revision components are securely inserted using press-fit porous surfaces or bone cement. The wound is irrigated thoroughly, deep tissue layers and skin are closed, and sterile dressings with deep surgical drains are applied as needed.

Revision hip replacement provides critical clinical benefits for individuals suffering from failed primary hip replacements:

• Profound Pain Relief: Effectively eliminates deep groin, buttock, and thigh pain caused by loose hardware, osteolysis, or persistent joint infection.
• Restoration of Joint Function and Mobility: Reconstructs proper hip biomechanics, allowing patients to regain independent walking, stair climbing, and daily activity.
• Correction of Leg Length Discrepancy: Re-establishes structural leg length alignment compromised by bone collapse or hardware displacement.
• Prevention of Progressive Bone Loss: Reconstructs structural bone stock using porous metal technology or bone grafts, halting further osteolytic degradation.
• Joint Stability Restoration: Resolves chronic dislocation risk by optimizing component orientation and restoring soft tissue tension.

Recovery from revision hip replacement requires a longer, more gradual timeline than primary total hip replacement due to extensive tissue handling and bone reconstruction.

• Inpatient Phase (Days 1–4): In-hospital care focuses on pain management, wound check, deep vein thrombosis (DVT) prophylaxis, and initial weight-bearing training with walker or crutches.
• Early Recovery (Weeks 1–6): Gradual increase in home walking. Strict hip precautions (avoiding bending past 90 degrees, crossing legs, or extreme internal rotation) are maintained based on surgical approach. Crutches or a walker are typically required.
• Intermediate Phase (Weeks 7–12): Transition from walking aids to an independent gait. Physical therapy focuses on strengthening the gluteus medius and hip abductor muscles, improving posture, and restoring range of motion.
• Advanced Rehabilitation (Months 3–6): Resumption of low-impact recreational activities such as walking, swimming, and stationary cycling. Bone integration into porous implants reaches structural maturity.
• Long-Term Recovery (Months 6–12): Final stabilization of soft tissues, maximal improvement in strength and gait velocity, and long-term surveillance imaging.

Revision hip replacement is indicated for a range of mechanical, structural, and biological failure mechanisms affecting primary hip implants:

• Aseptic Loosening: Progressive breakdown of the bone-implant interface without bacterial infection, leading to micro-motion, severe groin or thigh pain, and joint instability.
• Periprosthetic Joint Infection (PJI): Deep bacterial colonization of the implant surfaces requiring single-stage or two-stage surgical revision combined with targeted antimicrobial therapy.
• Recurrent Joint Dislocation: Repeated instability and luxation of the ball from the socket due to component malalignment, soft tissue laxity, or abductor muscle deficiency.
• Periprosthetic Fracture: Bone fractures occurring around the prosthetic stem or cup, often secondary to falls or underlying focal bone loss (osteolysis).
• Polyethylene Component Wear and Osteolysis: Particle debris generated by wear of the artificial liner triggering an inflammatory response that dissolves surrounding bone.
• Mechanical Hardware Failure: Fracture or structural deformation of the metal stem, neck, or acetabular liner.

Preoperative preparation includes comprehensive physical and diagnostic evaluations. Blood testing includes inflammatory markers (ESR, CRP) and complete blood count. Diagnostic joint aspiration is performed if infection is suspected. Imaging consists of anteroposterior and lateral hip radiographs, CT scanning with metal artifact reduction, and occasionally nuclear bone scans. Medical clearance involves cardiovascular and pulmonary evaluation. Preoperative physical therapy instruction teaches post-operative movement precautions and gait training with assistive devices. Patients must stop specific blood-thinning medications under physician direction, optimize blood glucose control, treat active dental or urinary infections, and chlorhexidine body washes prior to surgery.

Common and mild risks include temporary surgical pain, localized bruising, mild swelling, and temporary leg length awareness. Moderate risks include superficial wound infection, joint stiffness, localized hematoma, and minor nerve irritation (transient femoral or sciatic nerve neurapraxia). Serious and rare complications include deep periprosthetic joint infection (PJI), recurrent dislocation, deep vein thrombosis or pulmonary embolism, intraoperative periprosthetic bone fracture, major sciatic or femoral nerve injury, vascular trauma, and hardware breakage or persistent aseptic loosening requiring re-revision.

The patient journey for revision hip replacement requires extensive clinical planning, multi-stage intervention when infection is present, and structured rehabilitation.

• Preoperative Workup: Advanced imaging using computed tomography (CT) scans, magnetic resonance imaging (MRI) with metal artifact reduction, laboratory inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), and joint fluid aspiration to rule out periprosthetic joint infection (PJI).
• Surgical Intervention: Performed under general or neuraxial (spinal) anesthesia. Surgical steps include explicit removal of old hardware, radical debridement of fibrous tissue, bone defect reconstruction using augments or bone graft, component trial positioning, and final fixation.
• Inpatient Recovery: Typically lasts 3 to 5 days. Early mobilization begins within 12 to 24 hours under physical therapy supervision, alongside intravenous antibiotic prophylaxis and multimodal analgesia.
• Outpatient Rehabilitation: Structured physical therapy continues for 3 to 6 months to restore gait, balance, and muscle strength around the hip abductor complex.
• Long-Term Surveillance: Follow-up appointments with radiographic imaging at 6 weeks, 3 months, 1 year, and biennially thereafter to evaluate bone integration and hardware stability.