Hip

Failed / Revision Total Hip Arthroplasty

Revision total hip arthroplasty (reoperation to replace or repair a failed total hip replacement) is among the most complex procedures in reconstructive orthopedics. While modern primary THA implants are highly durable, all prostheses can eventually fail, and some fail earlier due to infection, instability, or other causes. At Maryland Orthopedic Specialists, our adult reconstruction team has the expertise, implant access, and surgical planning resources to address even the most challenging revision hip cases, restoring stability, eliminating pain, and maximizing long-term function.

Ready to get started?

Schedule an appointment with a specialist experienced in treating failed / revision total hip arthroplasty.

Schedule Now

or call (301) 515-0900

In-network with most major insurance plans. Same-day appointments available for acute injuries.

What is failed / revision total hip arthroplasty?

Revision total hip replacement is surgery to repair or replace a previous hip replacement that has failed from wear, loosening, infection, instability, or fracture around the implant. The surgeon removes the worn or loose components and implants new ones, sometimes rebuilding lost bone. It is more complex than the original replacement.

Revision THA involves removing some or all components of a failed hip replacement and implanting new prosthetic parts, often with augmentation for bone defects. It is technically more demanding than primary THA due to:

Existing implants that must be removed without damaging remaining bone
Bone loss from the original implant, osteolysis, or periprosthetic fracture
Compromised soft tissue from prior surgery
Altered anatomy from the index procedure
Higher infection risk in the revision setting

Volume and trends: The number of revision THA procedures is rising as the volume of primary THA grows. AAOS projections estimate revision THA demand will increase significantly through 2030 as more procedures are performed in younger, more active patients.

Symptoms — do you recognize these?

Aseptic loosening: Gradual onset groin/thigh pain, worse with weight-bearing; often preceded by years of good function
PJI: Pain (often constant), warmth, swelling, sinus tract, fever — or may be subtle chronic pain without systemic signs
Dislocation: Sudden severe pain, deformity, shortened/externally rotated leg; inability to bear weight — medical emergency requiring emergent reduction
Periprosthetic fracture: Sudden onset pain after fall or minimal trauma; inability to bear weight
Bearing wear/osteolysis: Often asymptomatic until advanced; pain and instability as bone stock is lost

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

A thorough pre-revision workup is essential to identify the cause of failure before planning surgery.

Laboratory studies:

ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein): Elevated in infection; normal ESR and CRP have high negative predictive value for PJI
CBC with differential: Leukocytosis in acute PJI; often normal in chronic PJI
Alpha-defensin (synovial fluid biomarker): Highly specific for PJI
D-dimer, IL-6: Emerging PJI biomarkers under investigation

Hip aspiration: Joint aspiration with synovial fluid analysis (cell count with differential, culture and sensitivity, alpha-defensin, glucose) is mandatory in all cases of suspected PJI. Synovial WBC > 3,000 cells/μL with >80% PMNs is strongly suggestive of PJI (per MSIS/ICM criteria). Culture results guide antibiotic selection.

Imaging:

Plain X-rays (AP pelvis, AP and lateral hip): Assess component position, migration, periprosthetic lucency, osteolysis, polyethylene wear, fracture
CT scan: Quantifies bone defects (acetabular and femoral); assesses component version; essential for preoperative planning
Nuclear medicine bone scan / leukocyte-labeled scan: Helps distinguish aseptic loosening from infection when workup is equivocal
Metal artifact reduction sequence (MARS) MRI: Identifies soft-tissue masses (pseudotumors) and ALTR in metal-on-metal bearing patients

Treatment options

Surgical Procedure

Revision Hip Arthroplasty

Surgical revision of a failed hip replacement, addressing worn components, loosening, instability, or periprosthetic infection. Requires specialized revision implant systems and reconstruction techniques beyond primary replacement.

Click for more

Recovery & rehabilitation

Recovery after revision THA is substantially more demanding than primary THA:

Weight-bearing restrictions: Vary by procedure. Immediately weight-bearing after simple component exchange; toe-touch weight-bearing for 6–12 weeks after major acetabular reconstruction
Two-stage PJI exchange: 6–12 weeks between stages; active rehabilitation after Stage 2; return to community ambulation 3–6 months after Stage 2
Aseptic loosening revision: Return to household ambulation 6–12 weeks; full recovery 6–12 months
All revisions: More intensive PT than primary THA; longer recovery; expectations appropriately set pre-operatively

Frequently Asked Questions

How do I know if my hip replacement is failing?

New onset pain after a period of satisfactory function warrants evaluation, particularly groin, thigh, or buttock pain that worsens with activity. X-rays and laboratory tests can detect loosening and infection before advanced bone loss occurs. Annual X-ray surveillance is recommended for all THA patients.

What is a "two-stage" hip replacement for infection?

In a two-stage revision, all infected hardware is removed and an antibiotic-loaded spacer is placed. After 6–12 weeks of antibiotic treatment and confirmation of infection clearance, new implants are placed. This two-step process is necessary because biofilm-protected bacteria cannot be eradicated with antibiotics alone while the implant remains in place.

Is revision surgery as successful as primary THA?

Revision THA is significantly more complex with higher complication rates and less predictable outcomes than primary THA. Success depends on the cause of failure, degree of bone loss, presence of infection, and the surgeon's revision experience. In experienced hands, most patients achieve meaningful pain relief and improved function.

Can I prevent my hip replacement from failing?

Maintaining a healthy weight reduces implant loading. Avoiding high-impact activities reduces wear. Preventing and promptly treating remote infections (dental procedures, UTIs, skin infections) reduces hematogenous PJI risk. Annual surveillance X-rays allow early detection of osteolysis before structural compromise occurs.

What is a "constrained liner" and why would I need one?

A constrained liner mechanically locks the femoral head inside the acetabular socket, preventing dislocation. It is used when a patient has persistent dislocation despite correctly positioned components, particularly with deficient abductor muscles. The trade-off is higher interface stresses and potential for cup loosening.

Meet the specialists

Brian McCormick, MD

Adult Reconstruction · Hip and Knee Replacement

Meet Dr. McCormick →

Related conditions

Hip Osteoarthritis

Medically reviewed by Brian McCormick, MD

Last reviewed May 1, 2026

References

Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8 Suppl):61–65. https://doi.org/10.1016/j.arth.2012.02.022
Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992–2994. https://doi.org/10.1007/s11999-011-2102-9
Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. J Arthroplasty. 1994;9(1):33–44. https://doi.org/10.1016/0883-5403(94)90135-X
Berend KR, Lombardi AV Jr, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471(2):510–518. https://doi.org/10.1007/s11999-012-2595-x
Gehrke T, Alijanipour P, Parvizi J. The management of an infected total knee arthroplasty. Bone Joint J. 2015;97-B(10 Suppl A):20–29. https://doi.org/10.1302/0301-620X.97B10.36475
American Academy of Orthopaedic Surgeons. Revision Total Hip Replacement. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/revision-total-hip-replacement/