The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hip

Revision Total Joint Arthroplasty

Revision total joint arthroplasty — the surgical replacement or reconstruction of a failed hip or knee replacement — represents some of the most technically demanding work in orthopedic surgery. Where primary joint replacement is largely standardized, revision surgery confronts an entirely different set of challenges: compromised bone stock, scarred soft tissues, altered anatomy, and failed hardware. At Maryland Orthopedic Specialists, our Adult Reconstruction team has the specialized training, implant resources, and surgical expertise required to manage complex revision cases — restoring function and relieving pain in patients whose primary replacements have failed.

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What is revision total joint arthroplasty?

Revision surgery involves the removal of one or more components of a failed joint replacement and reconstruction with new implants. Depending on the mode of failure, revision may involve replacing all components (full revision), exchanging select components (e.g., polyethylene liner only, or femoral head and liner), or managing complex bone defects with augments, cones, sleeves, or structural allograft.

Revision surgery involves the removal of one or more components of a failed joint replacement and reconstruction with new implants. Depending on the mode of failure, revision may involve replacing all components (full revision), exchanging select components (e.g., polyethylene liner only, or femoral head and liner), or managing complex bone defects with augments, cones, sleeves, or structural allograft.

Common reasons for failure requiring revision:

  1. Periprosthetic joint infection (PJI): The most urgent indication; mandates comprehensive debridement and, in most cases, exchange of all implants.
  2. Aseptic loosening: Loss of implant fixation due to wear-particle osteolysis or cement fatigue; the most common non-infectious reason for revision.
  3. Instability: Recurrent dislocation (hip) or giving-way and functional instability (knee) from component malposition, ligament failure, or polyethylene wear.
  4. Periprosthetic fracture: Fracture around or at the tip of an implant requiring implant revision if the stem is loose or bone stock is deficient.
  5. Stiffness / arthrofibrosis: Severe limitation of range of motion after TKA that has failed conservative measures.
  6. Component failure: Fracture of a femoral stem or tibial baseplate; bearing dissociation; catastrophic polyethylene failure.
  7. Adverse local tissue reactions (ALTR): Primarily associated with metal-on-metal hip implants; tissue necrosis from metallosis.

Patients presenting with pain in a joint replacement require systematic evaluation before revision is contemplated. Establishing the specific diagnosis — particularly ruling out or confirming PJI — is essential because treatment strategies differ dramatically.

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.

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Revision Total Knee Replacement

Complex re-operation to address worn, loose, unstable, or infected knee replacement components. Requires modular augments, intramedullary stems, and increased constraint levels matched to the degree of bone and ligament deficiency.

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Frequently Asked Questions

Is revision surgery more dangerous than my original joint replacement?
Yes. Revision surgery carries higher rates of complications including infection, blood loss, nerve injury, instability, and implant failure than primary surgery. This is why the decision to revise is made carefully and the diagnosis confirmed thoroughly before proceeding.
Will revision surgery give me the same result as my original replacement?
Outcomes are generally good but not as predictable as primary surgery. Most patients experience significant pain relief and functional improvement, but recovery is longer and the long-term durability of revision implants is somewhat lower.
How do you know whether I need revision surgery?
Not all failed joint replacements require surgery. After a thorough evaluation — including labs, imaging, and aspiration — we determine the specific cause of failure. Some causes respond to non-surgical measures; structural failure of components requires surgery.
Do I need to go to a specialized center for revision surgery?
Revision arthroplasty performed at high-volume centers by fellowship-trained Adult Reconstruction surgeons has consistently better outcomes than revision performed by lower-volume surgeons. MOS offers this expertise locally in the greater Maryland area.
How long does recovery from revision joint replacement surgery take compared to my original replacement?
Recovery from revision total joint replacement is typically longer and more demanding than primary replacement because more bone and soft tissue are involved, and the surrounding muscles may have weakened from the original failed implant. Most patients see substantial improvement in the first three months, but full recovery — including optimal strength and function — can take six to twelve months or more. Inpatient rehabilitation or a skilled nursing facility stay is more common after revision surgery than after primary replacement. Your MOS revision surgeon will set realistic milestones and coordinate closely with physical therapists to help you achieve the best possible outcome.

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Brian McCormick, MD

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Related conditions

Aseptic Implant LooseningInstability After Total Knee ArthroplastyPeriprosthetic Fracture
Medically reviewed by Christopher S. Raffo, MD
Last reviewed June 15, 2026

References

  1. Kurtz SM, Ong KL, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–785. https://doi.org/10.2106/JBJS.F.00222
  2. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today — has anything changed after 10 years? J Arthroplasty. 2014;29(9):1774–1778. https://doi.org/10.1016/j.arth.2013.07.024
  3. Fehring TK, Odum SM, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001;392:315–318. https://doi.org/10.1097/00003086-200111000-00041
  4. Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J. 2016;98-B(1 Suppl A):120–124. https://doi.org/10.1302/0301-620X.98B.36345
  5. Paprosky WG, Greidanus NV, Antoniou J. Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999;369:230–242. https://doi.org/10.1097/00003086-199912000-00023
  6. American Academy of Orthopaedic Surgeons. Revision Total Knee Replacement. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/revision-total-knee-replacement/