Revision Hip Arthroplasty

Why this approach — at MOS

Revision hip arthroplasty is among the most technically demanding procedures in orthopedic surgery. Its outcomes are directly tied to surgical experience, pre-operative planning, and access to the full range of implant reconstruction options. Not every surgeon who performs primary hip replacement has the training and case volume to manage the spectrum of revision scenarios safely.

Our adult reconstruction specialist brings fellowship-level training in complex revision hip surgery. The pre-operative evaluation is thorough: all available implant information is reviewed, lab work and joint fluid analysis are completed, and bone loss is characterized by CT scan when necessary. The operative plan — including ETO decision-making, augment selection, and stem choice — is made before the patient enters the operating room.

In cases of suspected infection, a standardized workup is completed before any revision procedure. Two-stage reconstruction for periprosthetic joint infection involves removal of all infected components, placement of an antibiotic-loaded cement spacer, a period of targeted antibiotic therapy, and reimplantation once infection eradication is confirmed.

The principles guiding revision reconstruction at MOS: restore hip biomechanics (leg length, offset, center of rotation), achieve durable fixation in available bone, manage any bone defects with appropriate grafting or augmentation, and minimize the risk of complications that would necessitate a third operation. Patients in the Montgomery County region seeking a second opinion on a proposed revision, or those who have been told they are "too complex" for their current surgeon, are encouraged to request a consultation.

Who is a candidate?

Indications

• Aseptic loosening: The bond between the implant and bone breaks down over time, causing pain with weight-bearing and implant migration on serial X-rays
• Polyethylene wear and osteolysis: The bearing surface wears and particles trigger bone resorption (osteolysis) around the implant, weakening fixation
• Periprosthetic joint infection (PJI): Bacterial infection around the implant — often requiring a two-stage reconstruction (explant, antibiotic spacer, then re-implantation)
• Recurrent dislocation / instability: Recurrent hip dislocations despite closed reduction and bracing, often due to component malposition or soft tissue insufficiency
• Periprosthetic fracture: Fracture through bone adjacent to the implant, disrupting fixation
• Component fracture: Rare but occurs — fracture of the femoral stem or neck
• Corrosion / trunnion failure: Adverse local tissue reaction to metal debris from modular implant interfaces
• Failed primary implant (any cause): When a patient has persistent, unexplained pain, workup is performed to identify the source

Contraindications

• Uncontrolled or uncorrected infection without a staged plan
• Active systemic infection that has not been treated
• Medical comorbidities that make prolonged surgery unreasonably risky
• Insufficient bone stock without a plan for augmentation or reconstruction
• Patient refusal or inability to comply with post-operative restrictions

Conservative Treatment First

When a hip replacement fails, non-surgical management is occasionally appropriate for a limited period — particularly in patients whose symptoms are mild, who have significant medical risk factors, or who have infection requiring antibiotic optimization before surgery. Analgesics and activity modification can control symptoms temporarily.

However, revision hip arthroplasty is fundamentally a condition that worsens without surgical treatment. Continued implant loosening destroys more bone. Infection spreads. Recurrent dislocations carry cumulative soft tissue damage. For most patients with documented implant failure, timely surgery is in the patient's best interest — delay often makes the reconstruction more difficult.

The procedure

What Is Revision Hip Arthroplasty?

Revision hip arthroplasty is a complex surgical procedure that removes and replaces one or more components of a failed primary hip replacement. It is significantly more demanding than primary hip replacement due to scarring, bone loss, and altered anatomy, and requires a surgeon with specific expertise in revision reconstruction techniques.

Hip replacement implants are designed to last 20–30 years, and the majority perform well for decades. But no implant lasts forever, and failure can occur earlier due to a variety of mechanisms. When a hip replacement fails, revision surgery is often the only way to restore function and relieve pain.

Revision hip arthroplasty is not simply "re-doing" a hip replacement. The surgeon must remove well-fixed implants — sometimes cemented in place or extensively bone-ingrown — from bone that has been altered by prior surgery. The bone stock available for supporting the new implant is often compromised by wear-related osteolysis (bone loss from implant debris), stress shielding, or prior surgical damage. Restoring leg length, stability, and biomechanics in this environment is substantially more technically demanding than in a primary procedure.

This is a procedure that demands both experience and access to the full range of implant systems, augments, and bone grafting options. The goals are to restore a stable, pain-free hip and to maximize the longevity of the revision reconstruction.

What Happens During Revision Hip Arthroplasty?

Revision hip arthroplasty is performed at a hospital under general or spinal anesthesia. Operative time is 120–240 minutes depending on complexity. Two or more units of blood may be prepared; cell salvage (autotransfusion) is commonly used.

Pre-Operative Assessment Revision surgery begins weeks before the operating room. Detailed X-rays and CT scans define the degree of bone loss and the nature of the failed components. Lab work and joint aspiration rule out or confirm infection. Implant type is identified. Bone graft and implant needs are templated, and the surgical plan is established — including whether an extended trochanteric osteotomy (ETO) will be needed.

Component Removal The original implants must be removed — this is often the most technically demanding step of the procedure. Implants with extensive bone ingrowth require specialized tools (flexible osteotomes, ultrasonic cement removal devices, trephine reamers) to extract without causing unnecessary bone damage.

If the femoral stem is extensively ingrown and cannot be safely removed by conventional means, an extended trochanteric osteotomy (ETO) is performed. A controlled longitudinal bone cut along one-third of the femoral circumference creates a cortical flap that is hinged open, exposing the implant-bone interface along its full length. The stem can then be extracted safely. The trochanteric flap is reattached with cables or plate-and-cable constructs at the end of the procedure, and union is expected in 6 months in the vast majority of patients.

Acetabular Reconstruction The acetabular component is removed and the acetabulum is inspected. Bone defects are classified (AAOS or Paprosky classification) and addressed. Small defects may be managed with impaction bone grafting and cemented or press-fit cups. Larger defects may require augments — structural metal wedge or buttress components that fill the bone loss and restore a stable platform for the acetabular shell. Highly porous titanium cups (trabecular metal or equivalent) are commonly used for revision acetabular reconstruction because of their superior biological fixation.

Femoral Reconstruction A new femoral stem is selected based on the available bone stock. Short, standard-length stems are often inadequate in revision cases. Longer fluted tapered stems that bypass areas of bone loss and achieve fixation in intact diaphyseal cortex are a common choice. After trial reduction to assess stability, leg length, and offset, the final implant is assembled.

Stability Assessment and Closure The hip is taken through a full range of motion to assess stability, bearing surface impingement, and leg length equality. Final closure is performed in layers. Drains may be placed. Patients are admitted for 2–4 days depending on complexity.

Recovery timeline

Frequently Asked Questions