Revision Hip Replacement

A revision hip replacement is a “redo” or a repeat surgery to replace the parts of a hip implant that have worn out, loosened, become infected, or otherwise failed. Most modern hip implants last 20-30 years but no artificial joint lasts forever. Over time the parts can give out for both biological and mechanical reasons.

When that happens, the old parts are removed and replaced with more comprehensive parts. Revision surgery is more complex than the original hip replacement. It takes more planning, special longer-lasting implants, and has a longer recovery. But the goal is exactly the same, a pain-free hip that lets you get back to the activities you enjoy.

This page explains why implants fail, what the redo surgery involves, and what recovery looks like.

What conditions require a revision hip replacement:

This treats a previous hip implant that has stopped working properly. Like any mechanical device, an artificial hip can fail over time, and there are four main reasons it happens:

• Wear and loosening. For the implant to work, it has to stay firmly anchored to the bone. Over time it can loosen, causing pain and reduced mobility. The plastic liner also slowly wears down and sheds tiny plastic particles; the body treats those particles as foreign. While mounting a immune response to these particles, you body also accidentally dissolves nearby bone too (a process called osteolysis). This loosens the implant further. This happens faster in younger, heavier, or very active people.
• Infection. Any surgery carries an infection risk, and around an implant it can show up months or even years later. Bacteria can even travel from somewhere else in the body (like the teeth) and settle around the joint. Infection can loosen the implant and may cause pain or a draining wound. People with diabetes or obesity are at higher risk.
• Injury. A fall or accident can loosen the implant, break the bone around it, or break the implant itself.
• Dislocation. If the ball repeatedly slips out of the socket, the surrounding muscles and tissue get stretched and damaged, making future dislocations more likely. Fixing the alignment may require revision.

 

Prosthetic components removed due to failure

When should you consider surgery:

The usual signals are returning hip pain, new instability / repeated dislocations, reduced mobility, or signs of infection. This includes pain and a draining wound.

If your surgeon suspects a problem, they’ll usually run more tests than they did the first time around. Often we order blood tests and imaging (X-ray, CT, MRI, or bone scan), and frequently we draw a sample of fluid from the joint to check for infection, since infection is treated very differently.

Confirming the exact cause is important, because it shapes what kind of revision surgery you’ll need.

What happens during revision surgery:

The exact procedure depends on what failed, and it’s more involved than the original surgery. Working through the old incision or a new one, the surgeon examines the tissues and parts to see what’s loose or infected. From there:

• If only part of the implant is worn (and the rest is still firmly attached), sometimes just the plastic liner and the ball are swapped out.
• If parts are loose, they’re carefully removed. We try to preserve as much of your bone as possible. Occasionally the surgeon makes a controlled opening in the bone to get a stuck part out.
• Special revision implants are then used to rebuild the joint. These often include longer, stouter, bone in growing stems for better stability. We may also use adjustable “modular” stems that can compensate for missing bone. If a lot of bone is gone, donor bone graft or metal pieces may be used to build it back up.

Infection makes things more complex. When the implant is infected, the surgery is often done in two stages: first the infected implant is removed, the joint is thoroughly cleaned, and a temporary antibiotic-loaded spacer is put in.

After several weeks of antibiotics clear the infection, a second surgery puts in the new permanent implant. (In select cases this can be done in a single stage.) Treating an infected implant usually also means a long course of IV antibiotics and a longer recovery.

What does recovery look like:

Recovery from a revision is longer than from the original hip replacement. The exact length depends on why the revision was needed. For the first 4-6 weeks, everyday tasks like cooking, shopping, bathing, laundry, and driving are limited.

Most people get around with crutches or a walker and follow precautions that restrict certain movements. Full recovery and return to favorite activities takes about 4-6 months. Driving can usually be resumed at 6 weeks. Most of the time we want you walking the first day after surgery. Sedetary work can usually be resummed around 4-6 weeks post op but heavy manyal labor may take 4+ months.

The reassuring part: even though it’s a longer road, most people end up with the same pain-free, mobile hip. Revision surgery is designed to restore this.

What are the major risks and complications:

Because revision surgery takes longer and the recovery is more drawn out, the risks are somewhat higher than with the original hip replacement surgery. They include:

• Infection.
• Blood clots in the leg, which can be dangerous if one travels to the lungs.
• Nerve or blood vessel injury near the surgical area.
• A difference in leg length afterward.
• The bone failing to bond to the new implant, or the implant loosening again.

To lower these risks, surgeons use measures like compression stockings, blood thinners, antibiotics, physical therapy, and activity precautions. Your surgeon will discuss all of this with you.

What if you don’t have surgery:

A failing hip implant generally doesn’t fix itself, so the question is usually when to revise rather than whether to. Left alone, a loose or worn implant tends to keep causing pain and instability. Additionally, the bone loss around it often continues, which can make the eventual repair harder and more complex.

Infection in particular shouldn’t be left untreated, since it can spread and become dangerous. That said, the timing is a decision to make with your surgeon, weighing your symptoms, the imaging, and your overall health.

The encouraging news is that revision surgeries are done very successfully today, with excellent long-term results even though the road is longer.

Revision surgery components:

Fully porous coated long femoral stem with anatomical bow

During revision surgery, a fully porous coated femoral stem is usually used for a better stability of the component. The stem is also longer than the primary prosthesis to provide more stability. Other types of stems may be used that may have detachable upper and lower parts (modular stems).

Modular femoral stem

A modular prosthetic stem allows the surgeon to compensate for excessive bone loss during extraction of the primary component. The modular stem may consist of holes for screw fixation and fully porous coating for bone ingrowth. The upper part of the prosthesis is designed to transfer load to the stronger inner of the bone.

In case of infected prosthesis, the revision surgery becomes more complicated. Decision regarding the surgery is made after assessing the duration and severity of the infection. Usually a two stage surgery is performed where in the first stage the infected implant is removed. 

Articulating cement spacer

The Hip joint is thoroughly washed and a cement spacer is introduced which is impregnated with antibiotics. After clearance from infection in a few weeks a second surgery is performed removing the spacer and introduction of new implants. 

 

How Medicare Covers Revision Hip Replacement (Both Components)

If you have Medicare, your healthcare provider may bill for CPT Code 27134 — this refers to a revision total hip replacement where both the socket (acetabular component) and the ball/stem (femoral component) of a prior hip implant are removed and replaced. This procedure is more complex than a first-time hip replacement and is typically done for loosening, wear, infection, or other implant failure.

“What Will It Cost You?”

If you don’t have secondary insurance, here’s what you can expect:
Estimated Out-of-Pocket Cost for Revision Hip Replacement, Both Components (27134): $448.00

“For example, hypothetical patient, George needed a revision hip replacement after his old implant loosened. His surgery included 1 procedure: revision hip replacement with both components replaced (27134). Thanks to Medicare, his total out-of-pocket cost was about $448. His secondary insurance then covered it completely!”