Revision Hip Replacement

Revision hip replacement is a surgery to replace the components of a Total Hip replacement. Hip is a large ball and socket joint which may be damaged due to arthritis or other cause.  The surgery involves replacing the parts forming the Hip joint with prosthetic/man made parts.

Total hip replacement is one of the most successful surgeries in modern medicine. On an average, hip replacement surgery may last for 15-20 years or more. Due to various biological and mechanical reasons the parts may fail, requiring a surgery involving removal of implant and replacing them.

Revision hip replacements are usually more complex surgeries than primary total Hip replacements requiring extensive planning and use of special implants. The ultimate goal however remains the same as of primary replacement.  The aim of providing pain free mobility so that the patients can return to activities they enjoy. 

Revision Hip Replacement

Prosthetic components removed due to failure.

Components of Total Hip Replacement

  • Acetabulum cup made of metal alloy or ceramic. It is is fixed with screws or press-fitted in the socket forming the Hip joint after removing damaged 
  • A special form of highly durable plastic called polyethylene is placed in the socket to allow smooth gliding
  • A stem made of metallic alloy is inserted in the upper part of the thigh bone (femur). The stem may be press-fit or fixed using a special form of bone cement.
  • A prosthetic head made of metal alloy or ceramic is placed on the stem replacing the natural head of the femur.

Acetabular shell with multiple screw hole options.

The acetabular shell is usually press fitted in the acetabular cavity. The acetabular cavity is prepared by reaming the cavity that allows new bone to grow into the outer porous coating of the acetabular shell. The multiple screw options are advantageous in revision surgery.

Prosthetic femoral head and acetabular liner

The acetabular liner made of highly cross linked polyethylene fits in the acetabular shell and provides a smooth surface for the prosthetic head to rotate in the cavity. The prosthetic head may be made of ceramic or cobalt chromium alloy.

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).

Causes of Component Failure

Like any mechanical device, the components of hip replacement surgery can fail over time. Number of factors can contribute to their failure and need for revision surgery. 

Wear and Tear : The implant (femoral stem and acetabulum cup) must be firmly fixed to the underlying bone. This is achieved either by the use of bone cement or the implant is press fit. Press fitting allows bone to grow onto the implant. 

The failure of bone to grow on the implant or loosening of bone cement weakens the fixation. This may lead to chronic pain with decrease in mobility.

Younger patients with a total Hip replacement outlive the lifespan of the implant requiring revision. Additionally, individuals who are overweight and engaging in high impact activities require a revision surgery sooner. This is due to excessive forces acting about the joint loosening the fixation. 

The plastic liner which is made of high quality polyethylene wears out over time giving out tiny particles. These are attacked by the body’s immune system recognizing them as foreign bodies causing inflammation. The immune cells fighting the plastic breaks also attack the healthy bone which leads to loosening of implant known as osteolysis. 

Infection : Every surgery carries a risk of infection which may occur immediately or occur in several months or even years. Infectious organisms accumulating in and around the prosthesis cause the implant to become loose same fail. 

Obese patients with diseases such as diabetes are at an added risk of infection. Infectious bacteria can enter into blood from distant sites such as teeth and accumulate forming an abscess around the prosthetic joint. Symptoms usually are pain or even a draining abscess from the joint. 

Trauma : Injuries sustained to the hip during a trauma caused by fall or accident can cause loosening of prosthesis. There may be a fracture of the bone around the implant (periprosthetic fracture) or rarely breakage of the metal implant itself. The revision usually requires use of special implants depending upon the amount of remaining bone. 

Dislocation : For the joint to function the ball must remain in the socket at all times. Dislocation occurs when the ball pops out of the socket due to trauma or certain positions of the artificial joint. Proper alignment of the components and balancing of forces by muscles and tendons is important. 

Once dislocated the joint becomes more prone to recurrent dislocations as muscles and tendons around the joint get damaged. This may warrant a revision surgery to properly align the prosthetic components preventing dislocation. 


Revision hip replacement is a complex Surgery requiring special implants work increased surgery and recovery time. Usually more number of investigations are needed. The patient may be subjected to blood tests and imaging studies (X-ray, CT scan, MRI, Bone scan). In case the surgeon suspects an infection, a joint aspiration may be done to rule out or confirm the infection. 

The surgical procedure on the day of surgery after anesthesia is more complex than primary replacement. The surgeon gets an access to the joint through the same incision or a different one. Careful examination of the soft tissues is done to look for infection and examine the components which are loose. 

Only the plastic liner and head of stem is replaced in some cases. This is done in case of the firm contact of acetabulum cup and femoral stem. In case of loose implant, they are extracted carefully trying to preserve the bone. Sometimes a controlled fracture may be done to gain access to the implant for removal. 

Specialized implants are used to recreate the Hip joint. It may sometimes require bone graft (from deceased compatible ) and metals to augment/compensate for the lost/damaged bone. 

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. 

Revision Hip Replacement1

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. 

In a selected few cases a single stage surgery may be performed depending upon the severity of infection. Infected protestors requiring revision usually remain a long time on iv antibiotics with a very prolonged recovery period. 


Revision hip replacements usually have a prolonged recovery period depending upon the cause of revision. Daily activities such as cooking, shopping, bathing, laundry, driving are limited for several weeks. Patients usually walks work an aid of crutches/walker with precautions restricting certain activities. 

Full recovery and return to activities the enjoys takes about 6 months.  Regardless most patients enjoy pain free mobility offered by the surgery allowing them to carry on their daily activities. 


The risk of complications are more in revision hip replacement owing to prolonged surgery time and prolonged recovery period. There are risks of infection, blood clots, pulmonary embolism (blood clots in lung). Additionally there may be damage to nerve/blood vessel or leg lengthening/shortening. There is also a risk of failure of bone to attach to the prosthetic implant and implant loosening. 

All the potential complications are discussed by the surgeon with the patient. Certain measures like compression stockings, blood thinners, physical therapy, antibiotics and precautions are undertaken to prevent complications. 


A greater number of revisions are being performed today successfully. This has lead to pain free hip joint, promising return to activities the patients enjoy. Although the revision surgeries are complex with a prolonged recovery time, long term outcomes are excellent. 

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Based on 115 reviews
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.