Performed by – Richard Hargrove, Azal Jalgaonkar, Reza Mansouri, Zuhair Nawaz, Andrew Perry, Seb Sturridge

Hip replacements can eventually loosen in the bone and become painful. This may be due to wearing down of the bearing surfaces within the hip or infection. Typically patients will feel pain in the groin or thigh, which starts gradually and is often worse on first standing up. This can be treated by removing the old implant and replacing it with a new one – revising the hip replacement.

What Happens in surgery?
A revision operation is usually more complex than a first time hip replacement. The old components need to be removed and new, usually larger, ones will be put in their place. Sometimes the bone has been worn away and will need replacing with artificial or grafted bone, obtained from a registered bone bank. Bone graft is perfectly safe from infection risk and encourages what is left of the original bone to re-grow. The type of replacement used will vary and special components will sometimes be needed. Generally, we try to avoid using bone cement with revisions.

Revised hip replacement
If infection is the cause of the loosening two operations may be necessary. The first to remove the implant and any infected tissue. The second operation, some 6-8 weeks afterwards, to insert the new definitive hip. During the interval between operations you will be able to go home but will need crutches to get about. Patients generally find it surprisingly easy and comfortable during this time.

After the operation
As the operation is more complex you will be closely monitored in the first day or two, sometimes on the High Dependency Unit. You will probably require a catheter and will generally have to have a post-operative blood transfusion.

The recovery period is likely to be longer than the first replacement, mainly because the muscles take longer to heal as they have been repaired for a second time. You will need to use crutches for longer and it may take up to a year for optimal recovery to be achieved. There is a higher risk of dislocation, fracture, thrombosis and infection following revision surgery, but the overall results are still good with at least 80% of second hips lasting at least 10 years.