Medically Reviewed by Dr Wang Lushun
Senior Consultant Orthopaedic Surgeon
MBBS (S’pore), MRCS (Edinburgh), MMed (Ortho), FRCS (Ortho) (Edinburgh)
A hip replacement replaces a severely damaged natural joint with an artificial one to improve movement and reduce pain. But problems can sometimes develop after the original surgery, whether in the months that follow or many years later. The implant may loosen or become unstable, infection can develop around the joint, or changes may occur in the surrounding bone.
When this happens, the next step is not always as simple as replacing the implant again. Previous surgery can change the anatomy of the hip, while bone loss, scar tissue and the condition of the existing implant can make further surgery more complex.
For someone experiencing persistent or new problems after a hip replacement, the first question is therefore not simply whether another operation is needed, but what has gone wrong with the existing hip replacement and what can be done about it.
New or worsening symptoms after a hip replacement do not necessarily mean that the implant has failed or that revision surgery will be needed. However, changes such as increasing pain, reduced mobility, instability or difficulty bearing weight can be reasons to have a previously replaced hip assessed.
The cause may lie with the artificial joint itself, the surrounding bone or the tissues that support it. Some of the problems that may eventually lead to revision surgery include:
Over time, parts of a hip replacement can wear or lose their secure fixation to the surrounding bone. Wear particles from the artificial joint can also trigger bone loss around the implant, a process known as osteolysis.
Loosening may cause increasing pain around the hip, groin or thigh, difficulty bearing weight or reduced mobility. If significant loosening or wear is identified, revision of the affected components may be considered.
Repeated dislocation or a persistent feeling that the hip is unstable may indicate a problem with the position of the implant components, the surrounding soft tissues or both.
When instability keeps recurring, revision surgery may be considered to address the underlying mechanical cause. This can involve repositioning or replacing particular components of the artificial joint.
An infection involving an artificial hip, known as a periprosthetic joint infection, can affect the implant, bone and surrounding tissues. Increasing pain, swelling, warmth or redness around the hip, wound drainage or fever may be signs that warrant medical assessment.
Treatment depends on factors such as the type and duration of the infection and the condition of the implant. Some infections may require removal of existing components and revision of the hip replacement, either during the same operation or in stages.
A fracture can sometimes occur in the bone around an existing hip replacement, known as a periprosthetic fracture. This may happen after a fall or other injury, particularly when the surrounding bone has become weaker.
Treatment depends on where the fracture has occurred, whether the implant remains securely fixed and the condition of the remaining bone. If an implant has become loose or the fracture compromises its stability, revision surgery may be required.
Once a problem with a replaced hip is suspected, the next step is to establish its cause and determine whether it involves the implant, surrounding bone, soft tissues or another source altogether.
Your doctor will ask when your symptoms began, how they have changed and whether you have experienced problems such as pain, instability or difficulty bearing weight. Details about the original hip replacement, including when it was performed and the type of implant used, can also help guide the assessment.
X-rays are commonly used to assess how the artificial hip joint is positioned and fixed, as well as the condition of the surrounding bone. They can help identify changes that may explain your symptoms and determine whether any implant components appear to be affected. Depending on the findings and suspected cause, additional imaging may be recommended to examine the hip in greater detail.
If infection is a possible cause, blood tests may be used to look for signs of inflammation. Joint aspiration, where fluid is taken from around the artificial joint for testing, may also be recommended in certain cases.
Together, these findings help the doctor determine what is causing the problem, whether revision surgery is appropriate and, if so, how extensive the revision may need to be.
Once revision surgery is considered appropriate, the procedure is planned according to what needs to be corrected. Unlike a first hip replacement, revision surgery involves working with an existing implant and with bone and soft tissues that may have changed since the original operation.
A hip replacement consists of several components, and not all of them necessarily need to be removed. If some components remain well positioned and securely fixed, the surgeon may revise only the parts contributing to the problem. In other cases, several or all components may need to be removed and replaced. The extent of surgery depends on which components are affected and the condition of the surrounding bone and soft tissues.
Removing existing components can be more technically demanding when they are firmly fixed or when there has been significant bone loss. The surgeon needs to account for the amount and quality of bone available to support the revised hip. Where necessary, bone grafting or specialised revision implants may be used to address areas of bone loss and provide support for the new components.
Recovery after revision surgery depends on how extensive the procedure was and the condition of the hip before surgery. Some patients may initially need restrictions on how much weight they place through the operated leg, particularly when bone reconstruction or fracture treatment has been required. Rehabilitation and follow-up are then adjusted according to the procedure performed and how the hip progresses during recovery.
Problems with a hip replacement do not always mean that the entire implant needs to be replaced. The priority is to identify the cause of the symptoms, assess the existing components and surrounding bone, and determine what treatment may be appropriate.
At Arete Orthopaedic Centre, patients with hip and knee conditions can receive specialist assessment and treatment, including further evaluation of problems following previous joint surgery. Dr Wang Lushun is a senior consultant orthopaedic surgeon with more than 20 years of experience and a clinical focus that includes complex revision hip and knee replacement surgery.
If you are experiencing new or persistent pain, instability or difficulty with a previously replaced hip, book an appointment to determine the cause and discuss the best possible treatment.
Revision hip replacement can be more technically demanding because existing components may need to be removed, while previous surgery, scar tissue or bone loss can affect how the new components are positioned and fixed. Some patients may also require additional reconstruction as part of the procedure.
Yes. A hip replacement can undergo more than one revision during a patient's lifetime. However, previous operations can affect the remaining bone and soft tissues, so each subsequent revision needs to be planned according to the condition of the hip at that time.
If available, yes. Previous operative reports, implant information, X-rays and other imaging can help the hip doctor understand how the original replacement was performed and which components were used. If these records are no longer available, the hip can still be assessed and further investigations arranged where necessary.
MBBS (S’pore), MRCS (Edin), MMed (Ortho), FRCS (Ortho) (Edin)
With over 20 years of experience, Dr Wang Lushun is an orthopaedic surgeon who specialises in treating a wide range of sports injuries and musculoskeletal conditions. He has in-depth experience in minimally invasive surgery and advanced robotic surgery. Dr Wang provides orthopaedic care to athletes and everyday individuals throughout their journey to recovery.
