Revision Hip Replacement

Understanding the wear-and-tear changes that can affect your hip joint over time

Revision hip replacement surgery, also known as revision hip arthroplasty, is a complex procedure performed to address problems that can develop after a previous hip replacement. This may include pain, implant loosening, infection, dislocation, or wear of the prosthetic components. This page provides a detailed guide to help you understand what revision surgery involves, why it may be recommended, and what to expect before, during, and after the procedure. It is designed to equip you with clear, practical information and support as you prepare for surgery with Dr Jason Hockings.

What is revision hip replacement surgery?

Occasionally, a primary hip replacement may require revision due to persistent pain, implant wear, instability, loosening, fracture, or infection. Revision hip replacement surgery involves the careful removal and replacement of one or more components of the original hip prosthesis.

Depending on your individual condition, this procedure may also require the reconstruction of bone or soft tissue using bone grafts, augments, or specialised revision implants designed to restore stability and function. In cases of infection, a staged approach may be necessary, involving temporary spacers and antibiotic treatment before reimplantation.

Revision hip replacement is technically more complex than a primary procedure, requiring advanced surgical planning, careful handling of bone and soft tissues, and the use of specialised implants. Dr Jason Hockings has extensive experience in revision hip arthroplasty and will tailor your surgical plan to address your unique anatomy, diagnosis, and previous surgical history.

Common reasons a hip replacement may fail

While most total hip replacements function well for many years, there are several reasons why a hip implant may fail over time. Understanding these causes can help patients recognise potential problems early and seek appropriate care.

Aseptic loosening: This is one of the most common reasons for revision surgery. Over time, the bond between the implant and the surrounding bone may weaken, even in the absence of infection. This can lead to pain, instability, and difficulty walking.
Wear and tear of implant materials: Although modern implants are made from highly durable materials, the artificial joint surfaces can wear down over time, especially in younger or more active patients. This wear may lead to the release of microscopic particles into the surrounding tissue, potentially causing inflammation and bone loss (osteolysis).
Infection: A deep infection around the hip implant is a serious complication that may require revision surgery. Infections can occur shortly after surgery or develop years later. In many cases, the implant must be removed and replaced in a staged surgical process.
Dislocation or instability: If the hip joint becomes unstable or dislocates frequently, revision may be necessary to restore stability. This can occur if the soft tissues are no longer supporting the joint effectively or if the components are not ideally positioned.
Periprosthetic fracture: A break in the bone around the hip implant (known as a periprosthetic fracture) can compromise the stability of the prosthesis. This may happen due to a fall or trauma, and surgical intervention is often required to repair the fracture and revise the implant.
Implant malalignment: Occasionally, implant components may have been placed in a position that does not function optimally with your anatomy. This misalignment can lead to pain, poor mobility, or early failure of the prosthesis.
Metal hypersensitivity or reaction: Some patients may develop a reaction to metal ions released from certain types of implants. This condition, known as adverse local tissue reaction (ALTR), can lead to pain, swelling, and tissue damage around the hip joint.

Signs and symptoms of a failing hip replacement

In many cases, problems with a hip implant develop gradually. Recognising the warning signs of a failing hip replacement early can lead to timely intervention and help prevent further complications. If you experience any of the following symptoms, it’s important to arrange a review with Dr Jason Hockings for a thorough evaluation.

Persistent or worsening hip pain: Pain that continues or intensifies months or years after your initial hip replacement may be a sign that something isn’t functioning correctly. This pain may be felt deep in the groin, buttock, or thigh, and may worsen during walking or weight-bearing activities.
Reduced mobility or stiffness: A previously well-functioning hip replacement that suddenly becomes stiff or limited in movement could be failing. This may occur due to implant loosening, wear, soft tissue scarring, or mechanical problems with the joint.
Instability or recurrent dislocations: If your hip feels unstable, ‘gives way’, or you’ve had one or more dislocations (where the ball pops out of the socket), this may indicate soft tissue laxity, poor implant positioning, or damage to the surrounding structures.
Swelling, warmth, or redness: Persistent swelling around the hip joint, especially when accompanied by warmth, redness, or tenderness, could suggest an infection or inflammatory reaction. These signs should never be ignored and warrant urgent assessment.
A change in leg length or limp: A noticeable limp or the feeling that one leg is longer or shorter than the other may result from implant loosening, subsidence (sinking of the stem), or poor positioning of the prosthesis.
Audible noises: Clicking, grinding, or popping sounds coming from the joint may be harmless in some cases, but if they are new or accompanied by pain, they may indicate implant instability or wear.
Difficulty performing daily activities: If tasks such as walking, getting in and out of a chair, or climbing stairs become increasingly difficult despite having had a hip replacement, further investigation may be needed to assess the function of the implant.

Dr Hockings’ approach to diagnosing implant problems

If you’re experiencing problems following a total hip replacement, a careful and thorough diagnostic process is essential. Dr Jason Hockings is highly experienced in evaluating failing hip replacements and takes a systematic approach to ensure the underlying cause is clearly understood before recommending revision surgery.

1. Comprehensive medical history and symptom review

Your consultation will begin with a detailed discussion about:

When your symptoms began and how they’ve changed over time
Your level of pain, stiffness, instability, or reduced mobility
Any previous complications such as infection or dislocation
Your medical history, general health, and any surgeries you've had since the original hip replacement

Dr Hockings will also ask about your activity levels, walking ability, use of mobility aids, and how your symptoms are impacting your quality of life.

2. Physical examination

A focused orthopaedic examination will assess:

These insights help Dr Hockings determine whether the implant is functioning mechanically and structurally as it should.

3. Imaging studies

A range of imaging tests may be requested to assess the position and condition of your implant:

X-rays: The most common starting point. These allow Dr Hockings to evaluate the alignment of the components, identify loosening, subsidence (sinking of the stem), fractures, or implant wear.
CT scan: A 3D scan provides detailed images of bone and implant positioning, especially useful in cases where bone loss or structural changes are suspected.
Bone scan or nuclear imaging: May be used to detect signs of infection, inflammation, or implant loosening.
MRI (in certain cases): Advanced imaging with metal artefact reduction can be used to assess surrounding soft tissues or detect fluid collections.

4. Blood tests and joint aspiration (if infection is suspected)

If infection is a potential cause of implant failure, further tests may include:

5. Collaborative decision-making

Once all information has been gathered, Dr Hockings will discuss:

The likely cause of your symptoms
Whether revision surgery is necessary or if non-operative strategies could help
The risks, expected outcomes, and timing of any proposed surgery
The specific surgical plan if revision is recommended, including implant type, surgical approach, and any need for bone grafts or specialist components

This collaborative approach ensures you are fully informed and supported to make the right decision for your health and lifestyle goals.

Surgical options: Types of revision hip procedures

The type of revision hip replacement you may require depends on which part of the original prosthesis is failing, as well as the extent of bone loss, infection, or implant wear. Revision surgery is tailored to each patient and can range from minor adjustments to complete reconstruction of the hip joint.

Below are the most common types of revision procedures:

Isolated
liner exchange

This is a relatively limited procedure where only the plastic liner inside the acetabular cup (socket) is replaced. It may be suitable if the surrounding components are still firmly fixed and functioning well.

Femoral
component revision

This involves removing and replacing the femoral stem (the part inserted into the thigh bone). This may be needed if the stem has loosened, fractured, or if there is bone loss around it.

Acetabular
component revision

The acetabular cup (socket) is removed and replaced. If there has been significant bone loss in the pelvis, bone grafts or specialised implants (such as augments or cages) may be used to rebuild the socket and provide stable fixation.

Full revision
(both components)

In cases where both the femoral and acetabular components are failing, a full revision may be required. This involves replacing the entire hip prosthesis and may include reconstructive techniques to address bone defects.

Two-stage revision
for infection

If a deep infection is present, a two-stage approach is often recommended. In the first stage, the prosthesis is removed, and a temporary antibiotic-loaded spacer is inserted. After the infection is cleared (typically over several weeks to months), a second operation is performed to implant a new hip replacement.

Each of these procedures requires detailed pre-operative planning, advanced surgical techniques, and careful post-operative management to support the best possible outcome. Dr Jason Hockings will discuss the most

Planning your surgery: Surgical approach and implant selection

Revision hip replacement surgery requires a carefully planned and highly individualised approach. Unlike a primary hip replacement, which often follows a standardised pathway, revision procedures are more complex and must be tailored to address the unique issues associated with your existing implant, bone structure, and soft tissues. Dr Jason Hockings draws on advanced diagnostic tools, surgical experience, and evidence-based techniques to formulate a surgical plan that prioritises stability, longevity, and function.

Pre-operative planning and imaging

Before your surgery, Dr Hockings will thoroughly review your clinical history, symptoms, previous surgical notes (if available), and recent imaging. This includes:Your consultation will begin with a detailed discussion about:

X-rays to assess implant positioning, loosening, or signs of wear
CT scans to evaluate bone loss or structural changes in detail
Blood tests to screen for infection or inflammation
Joint aspiration (if needed) to assess for infection markers in the joint fluid

This information helps determine which components of the prosthesis need to be revised and what reconstructive techniques may be required.

Surgical approach

The surgical approach chosen for your revision surgery will depend on several factors, including your anatomy, previous incision sites, the location of the failing component, and the complexity of the procedure. Common approaches include:

Posterior approach- This approach provides excellent access to both the femoral and acetabular components and is often used in complex revision surgeries. It allows for better exposure when bone grafting or extensive reconstruction is required.
Extended anterior or lateral approaches - If your original hip replacement was performed using an anterior approach, Dr Hockings may consider modifying this for the revision. However, for more extensive reconstructions, the posterior approach is often preferred due to its versatility and access.

In many cases, the approach is customised based on intraoperative findings and the condition of the soft tissues and bone.

Choosing the right implants

Implant selection is one of the most critical aspects of revision hip surgery. Dr Hockings selects implants based on:

The extent of bone loss - specialised implants such as modular femoral stems, dual mobility cups, revision acetabular components, or augment blocks may be used to restore joint stability and compensate for missing bone.
Soft tissue condition - in cases where the surrounding ligaments or tendons have been compromised, a constrained liner may be required to help prevent dislocation.
Patient factors - your age, activity level, bone quality, and overall health play a role in determining the most suitable implant components for durability and function.
Previous implant compatibility - when possible, Dr Hockings aims to preserve well-fixed components. However, if replacement is necessary, modern implant systems allow flexibility to match and align with your existing anatomy.

Each implant used in revision surgery is selected for its proven design, material quality, and suitability for your specific revision needs. The goal is to restore stability, improve function, and maximise the longevity of your new hip replacement.

Inside the operation: What to expect during surgery

Revision hip replacement surgery is more complex than a primary hip replacement and requires careful execution. The operation is tailored to the specific reasons for revision, such as implant loosening, infection, wear, or bone loss, and may involve removing and replacing one or more components of your original prosthesis.

Anaesthesia and positioning

On the day of surgery, you will meet with your anaesthetist to finalise your anaesthetic plan. Most revision hip procedures are performed under a spinal anaesthetic with sedation or a general anaesthetic. This will be discussed with you prior to surgery to ensure your comfort and safety. Once you are in the operating theatre, you will be positioned to allow optimal access to the hip joint, typically lying on your side or back depending on the surgical approach selected. Your leg will be carefully supported, and sterile drapes will be placed to maintain a clean surgical field.

Step-by-step outline of the surgical procedure

While each revision case is unique, the operation generally follows this sequence:

Incision and exposure: Dr Hockings makes an incision over your hip joint, often along or near the scar from your previous surgery. The soft tissues and muscles are carefully moved aside to access the prosthesis and surrounding bone.
Assessment of existing components: The existing implants are evaluated for wear, loosening, or damage. If any parts of the prosthesis remain stable and well-fixed, they may be preserved to avoid unnecessary disruption to the bone.
Removal of failing components: The affected prosthetic components (e.g. femoral stem, acetabular cup, or liner) are removed using specialised instruments. This step must be done delicately to protect the surrounding bone and soft tissues. If there is bone loss, bone grafting may be required.
Bone preparation and reconstruction: Any bone defects are cleaned and reconstructed using bone grafts, metal augments, or modular implants to rebuild the structural support of your joint. This ensures the new components can be securely fixed.
Implanting new prosthetic components: New implants are then carefully inserted. These may include:

Stability and motion checks: Dr Hockings will test the new joint for proper alignment, stability, leg length, and range of motion before finalising the implantation.
Closure and dressings: Once all components are secure and the hip is functioning well, the layers of soft tissue and skin are closed with sutures. A sterile dressing is applied, and a local anaesthetic infusion may be used to help manage pain after surgery.

Duration of surgery

Revision hip surgery typically takes longer than a standard hip replacement, anywhere from 2 to 4 hours depending on the complexity of the case and whether reconstruction is required. You will be monitored in recovery before returning to the ward.

Risks and important considerations

All surgical procedures carry risks, and revision hip replacement is generally more complex than a first-time hip replacement. Understanding the potential risks and how they are managed can help you make informed decisions and feel more confident going into surgery. Dr Jason Hockings will discuss these risks with you during your consultation and explain the steps taken to reduce the chance of complications.

Why revision surgery carries increased risk

Revision hip replacement surgery is typically more technically demanding because:

There may be damage to the surrounding bone or soft tissues.
Scar tissue and altered anatomy from the previous surgery can make exposure more difficult.
Bone loss or infection may require additional reconstructive techniques.
Surgery times may be longer, increasing the risk of blood loss or complications.

Dr Hockings is experienced in managing these complexities and uses thorough pre-operative planning and precise surgical technique to address the unique challenges each case presents.

Potential risks of revision hip surgery

Some of the risks specific to revision hip replacement include:

Infection

Infection is a serious but uncommon complication. It may be superficial (around the skin and wound) or deep (involving the joint itself). Deep infections may require additional surgery and extended antibiotics. Dr Hockings uses strict sterile protocols, pre-operative screening, and antibiotic therapy to minimise this risk.

Dislocation

Revision hips are at higher risk of dislocating compared to primary hips, especially if there is muscle weakness, scar tissue, or altered anatomy. Specialised implants such as dual mobility cups may be used to help reduce this risk.

Blood clots (DVT/PE)

You’ll receive medications, compression stockings, and early mobilisation to reduce the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE). Staying active after surgery is one of the best ways to minimise this risk.

Loosening or failure of the new implant

Although modern implants are designed to be long-lasting, any artificial joint can loosen over time. Dr Hockings selects appropriate implants based on your bone quality, anatomy, and activity level to support a durable outcome.

Leg length difference

It can be more difficult to maintain leg length symmetry during revision surgery, particularly if there has been significant bone loss. Dr Hockings uses intraoperative assessment and careful implant positioning to reduce the likelihood of noticeable leg length discrepancy.

Nerve or blood vessel injury

Major nerves and vessels are close to the hip joint and can be affected, although this is uncommon. Most nerve injuries, if they occur, are temporary and improve with time.

Ongoing pain or stiffness

Some patients may continue to experience hip discomfort, particularly if the surrounding soft tissues are weakened. Rehabilitation plays a key role in regaining mobility and improving long-term outcomes.

General surgical risks

As with all major operations, revision hip replacement carries general risks such as:

Your role in reducing risk

There are several things you can do before and after surgery to reduce your risk of complications:

Optimise your health

Conditions like diabetes, obesity, anaemia, or smoking can increase your risk. Dr Hockings may recommend a health optimisation program prior to surgery.

Follow post-operative instructions

Carefully following rehabilitation guidelines, wound care advice, and medication schedules will support a safer and more successful recovery.

Attend all follow-up appointments

These allow your recovery to be monitored and any early concerns to be addressed promptly.

Revision hip replacement with Dr Jason Hockings

If you’re experiencing problems with your existing hip replacement, you’re not alone and you’re not without options. Revision hip replacement surgery is a specialised procedure that requires careful planning, clinical experience, and a personalised approach to ensure the best possible outcome.

Dr Jason Hockings is a fellowship-trained orthopaedic surgeon with extensive experience in complex primary and revision hip arthroplasty. He uses a methodical, patient-centred approach supported by the latest imaging, planning software, and surgical techniques to deliver safe and effective care.

Personalised care from assessment to recovery

Your revision journey with Dr Hockings begins with a comprehensive assessment, including:

A full history and examination
Review of your original surgical records, if available
Detailed imaging including X-rays, CT scans, and possibly blood tests
Identification of the underlying cause of implant failure (e.g. loosening, infection, fracture)

Dr Hockings will explain your diagnosis in clear terms and outline your treatment options. If revision surgery is recommended, you’ll receive a detailed surgical plan tailored to your anatomy, bone quality, and goals.

Advanced planning and surgical precision

Dr Hockings uses digital planning tools, modern implants, and custom instrumentation when needed to ensure precision and reduce complications. Whether your case involves infection, bone loss, or instability, he will discuss the type of procedure required and the likely recovery time. If necessary, he collaborates with infectious disease physicians, anaesthetists, and physiotherapists to provide multidisciplinary care before and after your operation.

Ongoing support through your recovery

Your care doesn’t end in the operating theatre. Dr Hockings is committed to supporting you throughout your recovery, with scheduled follow-up appointments, coordinated physiotherapy, and ongoing education to help you regain confidence and mobility.

Patients often report significant improvements in pain relief, stability, and function following revision hip replacement, especially when they are well-prepared and actively involved in their recovery process.

If you’re concerned about a painful or failing hip replacement, Dr Jason Hockings can provide clarity and expert guidance. A personalised consultation will help determine whether revision surgery is right for you, and what steps to take next.