When a person undergoes a hip or knee replacement, the expectation is that the new joint will last for many years—often decades. For most people, that’s exactly what happens. But sometimes, a replacement joint can wear out, loosen, or develop complications. When this occurs, a revision surgery may be required.
In this article, we’ll explore what revision hip and knee replacement involves, why some joint replacements fail, and what patients can expect from the procedure and recovery.
Why Joint Replacements Sometimes Fail
Most hip and knee replacements are highly successful, but like any medical treatment, they aren’t perfect. Over time, certain issues can develop that affect the stability and function of the artificial joint. Common reasons for failure include:
- Wear and Tear: Just like natural joints, artificial implants experience gradual wear. With time, tiny particles can shed from the implant, causing inflammation and bone loss around the joint.
- Loosening of the Implant: The prosthesis can sometimes detach from the surrounding bone, leading to pain and instability. This is more likely in younger, more active patients.
- Infection: Although uncommon, an infection around the joint can cause severe pain and damage, often requiring revision surgery.
- Dislocation or Instability: In hip replacements particularly, the ball of the joint may dislocate from its socket if the muscles or soft tissues aren’t strong enough to support it.
- Fracture Around the Implant: A fall or accident can lead to a break in the bone surrounding the implant, which may mean the joint needs to be replaced again.
- Allergic Reaction or Implant Failure: In rare cases, the materials used in the prosthesis can cause adverse reactions or the implant itself may fail prematurely.
What Revision Surgery Involves
Revision surgery is not simply a repeat of the original procedure. It is often more complex and technically demanding, requiring a tailored approach depending on the problem.
Here’s what the process generally involves:
- Detailed Assessment: Before surgery, imaging (such as X-rays, CT scans, or MRIs) and blood tests are performed to understand the cause of failure. If infection is suspected, fluid may be drawn from the joint for testing.
- Removing the Old Implant: The surgeon carefully removes the worn or damaged prosthesis. This can be challenging if the implant is firmly fixed to bone. Special tools and techniques are used to avoid unnecessary bone loss.
- Bone Reconstruction (if needed): In cases where bone has been damaged or lost, grafts or specialised implants may be required to rebuild the joint structure.
- Placing the New Prosthesis: A new implant is inserted, often using longer or more specialised components to ensure stability. In some cases, revision implants have added features such as stems, plates, or cages to provide extra support.
- Closing and Recovery: As with the first replacement, soft tissues and muscles are repaired before the wound is closed. Depending on the complexity, surgery can take longer and may involve more blood loss compared with the initial replacement.
Expected Outcomes and Recovery
The goal of revision surgery is to relieve pain, restore stability, and improve function. However, outcomes vary depending on the underlying reason for revision, the patient’s overall health, and the complexity of the procedure.
Typical recovery expectations include:
- Hospital Stay: Patients often stay a little longer in hospital compared with their first replacement—usually 4–7 days, though this can vary.
- Rehabilitation: Physiotherapy begins soon after surgery. Recovery may take longer, and rehabilitation is often more intensive than after a first-time replacement.
- Pain Relief: Most people experience significant pain reduction, though the results may not always be as dramatic as with the original joint replacement.
- Function: Many patients regain the ability to walk comfortably and return to daily activities. However, high-impact sports and heavy manual work may remain limited.
- Longevity: Revision implants are designed to last, but their durability may be slightly shorter than a first replacement, particularly if bone stock is reduced.
Risks and Considerations
Revision surgery carries similar risks to primary joint replacement, but because it is more complex, the likelihood of complications can be higher. These risks include:
- Infection
- Blood clots
- Nerve or blood vessel injury
- Stiffness or instability
- Differences in leg length (for hips)
- Need for further surgery in the future
Your surgeon will discuss these risks with you and weigh them against the potential benefits of undergoing revision surgery.
Living with a Revision Joint Replacement
For most patients, revision surgery brings meaningful improvements in pain and mobility. Many are able to return to walking, gardening, travelling, and enjoying family life again. While outcomes may not always match those of a first replacement, the surgery often restores independence and quality of life.
Regular follow-up appointments with your surgeon are crucial, as they allow early detection of any potential issues. Maintaining a healthy weight, staying active, and following physiotherapy advice can also help protect the longevity of the new joint.
Frequently Asked Questions
- How long does a hip or knee replacement normally last?
On average, hip and knee replacements last 15–20 years, with some lasting even longer. Advances in materials mean that modern implants are performing better than ever.
- Is revision surgery more painful than the first replacement?
Pain after revision surgery is typically similar to the first operation. However, recovery can take longer due to the complexity of the procedure.
- Can all failed implants be revised?
In most cases, yes. However, severe infection, very poor bone quality, or certain medical conditions may limit surgical options.
- What happens if revision surgery fails?
In rare situations, further surgery may be required. Options include more complex reconstructions or, in extreme cases, procedures to stabilise the joint without full replacement.
