Revision Hip & Knee Replacement

Specialized Care for Failed, Painful, or Worn Joint Implants

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A revision total joint replacement is a complex orthopedic procedure performed when an existing hip or knee replacement wears out, becomes painful, loosens, or fails to function as intended. Unlike primary joint replacement, revision surgery involves removing or repairing existing implants, correcting bone loss or soft tissue damage, and restoring joint stability and function with new components specifically designed for revision cases.

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Revision total joint replacement requires robust resources and a multi-disciplinary team in order to achieve success, including your orthopedic surgery team, a hospital system with resources including advanced therapy modalities, subspecialty availability such as infectious disease specialists, vascular surgery specialists, etc, skills and experienced nurses and post-operative care members, and all of the potentially required implants and surgical tools necessary.

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Why Revision Joint Replacement Is Performed

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Revision total hip and knee replacement may be necessary for many reasons, including:

• Implant loosening or wear

• Infection involving the joint replacement

• Recurrent dislocation (instability)

• Periprosthetic fracture (bone fracture around the implant)

• Osteolysis (bone loss from particulate debris)

• Implant breakage or mechanical failure

• Persistent pain or stiffness

• Reaction to implant materials (rare)

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The goals of revision surgery are to relieve pain, restore mobility, and protect long-term bone and soft tissue health.

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Symptoms That May Indicate Evaluation for Revision Surgery

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Patients with a prior joint replacement should seek orthopedic evaluation if they experience:

• Increasing pain in the hip or knee

• New or progressive swelling

• Loss of mobility or range of motion

• Instability, clicking, or “giving way”

• Warmth, redness, or drainage from the surgical site

• Limping or altered gait

• Leg length inequality (hip patients)

• Fever, chills, or signs of infection

• A sudden injury or fall

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Symptoms may develop months or years after the initial surgery and should not be ignored, as early diagnosis often improves outcomes and preserves bone stock.

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Common Etiologies Leading to Revision Surgery

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1. Aseptic Loosening & Wear

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Over time, implants may loosen due to mechanical wear, bone resorption, or micro-motion. This is one of the most common reasons for revision in both hip and knee replacements. Most commonly this is not seen until at least 15 or more years after surgery, but at times this can happen unexpectedly much earlier.

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2. Infection (Periprosthetic Joint Infection)

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A deep infection around the implant can cause pain, joint damage, and implant failure. Management often requires staged revision surgery, antibiotics, and careful monitoring. Management of infected joint replacements requires experience, expert surgeons with robust multi-disciplinary teams including infectious disease specialists, hospitalists, physical and occupational therapists, as well as nursing and post-operative care members.

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3. Instability or Dislocation

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Hip replacements may dislocate, and knee replacements may become unstable due to ligament imbalance, polyethylene wear, or component malposition. Revision stabilizes the joint and restores alignment.

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4. Periprosthetic Fracture

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A fracture around the implant can compromise bone support and typically requires surgical fixation and possible implant revision. These are complex situations that require skills surgical cares and robust multi-disciplinary teams, similar to description above.

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5. Osteolysis & Bone Loss

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Polyethylene wear particles can trigger bone resorption over time. Revision surgery replaces worn components and reconstructs bone defects.

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6. Implant Breakage or Mechanical Failure

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Though uncommon with modern implants, mechanical failure can occur and requires removal and replacement of damaged components.

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When to Consider Revision Joint Replacement

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Revision evaluation is typically recommended when:

• Pain interferes with daily activities

• Imaging shows loosening, wear, or bone loss

• Infection is suspected based on labs or symptoms

• Dislocations or instability occur repeatedly

• A fracture involves or compromises the implant

• Implants have reached their expected lifespan (often 15–25+ years)

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Early specialist evaluation can prevent worsening bone loss and preserve future treatment options.

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Advanced Techniques for Modern Revision Surgery

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Revision hip and knee replacement often involves:

• Specialized revision implant systems

• Specific post-operative protocols based on experience and research

• Unique surgical tools and, at times, technology

• Expert anesthesiologists, hospitalists, subspecialty doctors, and experiences nurses and care providers

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These advancements help restore stability and longevity in complex cases.