What is a revision hip replacement?
A revision hip replacement is a second (or later) operation to replace or adjust a hip implant that has worn out, loosened, become unstable or infected. It can be as small as exchanging a worn liner and ball, or as large as replacing the cup, the stem and rebuilding lost bone. Revision is a more complex operation than a first replacement, which is why it is best done by a surgeon trained in it. Dr. Stepanyan completed a fellowship in adult reconstruction at the University of Pennsylvania.
Why do hip replacements fail?
In a large analysis of revision hip surgeries in the United States, the most common reasons were instability (dislocation), mechanical loosening, and infection.1 Other causes include wear of the plastic liner with bone loss around it, fractures near the implant, and pain with no clear cause. The mix changes with time since the first surgery: dislocation and infection tend to appear early, while loosening and wear usually arrive after years.
How do I know if my hip needs revision?
Warning signs include new groin, thigh or buttock pain, pain when you first take steps that eases and returns, a feeling that the hip is giving way, repeated dislocations, a change in leg length, or swelling, redness or drainage near the old incision. Sometimes there are no symptoms and the problem is found on a routine X-ray, which is one reason to keep your regular follow-up visits even when the hip feels fine.
How is the problem worked out?
Revision starts with finding the cause. Dr. Stepanyan reviews your operative records and implant type, examines you, and orders X-rays and often a CT scan. If infection is possible, blood tests and sometimes a sample of fluid from the joint are needed, because infection changes the plan completely. Treating the wrong problem is the most common reason a revision does not fix the pain.
Is surgery always needed?
No. A hip that is stiff or sore after a replacement, or one with a mild, stable change on X-ray, may only need monitoring, therapy or treatment of a nearby problem such as a tendon or the spine. A dislocating hip may do well with bracing and a change in activity if the parts are well positioned. Revision is recommended when the implant itself is the problem and the pain or risk is real.
What happens in a revision?
The approach depends on what needs to be done. Dr. Stepanyan removes the failed parts while protecting the remaining bone, cleans the area, rebuilds bone loss when needed with specialized implants or bone graft, and fits new components that are stable and well aligned. If infection is the cause, the operation is often done in stages: the infected implant is removed and treated with antibiotics, and a new one is placed later once the infection is cleared.
Operating time is longer than a first replacement, and recovery is usually slower. Most patients stay in the hospital one to a few nights.
What outcomes can I expect?
Most patients get good pain relief and better function, but results are less predictable than after a first replacement, and a revised hip carries a higher chance of another revision. The size of the operation, the quality of the remaining bone, and whether infection was involved all matter. Dr. Stepanyan will go over realistic expectations before surgery.
Should I get a second opinion?
Yes, if a revision has been recommended and you want to confirm the cause, or if you have had pain since a replacement and nobody has found an explanation. Request a visit and bring your operative note, implant sticker if you have it, and all X-rays.
Where can I see Dr. Stepanyan?
Dr. Stepanyan sees patients with hip problems in Glendale, East LA and Santa Fe Springs, and operates at Adventist Health Glendale, Glendale Memorial Hospital, Adventist Health White Memorial and White Memorial Montebello, and Providence Saint Joseph Medical Center.
What does recovery look like?
Revision recovery varies more than recovery from a first replacement. These are general stages; your plan will be tailored to what was done.
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Weeks 0–2
Protect and walk
Most patients stay one to a few nights and begin walking with a walker the same or next day. Weight-bearing may be limited if bone was rebuilt or a fracture was repaired.
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Weeks 2–6
Regain mobility
You progress from walker to cane as your leg and the repair allow. Therapy focuses on safe movement, strength and balance.
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Weeks 6–12
Build strength
Restrictions ease and walking distance grows. Many patients return to light activity and driving during this period.
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3–12 months
Full recovery
Strength and endurance continue to improve for up to a year. Regular X-ray follow-up checks that the new implant stays stable.
Because every revision differs, ask Dr. Stepanyan what limits apply to you and for how long. Call the office promptly for fever, new drainage, increasing pain, or a hip that feels unstable.
Sources
- Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128-133. PubMed