Overview
A revision total hip replacement removes and replaces part or all of an earlier hip replacement. The reasons to revise are specific. The joint is painful, loose, dislocating, or infected, or the bearing has worn out. Not every ache around a replaced hip calls for a revision. The workup is careful, and honest triage starts on the phone.
Maybe you have a hip replacement, from here or from elsewhere. Now there is new pain, instability, giving way, or a change in leg length that is not settling. Call our office before booking a clinic visit. Our team can usually tell on the phone whether the case fits our practice, or whether a revision-specialty center would serve you better. We would rather save you the trip than see you for something we would have to refer out.
Who is a Candidate
Most painful replaced hips are not revision candidates at first pass. Revision is considered when:
Polyethylene or bearing wear
The plastic (polyethylene) liner between the ball and the cup has worn, sometimes with a reaction to the wear debris. On imaging, the ball no longer sits centered in the cup. If the metal shell and stem are solid and well-positioned, we can often swap the liner alone and keep the metal parts. That is called an isolated liner exchange.
Aseptic loosening
The cup or the stem has lost its bond to bone. Imaging shows growing clear lines around the implant (a sign of loosening), parts that have shifted, or a change in offset or leg length.
Recurrent instability
The hip keeps dislocating or slipping partway out. The workup looks at implant position, offset, leg length, the soft tissue, and patient factors such as how the spine and pelvis move together.
Infection
Infection around a hip replacement is its own category. Deep infection, especially with a long-standing draining opening in the skin, usually needs revision in stages, with a temporary antibiotic spacer between them. That work belongs at a dedicated revision-specialty center, not a single-stage revision here.
Periprosthetic fracture
A fracture of the femur or pelvis around the implant. Treatment depends on the fracture pattern, whether the parts are still solid, and bone quality.
How the Decision Is Made
The decision begins on the phone. Our scheduling team will ask when the replacement was done, where, what the new symptoms are, and whether there has been fever, drainage, or a recent invasive procedure. That conversation sorts cases into three rough buckets:
Straightforward workup in our clinic
New hip pain with no signs of body-wide illness, no drainage, and no recent dental or invasive procedure that could have seeded the joint. You are seen in clinic, imaged, and, if revision is the right call, the surgery is planned here. Liner exchanges, single-part revisions, and many stable full revisions fall in this bucket.
Evaluated here, planned for referral
Some cases belong at a dedicated revision-specialty center. These include massive bone loss in the socket that needs complex rebuilding. They also include suspected deep infection that needs staged surgery, and multi-part revisions that need a big step up in built-in implant stability. We work up the case, make the diagnosis, and help you land in the right hands.
Referred directly
An acute infection with a draining opening, a fracture around the implant that has made the patient medically unstable, or a fracture pattern that needs specialty equipment we do not stock. The phone triage catches these and routes them right away.
A typical in-clinic workup starts with X-rays of the pelvis and hip. If infection is possible, we add blood tests that measure inflammation (ESR and CRP). Often we also draw fluid from the hip (an aspiration) and send it for cell counts and culture. We obtain prior surgery and implant records when available. Knowing the exact make and model of your implant tells us whether we can swap the liner alone without removing the metal shell.
What Revision Involves
Revision covers a wide range. At one end is a short operation that swaps only the plastic liner. At the other is a major rebuild that removes and replaces both the cup and the stem, fills in bone loss, and restores offset and leg length. The common threads are listed below. What is actually done in any given case depends on what we find at surgery.
Exposure and implant assessment
The prior incision is usually reused. The hip is opened, the ball is taken out of the socket, and each metal part is tested for stability. A part that is solid and well-positioned may stay. A loose or badly positioned part comes out.
Component removal
Cups are removed with curved chisel-like tools that work around the cup to protect the bone behind it. Well-fixed stems need special instruments. When a stem cannot be safely removed from above, we use a planned, controlled split of the upper femur (an extended trochanteric osteotomy). Every step is designed to keep as much of your bone as possible.
Assessment of bone stock
The socket and femur are checked for areas of missing bone. Small defects are filled with ground bone graft or small metal wedges. Larger socket defects, especially ones that need structural graft, cup-cage constructs, or custom implants, are generally better served at a revision-specialty center.
Revision components
Revision cups are often larger and held with extra screws. Revision stems are usually longer. They grip the shaft of the femur when the flared bone nearer the joint is too damaged to hold a standard stem. The ball and liner are chosen for stability, taking head size and your history of instability into account.
Restoration of offset and leg length
During surgery we use trial parts, live X-ray, and comparison with your other leg to restore offset and leg length. We test stability by moving the hip through its range. Extra built-in stability (constraint) is added only when implant position and the soft tissue are not enough.
Closure
The joint is washed out, a drain is placed when needed, and the tissue is closed in layers. We often send cultures from surgery even when infection was not the reason for the revision.
Recovery
Recovery after a revision total hip replacement moves in phases. It is generally slower than after a first-time replacement. The soft tissue has been operated on before, and in many cases there is less bone for the new parts to grip.
Early recovery
How much weight you can put on the leg depends on what was done. A simple liner exchange allows full weight right away. A case with a controlled bone split or a fracture repair is protected. A walker, then a cane, is used until your walk is steady. Hip precautions are chosen case by case, based on the approach and how stable the hip was at surgery.
Return to activity
Progress is gradual and guided by exam findings at each follow-up: your walk, hip strength, range of motion, and how the incision is healing. It is not a fixed calendar. Driving, desk work, physical work, and recreation each have their own criteria and are cleared one at a time.
Long-term surveillance
Revision hips are followed long-term, with periodic exams and X-rays. We watch for liner wear, parts that shift, and any change in offset or leg length. Call early for new pain, drainage, a change in leg length, or fever.
What Revision Treats
What to Expect from Our Practice
Our posture in New Braunfels is call-first screening, an honest scope of practice, and continuity of care. If yours is a case our surgeons handle here, you will be seen in clinic and worked up. If revision is the right call, our surgeons handle the operation. If your case is better served at a dedicated revision-specialty center, our team will say so on the phone and help you find the right place. We would rather save you the trip than see you for something we would have to refer out.
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a failed or failing hip replacement, from loosening, wear, instability, or infection, that grows more painful and harder to fix the longer it is left. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with patients before revision arthroplasty include:
- bleeding and infection (including rare deep infection around the implant)
- anesthesia risk
- blood clot in the leg or lung, reduced with blood thinners, walking, and compression stockings after surgery
- dislocation, especially after revision, when the soft-tissue tension has been changed
- leg-length or offset change
- fracture of the bone around the implant
- injury to the sciatic or femoral nerves around the hip
- problems with wound healing in a hip that has been operated on before
- pain that continues when the revision does not fully fix the source
- another revision over time if the bone or soft tissue fails
Frequently Asked
questions we hear in clinicMy replaced hip hurts. Does that mean I need a revision?
Not necessarily. Not every ache around a replaced hip calls for a revision, and most painful replaced hips are not revision candidates at first pass. The reasons to revise are specific: a joint that is painful, loose, dislocating, or infected, or a bearing that has worn out.
What should I do first?
Call our office before booking a clinic visit. Our team will ask when the replacement was done, where, what the new symptoms are, and whether there has been fever, drainage, or a recent invasive procedure. They can usually tell on the phone whether the case fits our practice or whether a revision-specialty center would serve you better.
What does the workup involve?
A typical in-clinic workup starts with X-rays of the pelvis and hip. If infection is possible, we add blood tests that measure inflammation (ESR and CRP), and often draw fluid from the hip for cell counts and culture. We also obtain prior surgery and implant records when available.
Will the whole replacement be redone?
Not always. Each metal part is tested at surgery, and a part that is solid and well-positioned may stay. If the metal shell and stem are solid, we can often swap the worn plastic liner alone, which is called an isolated liner exchange.
How is recovery different from a first-time replacement?
It is generally slower, because the soft tissue has been operated on before and in many cases there is less bone for the new parts to grip. How much weight you can put on the leg depends on what was done, and progress is guided by exam findings at each follow-up rather than a fixed calendar.
What if my case is too complex for your practice?
Some cases belong at a dedicated revision-specialty center, such as massive bone loss in the socket, suspected deep infection that needs staged surgery, or multi-part revisions that need a big step up in built-in implant stability. We work up the case, make the diagnosis, and help you land in the right hands.
Further Reading
External patient-education references and related OSI pages for additional background:
