If the joint suddenly becomes deformed, you cannot bear weight, or it is hot and swollen with fever, seek care today. Dislocation, periprosthetic fracture and infection all need urgent local assessment. Do not fly with any of them.
A replacement that has loosened, worn out, dislocated or been badly positioned. Revision surgery is substantially harder than the original operation and depends heavily on the surgeon's experience with it.
Patients in this situation are often frustrated and have frequently been told little about why the first operation failed. Establishing the reason is not academic — the cause determines the operation, and revising for the wrong reason is how a second failure happens.
Aseptic loosening is the commonest long-term reason. Microscopic wear particles from the bearing surface provoke a reaction in the surrounding bone, which gradually resorbs, and the implant loses its fixation. It typically presents as pain on starting to walk that eases after a few steps.
Infection may occur early after surgery or years later from bacteria carried in the bloodstream from a dental or skin source. It has its own dedicated page because the treatment is completely different from every other cause of failure.
Instability and dislocation, most often in hips, arises from component positioning, soft tissue laxity or a wear-related change in the mechanics. Recurrent dislocation is disabling and usually requires revision.
Periprosthetic fracture — a break in the bone around the implant, generally after a fall in bone weakened by age or by loosening.
Malposition and wear — a component placed outside the optimal position wears asymmetrically and fails earlier. Polyethylene wear can sometimes be treated by exchanging only the liner rather than the whole implant, which is a far smaller operation.
This is the rule experienced revision surgeons work by, and it exists because the consequences of missing infection are severe. Revising an infected joint as though it were simply loose leads to a second failure and a far harder problem. Before any revision, infection must be excluded with inflammatory markers and, in most cases, an aspiration of fluid from the joint for culture. If a revision is being proposed without those tests, ask why.
The purpose of investigation is to establish the reason for failure, not simply to confirm it has failed.
Manufacturer, model, size and the operation note from the first surgery. These determine whether the failed part can be exchanged in isolation — a much smaller operation — or whether everything must come out. Without them, the surgeon must plan for every possibility, which means longer surgery and more expense. Your original hospital holds these records and is usually obliged to release them to you on request. It is worth several phone calls.
What is possible depends entirely on the reason for failure and on how much bone remains.
Where the metal components remain firmly fixed and well positioned and only the polyethylene bearing has worn, exchanging the liner alone is a considerably smaller operation with a much quicker recovery. It requires the original implant to be identified and its parts still available.
The loose implant is removed and a new one implanted in the same operation, using longer stems, augments or bone graft to compensate for lost bone. It is the standard approach for aseptic loosening, instability and malposition. It is technically demanding and results depend markedly on the surgeon's revision experience.
The implant is removed, an antibiotic-loaded spacer inserted, and prolonged antibiotic treatment given before a new implant is put in months later. It is the most reliable approach for established infection and is covered fully on the infected implant page.
A break around an implant is treated either by fixing the bone with plates and cables where the implant remains sound, or by revising to a longer-stemmed implant that bypasses the fracture where it does not.
Infection, loosening, wear, malposition or fracture each lead to a different operation. Revising without knowing the cause invites a second failure.
Bone loss determines whether standard revision components suffice or whether augments, structural graft or custom implants are required — and it drives the cost.
This matters more here than in any primary joint replacement. Ask how many revisions they perform each year, not how many replacements.
If your pain has been present since the day of the original operation and never improved, be cautious — that pattern often means the pain was never coming from the joint, and a revision will not fix it.
A periprosthetic fracture or an acutely infected implant needs treating where you are. Long flights with an unstable joint or an untreated infection are not safe.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
The commonest reasons are aseptic loosening from wear particles, infection, instability, component malposition and fracture around the implant. Establishing which applies to you is the whole purpose of the investigation, because each leads to a different operation. Serial X-rays, inflammatory markers and usually a joint aspiration answer it.
Yes, considerably. Removing well-fixed components without destroying bone, dealing with bone loss, and achieving stable fixation in compromised bone are all demanding. Recovery takes longer, complication rates are higher, and results are more variable. This is why the surgeon's revision experience matters so much more than in a primary replacement.
Yes, but it makes planning harder. Without knowing the components, the surgeon cannot know whether a simple liner exchange is possible and must prepare for a full revision with a range of implants available. It is worth persistent effort with your original hospital — the records exist and they are yours.
Generally less than a primary replacement, because the bone it is fixed into is compromised and the mechanics are less favourable. This is realistic rather than pessimistic, and it is a reason to think carefully about timing in a younger patient, and to protect the result afterwards with weight control and avoiding high-impact activity.
Be cautious. Pain that was never relieved at all frequently indicates the pain was not coming from the joint in the first place — the spine is a common culprit for hip pain, and referred pain is common around the knee. Revising in that situation replaces a working implant and leaves the pain unchanged. This needs careful assessment before anyone operates.
Four to eight weeks for a straightforward revision, including a longer hospital stay and a longer rehabilitation period than a primary replacement. If infection is present and two-stage surgery is needed, plan on three to four months in total, either as one long stay or two separate trips.
Send current and previous X-rays, your original operation note if you can obtain it, and recent CRP and ESR results. Establishing why it failed comes before anything else.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.