When a previous replacement has failed — loose implant, chronic pain, infection, or end of implant lifespan. Expert revision surgery.
Most joint replacements last 20+ years. Some do not. A loose implant, a persistent infection, or a fracture around the prosthesis requires revision surgery. This is significantly more complex than the original procedure — it demands a surgeon who has performed many of them and has access to specialised implant systems.
Implant loosening (aseptic loosening)
Over time, the interface between implant and bone can loosen — usually from microscopic motion, osteolysis (bone resorption triggered by wear particles), or poor initial fixation. Symptoms: deep aching pain, pain when rising from a chair, pain with walking that was not present before. X-rays show radiolucent lines around the implant. Treatment: remove the loose components, prepare the bone, and seat new revision-grade implants with augments where bone is missing.
Periprosthetic joint infection (PJI)
Infection around a joint implant is the most serious complication of joint replacement. It can occur in the weeks after surgery or years later (haematogenous seeding from a dental procedure or urinary infection). Symptoms: persistent wound drainage, swelling, redness, fever, or a knee that has never felt right since surgery. Treatment: either single-stage revision (implant removed, thorough debridement, new implant in same surgery) or two-stage revision (implant removed, antibiotic spacer placed, 6 weeks of antibiotics, then new implant). The choice depends on the organism, duration of infection, and bone quality.
Polyethylene wear
The plastic bearing in older implants wears over years. Wear debris triggers osteolysis. If caught early (on routine follow-up X-rays), sometimes just the bearing can be exchanged. More advanced wear usually requires full revision.
Instability
A knee or hip replacement that dislocates or feels unstable. Causes: soft tissue imbalance, component malposition, or ligament failure. Revision restores balance and stability.
Periprosthetic fracture
A fracture of the bone around an implant — usually femur or tibia. Treatment depends on implant stability and fracture pattern. Sometimes the fracture can be fixed with plates while preserving the implant. Sometimes the implant must be revised simultaneously.
Revision surgery is longer and more technically demanding than primary replacement. The old implant and cement must be removed without excessive bone loss. The bone is assessed for defects. Revision implants with stems, wedges, and augments fill defects and achieve stable fixation. Surgery takes 2–5 hours depending on complexity.