Overview
A revision total hip replacement is an operation in which part or all of a previously implanted hip replacement is removed and replaced. The reasons to revise a hip replacement are specific — the joint is painful, loose, dislocating, infected, or the bearing has worn — and not every ache around a replaced hip is a revision candidate. The workup is careful, and honest triage happens on the phone.
If you have a hip replacement — from here or from elsewhere — and are experiencing 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 you would be better served at a revision-specialty center. 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 polyethylene liner between the ball and the cup has worn, sometimes with a reaction to the wear debris. Imaging shows eccentric head position within the cup. An isolated liner exchange — where only the polyethylene is swapped and the metal components are retained — is often feasible when the shell and stem are well-fixed and well-positioned.
Aseptic loosening
The acetabular cup or the femoral stem has lost its bond to bone. Imaging shows progressive radiolucent lines, component migration, or a change in offset or leg length.
Recurrent instability
The hip dislocates or subluxes repeatedly. Workup evaluates component position, offset, restored length, soft-tissue integrity, and patient factors such as spinopelvic mobility.
Infection
Periprosthetic joint infection around a hip replacement is its own category. Deep infection, especially with a chronic draining sinus, usually requires staged revision with an interval antibiotic spacer at a dedicated revision-specialty center rather than single-stage revision here.
Periprosthetic fracture
A fracture of the femur or pelvis around the implant. Management depends on fracture pattern, component stability, 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, the nature of the new symptoms, and whether there has been fever, drainage, or a recent invasive procedure. That conversation triages into three rough buckets:
Straightforward workup in our clinic
New hip pain without systemic signs, no drainage, no recent dental or invasive procedure concerning for seeding. Seen in clinic, imaged, and — if revision is indicated — planned here. Liner exchange, single-component revision, and many stable full revisions fall in this bucket.
Evaluated here, planned for referral
Cases with massive acetabular bone loss requiring complex reconstruction, suspected deep infection requiring staged reimplantation, or multi-component revisions with major constraint escalation that are more appropriately handled at a dedicated revision-specialty center. We work up the case, make the diagnosis, and help the patient land in the right hands.
Referred directly
Acute infection with a draining sinus, hemodynamic instability from a periprosthetic fracture, or a fracture pattern that needs specialty equipment we do not stock. The phone triage catches these and routes them immediately.
A typical in-clinic workup includes AP pelvis and lateral hip X-rays, inflammatory markers (ESR, CRP) if infection is on the differential, and often an intra-articular aspiration for cell count, crystals, and culture. Prior operative and implant records are obtained when available — the component make and model informs whether an isolated liner exchange is feasible.
What Revision Involves
Revision total hip replacement covers a spectrum, from a short operation that swaps only the polyethylene liner to a reconstructive case that removes and replaces both the acetabular cup and the femoral stem, addresses bone loss, and restores offset and leg length. The common threads are listed below — what is actually done in any given case depends on findings at the time of surgery.
Exposure and implant assessment
The prior incision is usually reused. The hip is exposed, the joint is dislocated, and each metal component is tested for stability. A component that is well-fixed and well-positioned may be retained; a loose or malpositioned component comes out.
Component removal
Cups are removed with a curved osteotome system that works around the hemisphere to preserve acetabular bone. Well-fixed stems are removed with specific instruments — extended trochanteric osteotomy is used selectively when a stem cannot be safely removed from above. Every step is designed to preserve bone stock.
Assessment of bone stock
The acetabulum and femur are evaluated for contained and uncontained defects. Small defects are managed with particulate bone graft or small augments. Larger acetabular defects — especially those requiring structural allograft, cup-cage constructs, or custom triflange implants — are generally better served at a revision-specialty center.
Revision components
Revision acetabular shells are often larger and use adjunctive screw fixation. Revision stems are typically longer and engage the diaphysis of the femur for fixation when the metaphyseal bone is deficient. Head and liner choices account for head size, jumping distance, and the patient's history of instability.
Restoration of offset and leg length
Intraoperative trialing, fluoroscopy, and comparison to the contralateral side are used to restore offset and leg length. Stability is tested through range of motion, and constraint is added selectively only when component position and soft-tissue integrity are not enough.
Closure
The joint is irrigated, a drain is placed selectively, and the tissues are closed in layers. Intraoperative cultures are often sent even when infection was not the indication.
Recovery
Recovery after a revision total hip replacement is handled in qualitative phases. The arc is generally slower than after a primary replacement because the soft tissues have already been operated on and, in many cases, there is less bone stock for initial fixation.
Early recovery
Weight-bearing status depends on what was done — an isolated liner exchange allows immediate weight-bearing, while a case with an extended trochanteric osteotomy or a periprosthetic fracture fixation is protected. Assistive devices (walker, then cane) are used until the gait is secure. Hip precautions are chosen case-by-case based on approach and stability at the time of surgery.
Return to activity
Progression is gradual and guided by exam findings at each follow-up — gait, hip abductor strength, range of motion, and incision healing — rather than a fixed calendar. Driving, return to desk work, return to physical work, and return to recreation each have their own criteria and are cleared one at a time.
Long-term surveillance
Revision hips are followed on a longer schedule — periodic exam and X-rays to watch for polyethylene wear, component migration, and any change in offset or leg length. Patients are asked to call early for new pain, drainage, a change in leg length, or fever.
What Revision Treats
Physicians Who Perform Revision Total Hip Replacement
Providers Who Surgically Assist with Revision Total Hip Replacement
What to Expect from Our Practice
The posture at OSI New Braunfels is call-first screening, honest scope of practice, and continuity of care. If your case is one Dr. Vrana handles here, you will be seen in clinic, worked up, and — if revision is indicated — operated on by the same surgeon who saw you. 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. The risks we discuss with patients before revision arthroplasty include:
- bleeding and infection (including rare deep periprosthetic infection)
- anesthesia risk
- blood clot (DVT/PE) — mitigated by perioperative prophylaxis
- dislocation, particularly in revision settings where soft-tissue tension has been altered
- leg-length or offset change
- periprosthetic fracture
- injury to the sciatic or femoral nerves around the hip
- wound-healing complications in a previously operated hip
- continued pain when the source is not fully addressed by the revision
- repeat revision over time if bone stock or soft-tissue integrity fail
Further Reading
External patient-education references and related OSI pages for additional background: