Hip Revision Surgery in Perth
Hip revision surgery in Perth with Dr Rhys Clark, for hip replacements affected by loosening, infection, component wear, bone loss, dislocation or fracture.
What hip revision surgery is
A hip replacement is a mechanical construct inside a living joint, and like anything mechanical it can loosen, wear or fail. Revision surgery removes the failed or worn components and replaces them.
It is uncommon. Hip replacement is among the most reliably successful operations in surgery — roughly 90% of replacements are still in place and working well 18 years afterwards. But when one does fail, revision is what puts it right.
“My aim in any joint replacement surgery is to give you a long-term solution that shows results beyond your goals; however, sometimes hip revision surgery is a necessary part of that journey,” says Dr Rhys Clark.
What patients notice first
Failure is rarely sudden. Most people describe a change from how the hip had been behaving:
- Groin or thigh pain returning after a stretch of doing well
- Start-up pain — discomfort on the first few steps that eases, then returns with distance
- A sense of instability, or the hip giving way
- Recurrent dislocation, which is both alarming and a clear indication for assessment
- A new limp, or a feeling that the leg length has changed
- New clicking, grinding or clunking
- Feeling unwell alongside a painful hip, which raises the possibility of infection and warrants prompt assessment
None of these confirms failure on its own — hips can be sore for reasons unrelated to the implant, including the spine and the gluteal tendons. But all of them warrant assessment rather than waiting.
Why hip replacements fail
Loosening. The commonest reason. The bond between implant and bone weakens over years, and a component that moves fractionally under load causes pain and instability.
Wear. The bearing surface between the ball and socket wears over time. Modern materials wear slowly, but over a long enough period it can become significant.
Osteolysis. Debris shed by wearing components can provoke a reaction that weakens surrounding bone. It is often silent early, appearing on an X-ray before it causes symptoms — one of the arguments for keeping up long-term reviews even when the hip feels fine.
Infection. Uncommon but serious, and it changes the whole approach.
Recurrent dislocation. Where the hip repeatedly comes out of joint, revision may be needed to address component position or to use a more constrained design.
Periprosthetic fracture. A fall can fracture the bone around an implant, which may destabilise it.
Implant breakage and tendon irritation are less common but recognised reasons.
Working out what is actually wrong
This matters, because pain after a hip replacement is not automatically the replacement. The lumbar spine refers pain to the hip and buttock, and the gluteal tendons and bursa cause pain on the outer side. Operating on a hip whose pain is coming from elsewhere helps nobody.
Assessment usually involves:
- A careful history — whether there was a pain-free period after the original surgery, what provokes the pain now, where exactly it is felt
- Blood tests for markers of infection
- Aspiration of joint fluid where infection is suspected, to identify the organism
- X-rays, compared against older films to look for change over time
- CT imaging to assess component position, loosening and bone loss
- The original operation record where available, to establish which implant is in place
A pain-free interval followed by later onset points somewhere different from a hip that was never right.
What the operation involves
Complexity depends entirely on what is found. Rhys will assess whether you require only minor adjustments, or a more complex revision.
At the simpler end, revision may mean exchanging a worn bearing surface while leaving well-fixed components in place. At the other end it can mean removing all components, reconstructing lost bone, and implanting a new joint designed to work with the bone that remains.
Removing a well-fixed implant without taking healthy bone with it is one of the technical challenges — preserving bone stock matters, because that bone has to support whatever comes next.
Where bone has been lost, reconstruction may use longer stemmed components that gain fixation in healthier bone further down, metal augments to fill defects, bone graft to restore stock, or more constrained designs that provide stability the soft tissues no longer can.
When the hip is infected
Infection is handled differently, and the path is longer.
The usual approach is staged across two operations. The first removes the implant, clears infected tissue thoroughly, and often leaves a temporary antibiotic-loaded spacer in the joint. A course of antibiotics follows, guided by the organism identified. Once infection is confirmed cleared, a second operation implants the new joint.
It is demanding — two operations, a period of limited function between them, and prolonged antibiotics. It is standard because implanting a new joint into an infected bed tends to fail, and re-infecting a fresh implant sets everything back further than the staged approach costs.
Recovery, and being realistic
Recovery is generally slower than after a first replacement. The operation is longer, more tissue is disturbed, and any reconstruction needs protecting while bone heals around it. Expect a longer hospital stay and a longer period on walking aids. Where graft or augments have been used, weight-bearing instructions may be specific — follow them precisely.
Revision is effective at what it sets out to do. It is also honest to say the average result does not usually match a first replacement that has gone well, because there is less bone to work with and more scarring. Most patients gain a substantial improvement on the hip they had before the revision, which is the comparison that matters. You should expect this discussed frankly before committing to anything.
If your original surgeon is no longer available
Taking over a hip someone else replaced is routine. If your original surgeon has retired, moved, or you have relocated to Perth, picking up care part-way through is a normal thing to arrange.
Bring whatever records you have: operation reports, implant stickers or details, previous X-rays, and the name of the hospital. If you are weighing up whether revision is the right step at all, a second opinion is a reasonable place to start — and a reasonable thing to ask for.
To discuss a hip replacement that is causing problems, book a consultation or phone the rooms on (08) 6332 6365.
Why would a hip replacement need revising?+
The artificial joint can loosen, which may lead to pain, instability and dislocation. The polyethylene and metal components can become infected or wear down over time. Other reasons include recurrent dislocation, tendon irritation, implant breakage, fracture of the bone around the implant, and osteolysis — bone loss caused when debris from the artificial materials weakens the surrounding bone and soft tissue.
What are the signs a hip replacement is failing?+
Groin or thigh pain that returns after a period of doing well, pain on starting to walk that eases then returns with distance, a sense of instability or the hip giving way, recurrent dislocation, a new limp, a feeling that the leg length has changed, or new clicking and grinding. Feeling generally unwell alongside a painful hip raises the possibility of infection and should be assessed promptly.
Is hip revision surgery more difficult than the original operation?+
Usually, yes. Revision replacements are often more complex than the initial replacement, which can mean a longer operation, a longer recovery and a higher risk of complications. How complex it is depends on the level of damage to the artificial joint and the surrounding bone.
What tests are needed before hip revision surgery?+
Blood tests to identify infection, sometimes a sample of fluid drawn from the joint to identify the organism, and a CT scan or X-ray to establish component position, loosening and the extent of bone loss. These determine whether you need only a bearing exchange or a more complex reconstruction.
Does an infected hip replacement need two operations?+
Usually. The standard approach is staged — a first operation to remove the implant and clear the infection, often leaving a temporary antibiotic-loaded spacer, then a course of antibiotics, and a second operation to implant the new joint once the infection is confirmed cleared. Where infection is caught very early, a single operation retaining the implant may occasionally be possible.
How long is recovery after hip revision surgery?+
Longer than after a first replacement. Expect a longer hospital stay, a longer period using walking aids, and a more gradual overall timeline. Where bone has been reconstructed with graft or augments, you may be given specific weight-bearing limits to protect the reconstruction while it heals.
Will my hip be as good as it was after the first replacement?+
Revision is effective at addressing the specific problem — relieving pain, restoring stability, clearing infection. It is honest to say the average result after a revision is not usually quite as good as the average result after a well-functioning first replacement, because there is less bone to work with and more scarring. Most patients still gain a substantial improvement on the hip they had before revision.
My original surgeon has retired — can you take over my care?+
Yes, this is routine. Bring whatever you have: operation reports, implant details or stickers, previous X-rays and the name of the original hospital. Knowing which implant is in place makes planning considerably easier, though revision can be planned without it.