Hip Revision Surgery

Answers written by Mr Tofunmi Oni, Consultant Orthopaedic Surgeon (MBChB BSc PGDip FRCS (Tr & Orth), GMC 7074916). Mr Oni specialises in revision hip surgery, leads the weekly revision hip multidisciplinary meeting at East Kent Hospitals University NHS Foundation Trust, and operates privately at The Horder Centre in Crowborough and Nuffield Health Tunbridge Wells. Figures come from the National Joint Registry, the British Hip Society, the MHRA and the studies listed in the sources at the end. Last reviewed October 2026.

What is the difference between a hip revision and a hip replacement?

A primary hip replacement replaces your own worn joint. A revision removes or exchanges some or all of an existing artificial hip and rebuilds the bone around it, which may mean changing only the bearing surfaces, one component, or both, sometimes with bone graft, metal augments, cages or a long stem. It is a longer and more complex operation with a failure rate the British Hip Society describes as at least triple that of a primary, and around 6,000 are done in the UK each year, increasingly within regional revision networks.

Is hip revision major surgery, and how successful is it?

Yes. The risks of infection, dislocation, fracture, nerve or vessel injury and medical complications are all higher than for a first replacement. NJR data on routine single stage revisions for loosening put 90 day mortality at under one in a hundred, and that risk is lower with higher volume surgeons and units. Most patients get good pain relief and function, but about 21% of first revisions need a further revision within 15 years, and each later revision tends to last about half as long as the one before. That is the honest frame: a very worthwhile operation, done best by people who do a lot of it.

How painful is hip revision surgery, and how long is the hospital stay?

Pain is managed with a spinal or general anaesthetic, nerve blocks and regular painkillers, and most people find the first two weeks the hardest. An NHS revision leaflet notes that some pain may persist for a few weeks after discharge and that leg swelling can last three months or more. Hospital stay is longer than the one to three days typical after a primary and depends on the reason for the revision: a straightforward exchange of a worn bearing may mean two or three nights, while an infected or fractured hip takes longer in theatre and in hospital. Published series show both of those indications are associated with significantly longer stays.

How long does it take to walk normally after hip revision surgery?

You walk with two crutches from the first day, with the amount of weight you can put through the leg set by the surgeon depending on how much bone was reconstructed, sometimes protected for six weeks. A typical NHS revision pathway expects outdoor walking by four to six weeks, no walking aids by six to eight weeks, driving at about six weeks, desk work at four to eight weeks and physical work at around three months. Swelling and weakness can persist to six months.

Is a second hip replacement harder than the first?

Yes. Scar tissue, bone loss and the old implant all have to be dealt with, operating times and blood loss are higher, and the complication and failure rates are at least three times those of a primary. About one in five first revisions is revised again within 15 years, and the interval shortens with each further revision. That is why UK standards say revisions should be done by surgeons with specialist hip arthroplasty training and complex or repeat cases should go through a regional multidisciplinary meeting.

Should I go back to the same surgeon for a revision, or get a second opinion?

Either is reasonable. Your original surgeon knows the implant and the operation and should be told about the problem. Revision hip surgery is now organised through regional networks, and the British Hip Society says recurrent dislocation and complex or repeat revisions should be handled by a surgeon with a special interest and fellowship training in hip arthroplasty. You are entitled to ask for a second opinion. It is not a legal right on the NHS, but the GMC requires every doctor to respect your right to seek one, and refusals are rare: ask your GP to refer you, or ask your consultant directly. I provide second opinions on painful and failed hip replacements, including reviewing scans from other hospitals.

Why does my hip replacement hurt after one year, three years or twenty years?

Pain that starts or persists after the first few months is not normal and needs assessment. In the first year or two the usual causes are infection, instability, a tendon catching on the implant, or a stem that has not bedded in. Later causes are loosening, wear, bone loss around the implant, fracture of the bone around it, or a reaction to metal debris. In the NJR the largest single reason for revision is aseptic loosening at around a quarter of first revisions, followed by dislocation, fracture around the implant, infection, reaction to wear debris and unexplained pain. Infection from the original operation usually declares itself within the first 60 days, whereas loosening and wear typically present years later.

How do I know if something is wrong with my hip replacement?

Warning signs are new or worsening pain, a hip that feels unstable or gives way, clicking or clunking, a limp, a leg that seems shorter, swelling, redness or discharge at the scar, or fever. The NHS advises urgent GP or 111 contact for throbbing or cramping pain in the hip or leg, a high temperature, oozing or pus from the wound, or worsening redness and swelling. Patients with a metal on metal hip should report new pain, reduced mobility or a popping or clicking sound. The only way to know for certain is an X ray and blood tests with a hip surgeon.

What does a failed hip replacement feel like?

There is no single feeling. Loosening usually causes a deep ache in the groin or thigh that is worse on standing up and starting to walk and eases with rest. Infection causes more constant pain, often with warmth, swelling, night pain or feeling unwell. Instability feels like the hip slipping or catching. A fracture around the implant causes sudden severe pain and an inability to bear weight. Some failures, including reactions to metal debris, cause few symptoms at all, which is why follow up X rays matter.

What does a loose hip implant feel like, and how is it fixed?

A loose implant typically causes start up pain on the first steps after sitting, groin or thigh ache on weight bearing, and sometimes a shortening leg or limp; some loosening is picked up on X ray before symptoms. Diagnosis uses serial X rays looking for progressive lucent lines or movement of the stem or cup, CT for bone loss, and blood tests with aspiration where the markers are raised, because the British Hip Society standard says infection must be considered and excluded in every loose hip. Treatment is revision surgery to replace the loose component or components and rebuild bone where needed.

Can your body reject a hip replacement?

Not in the way the body rejects a transplanted organ; the materials are inert and there is no immune rejection of the joint. What can happen is a reaction to wear debris, most notably with metal on metal bearings, which can damage soft tissue and bone and accounts for roughly 13% of NJR first revisions. True metal allergy as a cause of failure is unproven: the British Hip Society position statement from January 2026 says a causal link between nickel exposure and implant failure or pain has not been established, and it is treated as a diagnosis of exclusion after infection and mechanical causes have been ruled out.

Is it normal to still have pain weeks after a hip replacement?

Yes. The NHS says pain and swelling usually improve over a few weeks, most people go home within one to three days, return to work at around six weeks and take several months to recover fully. The useful rule from an NHS revision leaflet is that a moderate ache which settles quickly is acceptable, and severe pain that takes hours to settle is not. Pain that is getting worse rather than better, fever or wound discharge need review.

What causes buttock, thigh or groin pain after a hip replacement?

Groin pain can come from the iliopsoas tendon catching on the edge of the cup, reported in anywhere from 4% to 30% of patients and usually treatable with an injection or a tendon release, or from a loose cup or infection. Thigh pain is classically linked to an uncemented stem that has not fully bonded or loads the bone unevenly, seen in around 5% to 8% in small series, and usually settles over the first year or two; persistent thigh pain needs X rays to exclude loosening. Buttock and outer hip pain are more often from the gluteal tendons and trochanteric bursa, which affect 4% to 17% of people after hip replacement, or from the lumbar spine. The British Hip Society standard asks surgeons to check leg length, abductor muscle function, the spine and the other hip for exactly this reason.

How do you know if a hip replacement is infected, and how common is it?

Deep infection affects roughly one in a hundred hip replacements, and NJR data show about four in a thousand go on to revision surgery for it. Signs include persistent pain, a wound that keeps leaking, redness, swelling, fever or feeling unwell, though normal blood tests do not exclude it. The standard work up is a CRP with or without ESR plus X rays, then aspiration of the joint under sterile conditions with cultures kept for at least seven days. Antibiotics should not be started before the samples are taken unless you are seriously unwell, because they can mask the result and make the infection harder to treat.

How long after a hip replacement is there a risk of infection?

The highest risk is in the first two to three months, and infection acquired at surgery is usually evident within the first 60 days. A small lifelong risk remains because bacteria from elsewhere, for example skin, teeth, urine or chest, can seed the implant through the bloodstream. That later risk is much lower but never zero, so any unexplained fever with new hip pain, at any time, should be checked.

What are the symptoms of a metal on metal hip problem, which implants were recalled, and what checks are needed?

Symptoms include new groin or hip pain, swelling or a lump around the hip, clicking or popping, a limp or reduced mobility, though some damaged hips feel fine, which is why surveillance continues. The DePuy ASR resurfacing and ASR XL total hip were recalled in September 2010 because the five year revision rate was higher than expected across all sizes. Current MHRA guidance, MDA/2017/018, requires annual review for life for stemmed metal on metal hips with a head of 36 mm or more and for women with resurfacings, with an Oxford Hip Score, whole blood cobalt and chromium levels, and a MARS MRI or ultrasound scan where levels are 7 ppb or above, rising, or symptoms change. Imaging carries more weight than a single blood result, and there is no fixed blood level that mandates revision.

How will I know if my hip replacement has dislocated, and can I walk on it?

A dislocation usually happens suddenly, with severe pain and a clunk, often during bending, twisting or getting up; the leg may look shorter and turned in or out, and you normally cannot stand or move the hip. The NHS notes it can happen soon after surgery or many years later. Do not try to walk on it. Call 999 or go to A&E, because the hip has to be put back under sedation or anaesthetic.

How common is dislocation, and how much force does it take?

Registry studies suggest around 1 to 4 in 100 hip replacements dislocate within two years; a Danish national study measuring the true rate found 3.5%, varying from under 1% to over 7% between hospitals. Dislocation is the second commonest reason for revision in the NJR at around 18% of first revisions. The risk is higher after revision surgery, in older or frail patients, with damaged abductor muscles, and with a stiff spine or previous spinal fusion. It does not take a fall: most dislocations happen with everyday movements that combine deep bending and twisting, particularly in the first weeks before the soft tissues have healed.

Why does my hip replacement keep dislocating, and what is a dual mobility hip?

Recurrent dislocation is usually multifactorial: cup or stem position, a small head, weak or detached abductor muscles, leg length or offset, a stiff spine, or a previous revision. The British Hip Society standard says every unstable hip should be discussed at a multidisciplinary meeting and complex or repeat cases at a regional network meeting. A dual mobility cup has a large polyethylene head that moves inside a polished metal shell with a smaller ceramic or metal head inside it, giving a much larger effective head. A 2024 meta analysis of eight studies and over 20,000 patients found about a 75% reduction in dislocation compared with standard bearings, with no difference in infection, fracture or patient reported outcomes. In revision cases dual mobility dislocation rates are around 2%, and constrained liners are kept as a salvage option.

Can an unstable hip replacement be treated without surgery?

A first dislocation is usually treated by putting the hip back without an operation, followed by movement precautions and physiotherapy to strengthen the abductors, and many patients never dislocate again. Recurrent instability is different. The British Hip Society standard states that braces have a very limited role in the definitive management of hip instability, so repeated dislocations are assessed for cause and generally treated by revision, often with a dual mobility bearing.

Can a hip replacement fail after one year?

Yes, although early failure is uncommon: the NJR 10 year revision estimate for recent primaries is 2.7%. Early failures are mostly infection, dislocation, fracture around the implant or a component that has not fixed to bone; wear and loosening are later problems. UK revision numbers roughly doubled between 2006 and 2012, largely because of early failures of certain metal on metal implants that have since been withdrawn, and have been falling since.

What is the average lifespan of a hip replacement implant?

The NHS says modern hips are designed to last at least 15 years. Pooled registry data show about 89% surviving 15 years, 70% at 20 years and 58% at 25 years, and current NJR cohorts are doing better than those older figures. Lifespan depends on age, activity, weight, implant type and fixation; younger patients are more likely to outlive their implant and need a revision at some point.

What are the most commonly reported problems after hip replacement?

In the NJR the leading reasons a hip is revised are loosening (about a quarter), dislocation (about 18%), fracture around the implant (about 17%), infection (about 16%), reaction to wear debris (about 13%) and unexplained pain (about 10%). Problems that do not usually need revision include a leg length difference, tendon and bursa pain around the hip, clicking, numbness around the scar and persistent stiffness. Around 7% of patients remain dissatisfied at one year.

Who should I see about a painful or unstable hip replacement?

Start with your GP or the surgeon who did the operation, who should arrange X rays and blood tests. UK standards say suspected failure should be investigated by an orthopaedic consultant with a special interest in hip arthroplasty, and that every unstable hip, every confirmed infection and every complex or repeat revision should be discussed at a hip revision multidisciplinary meeting, with the most complex cases going to a regional network centre. Do not start antibiotics for a painful hip without specialist advice unless you are seriously unwell.

What tests will be done to find the cause of a painful hip replacement?

First, plain X rays of the pelvis and hip compared with your earlier films, plus blood tests: full blood count, CRP with or without ESR, and kidney function. If the markers are raised or infection is suspected, the joint is aspirated under sterile conditions and the fluid cultured for at least seven days, ideally with no antibiotics in the preceding two weeks. CT is used for bone loss or a suspected break in the pelvic ring, MARS MRI or ultrasound for soft tissue and metal reactions, and whole blood cobalt and chromium for metal on metal hips; bone scans are rarely useful. Sometimes a diagnostic injection of local anaesthetic into the joint or a tendon helps pin down the source.

Sources

National Joint Registry, 22nd Annual Report 2025, chapter 3 outcomes after joint replacement. https://reports.njrcentre.org.uk

Sabah SA et al. Epidemiology of revision hip replacement surgery in the UK over the past 15 years: an analysis from the National Joint Registry. BMJ Open 2023;13:e072462. https://doi.org/10.1136/bmjopen-2023-072462

Deere K et al. How long do revised and multiply revised hip replacements last? A retrospective observational study of the National Joint Registry. Lancet Rheumatology 2022.

British Hip Society Surgical Standards, Revision Hip Network series: Investigation and Management of Prosthetic Joint Infection; Management of Aseptic Loosening; Revision of the Unstable Hip Arthroplasty; MDT meetings for low volume high complexity procedures. https://www.britishhipsociety.com

British Hip Society Position Statement, Nickel allergy in total hip replacement (January 2026). https://www.britishhipsociety.com

British Orthopaedic Association, BOAST: Acute management of peri-prosthetic joint infection (2023, updated 2024). https://www.boa.ac.uk

MHRA, MDA/2017/018 All metal-on-metal hip replacements: updated advice for follow-up of patients (June 2017). https://www.gov.uk/drug-device-alerts/all-metal-on-metal-mom-hip-replacements-updated-advice-for-follow-up-of-patients

MHRA, MDA/2010/069 DePuy ASR hip replacement recall (September 2010).

NHS.uk, Hip replacement: complications and recovery (reviewed March 2024, updated 2025 and 2026). https://www.nhs.uk/tests-and-treatments/hip-replacement/

Lenguerrand E et al. Risk factors associated with revision for prosthetic joint infection after hip replacement. Lancet Infect Dis 2018;18:1004-14.

Evans JT et al. How long does a hip replacement last? Lancet 2019;393:647-54.

Hermansen LL et al. True cumulative incidence of hip dislocation within 2 years after primary total hip arthroplasty. Acta Orthop 2022;93:503-8.

Darrith B et al. Outcomes of dual mobility components in total hip arthroplasty: a systematic review. Bone Joint J 2018;100-B:11-19.

Dual mobility versus fixed bearing implants in primary total hip arthroplasty: meta-analysis. Cureus 2024;16:e61715.

Rupani N et al. Centralisation of low volume high complexity orthopaedic surgery. Journal of Trauma and Orthopaedics (BOA), December 2024.

GMC, Good medical practice (2024), paragraph 18 on the right to a second opinion. https://www.gmc-uk.org

Royal Berkshire NHS Foundation Trust, Revision total hip replacement: advice and exercises (April 2026).

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