Revision joint surgery replaces a previously implanted knee or hip when the original replacement has worn out, loosened, become infected, or otherwise failed. It is a planned, specialised procedure - not an emergency operation. Revision implants are designed with longer stems, augments, and reinforcement options to handle the bone loss that comes with explanting the original. Patients return to walking and routine activity, with a recovery longer than the primary surgery.
Revision Total Hip Replacement
Revision hip replacement for loose, infected, or unstable implants at Max SMART Saket. Direct Anterior, posterior, and specialist revision reconstructions. 23+ years of joint-replacement experience.
Max SMART Saket
Mahajan's GK-1
Revision Total Hip Replacement is a demanding, highly expertise-oriented procedure performed in patients with a failed hip joint operation due to any reasons. The operation involves careful removal of the old failed hip implants and redoing it by Dr Ramneek's expert team, deciding the best techniques based on your bone condition in a meticulously planned way.
Common indications for revision hip replacement include implant loosening, worn-out bearing surfaces, recurrent dislocation, periprosthetic fracture, infection, or persistent pain related to the prosthesis.
The majority of revision procedures can usually be completed as a single-stage operation. In infection cases, a staged approach is often required. The first stage involves removal of the failed hip implants with placement of an infection-curing antibiotic spacer, followed by a final second-stage replacement with a suitable hip joint as per your original hip anatomy.
Revision Total Hip Replacement is more technically demanding and expertise-intensive than primary hip replacement, and also needs individualised pre-operative planning, implants based on your specific needs, and well-structured post-operative rehabilitation protocols to achieve the best possible outcome. Dr Ramneek's joint team has curated a systematic, successful protocol for such patients, providing the best results which takes care of your hip joint from admission until a full, pain-free, active lifestyle.
Same hip. See what revision rebuilds.
Who Revision Hip Replacement is for
Revision hip replacement is for adults who already have a hip implant and are facing a problem with it.
The hips we revise usually fall into one of these patterns:
Pain that has come back. The implant has loosened from the bone, and the groin or thigh hurts on weight-bearing in a way that feels different from the original arthritis pain.
Recurrent dislocation. The artificial hip pops out repeatedly during ordinary movements, with or without an obvious trigger.
Infection. The hip feels warm, drains fluid, swells, or causes fevers, and blood tests and joint-fluid samples confirm an infected implant.
Wear of the bearing surfaces. The polyethylene liner thins down and small fragments cause bone loss around the implant.
Periprosthetic fracture. The bone around the stem breaks after a fall.
Leg-length change or persistent limp from the previous operation.
We see revision patients across age groups. Many are older patients whose previous hip replacement was done years ago and is now wearing out; some are younger patients with an early problem like recurrent dislocation or an infected implant. We assess each patient individually and confirm the diagnosis with X-rays, sometimes a CT scan, blood work, and joint-fluid studies before we recommend revision.
Meet Your Surgeon
How long is the hospital stay?
Hospital stay for a revision hip replacement is usually two to three nights for a straightforward aseptic revision - longer than a first-time hip replacement, where most patients leave within a day or two. The extra night reflects the larger operation, slightly more pain in the first 24-48 hours, and careful attention to walking safely with a hip that has just been reconstructed.
Surgery itself usually takes longer than a first-time hip replacement because we need time to remove the existing implants, address any bone loss, and place the new components precisely. We use spinal anaesthesia where possible and supplement with local pain blocks so you are comfortable through and after the operation. Most patients stand and take their first steps with a walker the same evening or next morning. Physiotherapy starts on Day 1. By the time you go home you can walk with a walker or sticks, manage stairs with support, and look after basic self-care.
If your revision is being done in two stages for infection, the first stay is typically about a week while we place the temporary spacer and start antibiotics, you go home with treatment continuing for several weeks, and the second stay is two to three nights when we put in the new hip.
What does recovery actually look like
Every patient goes home with 7 to 8 contact numbers - covering doctors, physiotherapist, dieticians, emergency services, and administrative staff. Nobody feels alone in the recovery.
Recovery from revision hip replacement takes longer than recovery from a first-time hip replacement - typically two to three times longer to reach the same milestones. We tell you this upfront so the timeline does not feel like something has gone wrong.
In the first week, you are walking with a walker or sticks, doing gentle exercises, and managing the wound.
By two weeks, the stitches are out, swelling is settling, and most patients are using a single stick around the house.
Between weeks four and six, you transition off walking aids if your balance and strength allow it.
Driving usually returns at six to eight weeks once you can react safely.
Routine activities - desk work, light household tasks, longer walks - come back in months two and three. Stamina and confidence on stairs continue to improve through months four to six. Return to fuller activity like brisk walking, gym work tailored to your hip, and travel happens through the second half of the first year.
If your revision was done in two stages for infection, the whole recovery is longer because of the gap between operations. We see you back at six weeks, three months, six months, and one year, and we adjust your physiotherapy plan as you progress. Recovery is steady but not linear; some days will feel better than others, which is normal.
Signs your hip replacement may need a closer look
There are six signals that tell us your previous hip replacement may need a closer look:
Groin or thigh pain that has come back months or years after a hip that was comfortable, especially pain that hurts on weight-bearing and eases when you sit down.
Recurrent dislocation - the hip popping out more than once during ordinary movements like getting out of a low chair, bending to put on shoes, or turning in bed.
Warmth, redness, drainage from the old scar, or unexplained fevers, which raise the question of infection.
A new clunk, click, or squeak inside the hip during walking.
One leg starting to feel shorter than the other, or a limp that was not there before.
An X-ray finding picked up on follow-up or for another reason - the cup or stem has moved, the bone around the implant looks thinned, or the polyethylene liner has worn down.
Any one of these signals is reason to come in. We confirm with X-rays, sometimes a CT scan or blood work, and a joint-fluid sample where infection is on the table, before we discuss revision with you.
What are the surgical options for revision hip replacement?
Three branches of revision are possible, and the right one depends on what is failing in your hip:
Head-and-liner exchange. If the cup and the stem are still well-fixed to the bone, and only the polyethylene liner has worn down or the metal head is the problem, we can swap just those bearing parts. This is the smallest revision and recovery is closer to a first-time hip replacement than a full revision.
Single-component revision. We replace either the socket side or the stem side, leaving the other in place if it is well-fixed and well-positioned.
Full revision. Both the cup and the stem come out and new components go in. Within a full revision, the choice of new implants depends on bone loss: a standard cup if the socket bone is good, a larger or bone-graft-supported cup if the socket is deficient, a longer stem if the femur has lost bone, sometimes a modular stem that we assemble in the operating room to fit your anatomy.
A fourth path applies if your hip is infected. Here we use a two-stage approach. The first surgery removes all the infected components and places a temporary spacer made of antibiotic-loaded cement; you spend several weeks on antibiotics while the infection clears; the second surgery places the definitive new hip.
Patients with recurrent dislocation may also be offered a dual-mobility implant or a constrained liner to improve stability and reduce the chance of the hip popping out again. We discuss the right option for your hip in detail once we have your X-rays, scans, and any infection workup, and we walk you through the trade-offs before we agree the plan.
What happens during the surgery itself?
Same hip. See what revision rebuilds.
Planning starts before you reach the operating theatre. We study your X-rays and, where bone loss is suspected, a CT scan, so we know how much bone we have to work with on the socket side and on the femur side. We template the new components - cup size, stem length, the need for augments or bone graft - so the right inventory is opened in the operating room before we start.
On the day of surgery, you are positioned and prepped, and we plan an incision that often follows your old scar to keep new tissue undisturbed. The surgical exposure has to be larger than a first-time hip replacement because we need to see the bone around the existing implants. Most often we use the posterior or direct lateral exposure, sometimes extending it with a controlled bone window in the upper femur to safely free a well-fixed stem; for selected revisions where the anatomy permits, we use the Direct Anterior Approach.
We then remove the existing implants carefully, preserving as much of your own bone as possible. Once the old components are out, we assess what we find: bone defects in the socket are addressed with bone graft, porous metal augments, or a larger cup; bone loss in the femur is addressed with a longer stem that bypasses the weakened bone and gets a stable grip in the healthy bone below. We test the new hip with trial components for stability, leg length, and range, and only then implant the definitive components. The wound is closed in layers over a drain, and you are moved to recovery.
For an infected hip the first stage is removal plus spacer placement; the second stage repeats this planning and reconstructs the hip after the infection has cleared.
What technology and implants do we use for revision?
Revision hip replacement uses a different implant family from a first-time hip replacement, because the goals are different - we are reconstructing around what is left of your bone, not starting from a healthy joint.
On the socket side we use porous-coated cups designed to grow into the remaining pelvic bone, supplemented with screws for immediate stability. When the socket has lost bone, we add porous metal augments that fit into the defect and are bolted to the cup, or we use a larger cup that contacts more of the remaining bone. For severe socket bone loss with the pelvic ring weakened, we use specialised reinforcement constructs and bone graft, and in selected cases we use impaction bone grafting to rebuild the socket before placing the new cup. The liner that sits inside the cup is most often highly cross-linked polyethylene; for hips at high risk of dislocation we use a dual-mobility design that gives two layers of motion and a larger effective head size, which lowers the chance of the hip popping out. We rarely use fully constrained liners and only in select high-risk cases, because they transfer more force to the bone-implant interface and can fail earlier.
On the femur side we use a stem chosen to match your bone. If the upper femur is healthy, a standard revision stem works; if there is significant bone loss, we use a long stem that extends past the damaged area and grips the strong bone below. Modular stems let us adjust length, offset, and version in the operating room to match your anatomy. Cemented and cementless stems both have a role; cemented stems give immediate fixation that lets you bear full weight early and suit older patients with weaker bone, while cementless stems rely on bone growing into the implant over time. Head sizes of 36 millimetres and above are standard in revisions to improve stability.
For infected hips, the temporary spacer used in the first stage is made from antibiotic-loaded bone cement that delivers high local doses of antibiotic into the joint while preserving spacing for the definitive implants at the second stage. We choose the implant combination for your hip based on the X-rays, CT scan, and findings at surgery.
Risks we discuss before any revision surgery
Revision hip replacement is a bigger operation than a first-time hip replacement, and complication rates after revision are higher than after a first-time hip replacement. We discuss this openly with you so the consent is informed, not just signed.
Instability and dislocation. The artificial hip can pop out in the first weeks or later, particularly when soft tissues around the hip have been stretched by years with the old implant. Dislocation rates after revision are reported at three to five times the rate of a first-time hip replacement, which is why we routinely use larger heads, dual-mobility implants where appropriate, and careful soft-tissue closure.
Infection. Even with strict sterile technique, antibiotic prophylaxis, and screening for skin, dental, and urinary sources beforehand, a small proportion of revisions become infected after surgery. If your revision is being done for an existing infection, the risk of the infection returning is real and we monitor you carefully with blood tests and clinical review through the antibiotic window and after the second stage of surgery.
Periprosthetic fracture. The bone around the stem can crack when an old implant is being removed or when the new stem is being seated; we plan around this with bone windows and protective wires where the bone is thin.
Leg-length difference. Bone loss and soft-tissue contractures can make it harder to match the two legs exactly, and we plan with templating before surgery and trial reductions during surgery to minimise the difference.
Nerve injury, most commonly the sciatic nerve, which can cause weakness or numbness in the leg. This is uncommon but real and we mention it before surgery. Most nerve injuries recover over weeks to months, but a small proportion can leave lasting weakness.
Blood clots in the leg veins or lungs, which we lower with blood-thinner medication, mechanical compression of the legs, and early walking.
Bleeding requiring transfusion - more common in revision than in a first-time hip replacement because the operation is longer and the exposure is larger. We plan blood availability before surgery and use techniques to keep blood loss as low as possible.
Medical complications related to the longer surgery, more relevant in older patients with heart, lung, or kidney conditions, which is why pre-operative health checks are detailed and we sometimes optimise an existing medical condition before we book surgery.
The possibility of further surgery at some point in the future. Revision implants have very good long-term survivorship, but no implant lasts forever, and the risk of needing another procedure later is part of the honest picture.
We explain each of these in our consultation, what we do to lower the chance of each one, and what the plan is if any of them occurs. The whole point is that you go into surgery with a clear-eyed picture of what could happen, not a glossy one.
Frequently Asked Questions (FAQs)
Can I safely wait?
The questions worth asking before you decide - and when waiting is the right call, and when it is not.
Before we meet
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What should I expect, step by step?
The whole path, stage by stage - getting ready, the day itself, recovery, physio, life after.
Patient journey
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Where did he train?
Fellowships, years in practice, and international experience
Credentials and experience
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