Wear
the surface wears down after years of use.
Your first joint replacement did not work.
This page is about what comes next.
Has the replacement failed?
If the knee or hip that was already replaced has turned painful again - loosened, become infected, or never felt right - you are not back where you started.
Can a failed replacement be fixed?
A failed first replacement is a known problem, with a path through it.
How do we even decide on another surgery?
This page is for you, whether it is your own joint or a parent's, as you decide whether a second surgery - a revision - is the right move.
Will this page actually help us decide?
It explains
what a revision is
when it helps
how to judge whether you have the right surgeon for it
What even is a revision?
A revision replaces a joint implant that has failed.
The arthritis that first brought you to surgery is behind you. This is a new implant - built for the harder, second job - taking the place of the one that stopped working.
Why a first replacement fails
Loosening
the implant works loose from the bone.
Infection
an infection takes hold in the joint.
Instability
the joint becomes unstable, or a hip slips out of place.
A break in the bone
the bone around the implant fractures.
Some show up early - infection especially - and others, like wear and loosening, only after years.
Does it take one operation or two operations?
Whether it takes one operation or two depends on why the implant failed. When infection is the cause, the safer route is often two operations - the first to clear the infection, the second to put the new implant in once it has gone. Without infection, it is usually a single operation.
Can our regular orthopaedic surgeon do a revision?
A revision is a different operation, done by surgeons who do it regularly.
A first replacement starts from a worn but otherwise intact joint. A revision starts from one that has already been operated on - with less bone to build on, and a reason for the failure that has to be worked out before anything is replaced. That changes what the surgery asks for.
Why it asks more
Different implants
a revision uses implants built for the harder job, and not every hospital keeps them on the shelf.
More planning
scans map how much bone is left, and the likely implants and steps are planned before the operation begins.
Infection changes the approach
when infection is the cause, the route is different - often two operations instead of one - which takes specific experience to do safely.
None of this makes the search hard. It makes one question worth asking early - how often does the surgeon you choose do revisions?
Who do we trust with a second surgery?
Revision is work Dr Ramneek Mahajan has chosen to focus on.
A failed first replacement makes the next decision feel heavier. These are the parts of his record that matter for a revision.
What the record shows
Twenty-five years, 18,000+ joint replacements
and revision, including joints already operated on more than once, is one of the areas he focuses on.
He trains other surgeons
in robotic joint replacement, and chairs an annual hip-and-knee replacement conference.
Trained across Singapore, Germany and Australia
and has published on revision surgery.
HEAR FROM MORE FAMILIES
Meet Your Surgeon
How long does recovery take?
Recovery from a revision takes longer than from a first replacement.
More was done this time (bone rebuilt, the failure dealt with, sometimes an infection cleared first), so there is more to heal, and the pace is slower than the first time - normal for a revision.
What to expect
It takes longer than the first time
worth planning for, at home and around work.
If infection was the cause, recovery is longest
it is two recoveries rather than one, with weeks or months between them.
A two-stage revision after an infected knee - one patient's recovery
These videos are published on Max Healthcare's official YouTube channel. Each patient's experience is unique - outcomes depend on individual health, disease characteristics, and clinical factors. These accounts are not a guarantee of results.
What does the surgery actually involve?
The operation, stage by stage.
First, the plan
Before the day, scans and X-rays show how much bone is left and identify the implant that failed. If there is any sign of infection, that is settled first - an infected joint is treated a different way. The surgeon readies the implants, plus back-ups for what the joint may need.
Removing the failed implant
Often the hardest part. The old implant and any cement come out with tools made for the job, sometimes by opening a small window in the bone to free a stem that is still firmly fixed. Throughout, as much bone as possible is saved for the rebuild.
When infection is the cause: two stages
The joint is cleared out, an antibiotic spacer is put in its place, and antibiotics run for several weeks. Only once the infection is gone does the new joint go in, at a second operation.
Rebuilding the bone
Where bone has been lost, metal pieces or bone grafts fill the gaps. Longer stems reach past the weakened bone into stronger bone below, so the new implant has a firm hold.
A stable joint
How much the implant has to do for stability depends on the ligaments - up to a linked implant, its parts joined together, when they are weak. The joint is balanced through its full range of movement before the wound is closed.
After the operation
A revision is a longer operation, with a longer hospital stay than the first. Blood-thinning medicine and early, guided movement begin the recovery.
Will a second surgery cost more than the first?
A revision usually costs more than the first replacement.
A revision is a bigger operation than the first one, and a bigger operation costs more. The same things that make it harder - the implants, the planning, the theatre time - are what add to the bill.
Where the cost comes from
The implants
the specialised parts a revision needs cost more than the parts used the first time.
A longer operation
a revision takes more time in theatre, and more of the surgical team, than a first replacement.
A longer hospital stay
the days spent recovering in hospital tend to run longer than after a first replacement.
If infection is the cause
When infection is the reason, it usually has to be cleared before a new joint can go in - often as two operations with a wait in between, rather than one. That makes it the longest path, and usually the most expensive. If infection is a possibility, plan for it early.
What insurance covers, and what varies
Most of the hospital package for a revision is set by insurance. The one part that varies is the implant - what the joint needs (how much bone is left, the ligaments) differs from case to case, so its cost does too.
If you have health insurance, the practice's insurance team helps you check all of this before admission:
Your policy benefits - what your plan covers for a revision.
Cashless eligibility - whether the hospital can bill your insurer directly.
Any out-of-pocket cost - what, if anything, you would pay yourself.
That way, you know where you stand before you decide.
Cost is a real part of this decision. Ask for the full picture early, so the money is something you can plan for - not something that catches you later.
Frequently Asked Questions (FAQs)
- Dr. Ramneek Mahajan
