Revision Hip Replacement Surgery - Failed Hip Replacement Surgery

A failed hip replacement can be rebuilt. Loosening, dislocation and infection each have their own repair.

Revision hip replacement surgery takes out a worn, loose, unstable or infected hip implant and fits a new one, and the parts now used for the hardest problem, repeated dislocation, have cut that risk sharply. In a meta-analysis of 133,474 hips, a standard large ball dislocated about twice as often after revision as a dual mobility cup. This page sets out why hips fail, how the cause is proven before surgery, what the operation and the two weeks in Istanbul involve, and which records to send for a free review.

Signs of a failed hip replacement

Groin or thigh pain that returns years after a good result is the commonest warning.

Pain in the groin points to the cup in the pelvis, and pain down the front of the thigh points to the stem. The signs below also need an X-ray and a surgeon's opinion.

• Pain on the first steps after sitting that eases once walking is underway
• A hip that has come out of its socket, even once
• A leg that has become shorter, or a new limp
• A clunk or squeak with each step
• Swelling on the side of the hip, or a wound that leaks or reopens

Some failures cause no pain at all. A widening dark line around the implant, or a ball sitting off center in the cup, shows up first on a routine X-ray, and the yearly or two-yearly check matters long after the scar has faded for that reason.

Why hip replacements fail

Four causes dominate in national joint registries from seven countries. Aseptic loosening, meaning an implant that has come away from the bone without infection, accounts for 35.1 percent, with deep infection following at 18.2 percent, dislocation and instability at 15.9 percent, and a fracture of the bone around the implant at 11.4 percent.

Wear and metal debris

Wear explains much of the loosening. Older plastic liners shed microscopic particles over fifteen or twenty years, the body attacks them, and the reaction dissolves the bone holding the implant. Metal-on-metal hips are a separate case. Widely used until the early 2010s, they can release cobalt and chromium, which damage the muscle around the joint.

Proving the cause before surgery

Surgeons rule out infection in every revision, because an infected hip treated as a simple loosening fails again. Blood tests for C-reactive protein and the sedimentation rate come first. Fluid drawn from the hip with a needle under X-ray or ultrasound guidance goes for a cell count and culture, while plain X-rays compared with older films show whether the dark lines around the implant are new or growing, and a CT scan maps the bone left in the pelvis and the thigh. A patient with a metal-on-metal hip also needs blood levels of cobalt and chromium and an MRI set up to reduce metal glare. Hip fluid sometimes comes back with too few cells to read, and a second sample, or tissue taken through a small cut under imaging, settles the question before anyone books an operating room, because the answer decides whether the plan has one stage or two and whether the trip to Istanbul happens once or twice.

Five or more tissue samples therefore go to the laboratory during every revision.

A hip that keeps dislocating

Recurrent dislocation has a mechanical answer. Finding the reason comes first. A cup tilted at the wrong angle, a stem turned too far forward or back, a leg left too short, or weak and torn muscles on the side of the hip all let the ball escape, and the revision corrects whichever applies. Surgeons measure the angles of the old cup and stem on CT before deciding what to change. Then comes the choice of bearing. A dual mobility cup holds a large plastic ball that moves inside the metal shell, with a smaller metal or ceramic head moving inside that plastic, so the joint has two surfaces of movement and a much larger distance to travel before it can come out. A constrained liner locks the head into the cup with a ring and works when the muscles that stabilize the hip have gone, at the cost of extra stress on the fixation of the cup.

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Ten comparative studies and 2,046 revision hips went into a 2026 review, which found lower dislocation and re-revision with dual mobility than with constrained liners, and five years after revision 78 to 85 percent of hips had stayed in joint without another dislocation.

Infected hips, one stage or two

Two-stage exchange

1. Removal. The first operation takes out the implant and all cement, clears infected tissue and leaves a spacer of antibiotic-loaded cement in the hip.
2. Antibiotics. Six weeks of treatment follow, through a vein at first.
3. The new hip. A second operation fits the new implant once tests show the infection has cleared, two to three months after the first.

One-stage exchange

Everything happens in one operation. It suits an organism identified before surgery, healthy soft tissue and a patient fit for a long anesthetic. Across 14 studies and 1,429 patients, a 2024 meta-analysis found reinfection rates no different between the two approaches when the hospital chose patients using a written decision algorithm, while one-stage exchange done without such an algorithm carried 1.79 times the odds of reinfection. A second meta-analysis of 2,502 hips found better hip function scores after one stage. German registry data from 2013 to 2023 give the counterweight, with one-year mortality of 9.9 percent after one-stage and 6.3 percent after two-stage revision for infection across hospitals of every size.

Loose cups, loose stems and lost bone

The cup side

Surgeons grade bone loss in the pelvis on the Paprosky scale, from small contained cavities to defects where the rim or the floor of the socket has gone. Moderate loss takes a larger porous cup held with screws. Bigger defects take porous metal augments that fill the gap like building blocks, and the most severe take a cup-cage construct or a custom implant printed from the patient's CT scan.

The stem side

A loose stem comes out through the top of the thigh bone.

Removing a stem that is still well fixed, or one held by hard cement, sometimes takes a controlled cut along the side of the femur, an extended trochanteric osteotomy, which opens the bone like a lid and is wired shut at the end. The new stem bypasses the damaged upper bone and grips healthy bone lower down, and tapered fluted titanium stems with ridges that bite into the shaft have become the standard for this.

A fracture around the implant

When the stem is still firmly fixed, plates and cables repair the fracture and the implant stays. When the fracture has loosened the stem, revision to a longer stem that reaches past the break holds both the bone and the hip, and protected weight bearing follows for six weeks or more. Fractures of this kind need surgery within days. A patient with one gets treated near home.

From the operating room to the flight home

Packages published for revision hip replacement surgery in Istanbul plan five nights in hospital, in a room with a companion bed so one family member stays for the whole admission, and about 14 days in the country.

The first five days

The operation runs three to five hours. Physiotherapy starts the next morning with standing and a few steps on a frame, and blood-thinning treatment, begun on the first evening, continues for five weeks. How much weight the leg may take depends on the reconstruction, from full weight straight away after a simple liner exchange to touching the floor only for six weeks after an osteotomy or a large augment, and the surgeon writes that limit on the discharge letter.

The hotel week and the flight

After discharge the remaining nights pass in a hotel. Physiotherapy continues daily. Stitches come out at two weeks. The flight home follows that wound check, in an aisle seat where possible, with compression stockings, the blood-thinning injection given that day, and a walk every hour, and the international patients office, which books the hotel, the daily transport and the airport transfers, also arranges wheelchair help at both airports.

A two-stage revision for infection means two trips, six weeks or more apart, with the spacer in place and the antibiotic plan written out for your own doctor in between.

Your coordinator, assigned from the first message, stays on WhatsApp through both stages.

The international patients team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish, interpreting in other languages is arranged on request, and the consent conversation about dislocation, infection and leg length therefore happens in a language you follow. A request for a female surgeon goes to the department and is met wherever the rota allows. The hospital kitchen prepares halal, vegetarian and diabetic meals, a prayer room is on site, and the invitation letter naming the hospital and the surgeon goes out ten days before travel for the visa.

Reading a quote for a hip revision

Cost follows the extent of the revision. Exchanging a liner and a ball takes a fraction of the time and implant of a full revision with a new cup, augments, an osteotomy and a long tapered stem, and a two-stage infection case doubles the operations. Dual mobility or constrained parts, a custom cup, blood transfusion, intensive care and extra nights all move the total, and so do diabetes, kidney or heart disease and a high body weight, while leg length correction, a repair of torn muscles on the side of the hip and the cultures sent during surgery each add time and material. Packages published in this market include the surgery, anesthesia, the implant, medications, the hospital nights with a companion, daily doctor visits, an interpreter and airport transfers, while flights, the hotel and travel insurance sit outside them, and several state that a change of plan during surgery is charged separately.

Questions for any quote

Before comparing offers, find out whether the figure covers a full revision or a part exchange, which implant system it names, whether augments and a dual mobility cup are inside it, and how a two-stage plan would be billed. A real figure needs a surgeon to read your X-rays first. That review is free.

Follow-up from home

Once you are back home, X-rays at six weeks, three months and one year, then every one or two years, show the bone growing onto the new parts. A local clinic takes them. The operating surgeon compares them with the films taken in Istanbul.

Warning signs

Call the same day for any of these.

• The hip coming out, or a sudden inability to bear weight
• Fever, or fluid leaking from the wound
• A swollen calf, chest pain or breathlessness
• New groin or thigh pain after a period without it

A local emergency department sees you first. The surgeon talks to that doctor directly with the operation note in hand.

Revision hip replacement FAQ

References

1. Hauer G, Rasic L, Klim S, et al. Septic complications are on the rise and aseptic loosening has decreased in total joint arthroplasty: an updated complication based analysis using worldwide arthroplasty registers. Arch Orthop Trauma Surg. 2024;144(12):5199-5204.
2. Schwarze J, Moellenbeck B, Gosheger G, et al. The role of single positive cultures in presumed aseptic total hip and knee revision surgery: a systematic review of the literature. Diagnostics (Basel). 2023;13(9):1655.
3. Ibrahim A, Selim A, Dwebeng C, et al. Dual mobility vs. large femoral head (36 mm or more) in primary and revision total hip arthroplasty: a meta-analysis of outcomes. JBJS Rev. 2025;13(12). doi:10.2106/JBJS.RVW.25.00181
4. Shaik A, Akram N, Al-Saadi M, et al. Dual mobility vs constrained liners in managing instability after revision total hip arthroplasty: a systematic review and exploratory cost-effectiveness model. Cureus. 2026;18(5):e108186.
5. Qin Y, Liu Z, Li L, et al. Comparative reinfection rate of one-stage versus two-stage revision in the management of periprosthetic joint infection following total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2024;25(1):1056.
6. Lamo-Espinosa JM, Mariscal G, Gomez-Alvarez J, et al. One-stage versus two-stage revision surgery for periprosthetic hip infection: an updated systematic review and meta-analysis of clinical outcomes. J Am Acad Orthop Surg. 2025;33(7):e367-e379.
7. Resl M, Becker L, Wu Y, Perka C. One- or two-stage hip revision? High mortality in one-stage challenges its growing popularity: a registry study. J Arthroplasty. 2026;41(4):1261-1266.e1.