When is it necessary to revise a hip replacement?
There are various reasons why hip replacements will be revised.
Most commonly these days, we revise patients who have had their hip in place for about 15 to 25 years and require a new bearing surface. The polyethylene that was commonly used in the 1990s oxidized in the body, increasing the wear rate. Wear debris accumulates in the soft tissues and bone around the hip causing damage (osteolysis). Some types of metal on metal total hip replacement bearings were troubled by local soft tissue reaction to metallic debris and this is another reason for revision surgery.
The newer polyethylene that has been available now for 15 years has a far superior wear performance with at least 10 time less wear when combined with a ceramic head. Well-designed metal on metal resurfacing hips also have 10 times less wear than old polyethylene. Ceramic on ceramic bearings have 100 to 1000 times less wear than the old polyethylene. So we expect the hips that we do now to last longer than the hips put in last century.
Other reasons for revision include infection, bone fracture, tendon irritation and implant breakage, loosening or other mechanical problem. These are rare complications that can occur at any time after the primary surgery.