Revision Hip Surgery

Important: a loose implant should not be "put up with" for too long. Every week, more bone may be lost – and the later revision becomes more complex.

1. Find the cause X-rays, blood tests and usually a joint aspiration. A revision without a clear cause has poor prospects.

2. Always rule out infection Even apparently "mechanical" loosening can be caused by a low-grade infection. That is why we specifically test for bacteria before every revision (see below).

3. Plan For larger defects with a CT scan, if needed with three-dimensional reconstruction of the pelvis. This tells us before surgery how much bone is missing and which implants we need.

4. Operate We replace only what needs replacing. Well-fixed, well-positioned components stay where possible.

5. Rehabilitate Weight-bearing after revision depends on the reconstruction and is set individually.

Depending on how much bone is missing, we choose the appropriate solution – from a simple cup exchange to a custom-made implant.

What is trabecular metal? A highly porous metal whose structure resembles natural spongy bone. Your own bone grows into the pores and anchors the implant firmly – even where little bone remains.

Our results

• Trabecular metal cups and augments: in our long-term study, 92.5% of reconstructed sockets were still functioning well after an average of ten years. The hip function score rose on average from 55 to 81 points.
• Very large defects with two augments: even in the most severe socket defects (Paprosky IIIB), 89% of reconstructions held in the medium term; hip function improved significantly.
• Pelvic discontinuity with cup-cage: in patients with the most difficult defects – two thirds of them with a fracture through the pelvis – 89% of reconstructions were free of further revision at five years. Not a single cup had to be revised for loosening. The hip function score rose on average from 30 to 71 points.

We are among the leading centres in Germany for the treatment of pelvic discontinuity.

If the stem in the thigh bone has loosened, bone is often missing there. The new stem must therefore be anchored in healthy bone below the loosened area.

We have revision stems in many lengths, including modular stems whose length, neck and orientation can be adapted to your anatomy during surgery.

Our principle: as short as possible, but as long as necessary. A shorter stem preserves bone for any later procedures. A stem that is too short will not hold securely. Where possible, we do not remove a well-fixed stem at all.

If the hip repeatedly dislocates, we look for the cause: are cup and stem at the correct angle? Is leg length right? Are the muscles adequate? Depending on the cause, we correct the implant position or use dual-mobility cups, which are considerably more stable against dislocation.

Infection is the most serious complication of a joint replacement. It is rare – but when it occurs, it must be treated consistently and according to clear rules.

How is an infection diagnosed?

No single test can reliably prove or rule out infection. We therefore use the internationally recognised criteria of the European Bone and Joint Infection Society (EBJIS). They classify findings in three levels, like a traffic light:

• "Confirmed" – a single one of these findings is enough.
• "Likely" – at least two findings point to infection. We then usually treat it as an infection.
• "Unlikely" – all findings are negative.

The key point: we must know the organism

Success or failure of infection treatment depends crucially on which organism causes the infection and which antibiotics it is sensitive to. That is why we aspirate the joint before surgery and culture the fluid in the laboratory.

Please note: if a prosthetic infection is suspected, do not take antibiotics "just in case" – even if they are offered elsewhere. Antibiotics can mask the organism without curing the infection. It can then no longer be detected in the aspiration, and targeted treatment becomes more difficult. Contact us directly. Do not stop prescribed antibiotics on your own. If you have fever with severe illness or an acute deterioration, contact the emergency department or call 112 immediately; necessary emergency treatment must not be delayed.

How is infection treated?

A prosthetic joint infection cannot be cured with antibiotics alone. Bacteria form a protective layer (biofilm) on the implant surface that antibiotics can hardly penetrate. Treatment is therefore always a combination of surgery and antibiotic therapy.

Two-stage revision – the standard for chronic infections

1. First operation: the infected implant is removed completely and infected tissue is thoroughly debrided. We temporarily insert a spacer made of antibiotic-loaded bone cement or leave the joint without an implant for a while.
2. Antibiotic phase: targeted antibiotic therapy for several weeks, initially intravenously.
3. Second operation: once the infection is under control, the new implant is inserted.

One-stage revision – possible for selected organisms If the organism is known before surgery, is well treatable with antibiotics, and soft tissue and bone are in good condition, the implant can be removed and replaced in a single operation.

Early infection – sometimes the implant can stay If the infection occurs in the first weeks after surgery or very acutely, and the implant is well fixed, it may be enough to thoroughly wash out the joint, remove inflamed tissue and exchange the mobile parts. The key is: act quickly. Contact us immediately if you notice redness, swelling, wound discharge or fever after hip surgery.

Antibiotic therapy afterwards Every operation is followed by targeted antibiotic therapy – usually first intravenously, then as tablets, in total typically about 12 weeks. We work closely with infectious disease specialists and microbiologists.

Revision is a bigger operation than the first one. Recovery takes longer and the risk of complications is higher – especially with large bone defects and infections. Well planned and performed by an experienced team, however, revision leads to a clearly better and stable hip in most patients.