Revision Hip Replacement
Mr Dennis Kosuge has developed particular expertise in revision hip replacement surgery, including the management of severe acetabular (socket) defects. He was co-author of an award-winning presentation on this topic at the American Academy of Orthopaedic Surgeons (AAOS) in 2019. He operates at The Rivers Hospital, Sawbridgeworth and The Princess Alexandra Hospital, Harlow, serving patients from across Essex and Hertfordshire.
Frequently Asked Questions about Revision Hip Replacements
What is Revision Hip Replacement?
Why Might a Hip Replacement Need to Be Revised?
What are the signs that my hip replacement is failing?
How commonly do hip replacements fail?
Mr Kosuge’s Patient Information Booklet on Revision Hip Replacement. Please click on image to access the leaflet.
What is Revision Hip Replacement?
Revision hip replacement surgery involves the removal and replacement of a previously implanted hip prosthesis. Unlike a primary (first-time) hip replacement, revision surgery is technically more complex, as it must address both the removal of the existing implant and any bone or soft tissue changes that have occurred since the original operation.
Why Might a Hip Replacement Need to Be Revised?
Hip replacements are designed to last many years, but they may fail for a variety of reasons. Common causes for revision surgery include:
Aseptic loosening — the implant becomes loose over time as the bond between the prosthesis and the bone deteriorates
Periprosthetic joint infection (PJI) — bacterial infection around the implant
Instability and dislocation — recurrent episodes of the hip joint coming out of position
Bearing surface wear — gradual wearing of the cup or head component over time
Periprosthetic fracture — a fracture of the bone around the implant, often following a fall
Adverse reactions to metal debris (in older metal-on-metal implants)
Implant fracture
In some cases, patients may experience ongoing pain after a hip replacement without a clearly identified cause. Thorough investigation is required before any decision to revise is made.
What are the signs that my hip replacement is failing?
Symptoms of a failing hip replacement include new or increasing pain in the groin or thigh, instability, swelling, a change in leg length, or persistent warmth around the joint. If you notice any of these, seek specialist assessment promptly.
How commonly do hip replacements fail?
Around 90% of hip replacements are still functioning at 15 years. However, a proportion will require revision, particularly as patients are living longer and replacements are being performed in younger, more active patients.
How is a failing hip replacement investigated?
Revision hip surgery requires careful pre-operative planning. Mr Kosuge will arrange a thorough assessment including blood tests (to screen for infection), advanced imaging (X-ray, CT, and sometimes nuclear medicine scans), and in selected cases, joint aspiration to exclude or confirm infection. This information is used to understand the nature and extent of the problem and to plan the most appropriate surgical strategy.
What happens during revision hip replacement surgery?
The specifics of revision hip replacement surgery depend entirely on the underlying cause of failure and the extent of any bone loss. The procedure may involve replacing only one component (for example, the cup or the stem) or both components. In cases of significant bone loss, bone grafting or the use of specialist augmentation devices may be required. Mr Kosuge will be delighted to explain the planned procedure fully during your consultation.
On the left are pre- and post-operative x-rays of Revision Hip Replacements performed by Mr Kosuge.
More Frequently Asked Questions:
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Yes, significantly. Removing existing implants, reconstructing lost bone and placing new components is technically demanding and requires specialist expertise. Mr Kosuge has a particular interest in complex revision hip replacement including acetabular reconstruction, and was co-author of an award-winning presentation on this topic at the American Academy of Orthopaedic Surgeons in 2019.
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Revision hip replacement is a longer and more complex operation than primary replacement, typically taking 2 to 4 hours depending on the extent of bone loss and the number of components being replaced. Mr Kosuge will explain the planned procedure in full at your consultation.
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Recovery from revision hip replacement is typically longer than after primary replacement, often taking 6 to 12 months to recovery. The timeline depends on the complexity of the revision and the degree of bone loss addressed. Mr Kosuge provides comprehensive post-operative guidance throughout your recovery.
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The most common cause is aseptic loosening — where microscopic wear particles trigger an immune response that gradually weakens the bond between the implant and bone. Other causes include infection, instability and fracture around the implant.
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Do not wait. Seek specialist assessment promptly. Mr Kosuge can arrange an urgent clinic appointment at The Rivers Hospital, Sawbridgeworth. Early diagnosis of a failing replacement allows better pre-operative planning and generally leads to a better outcome from revision surgery.
Book a Consultation
If you have concerns about a previous hip replacement — whether you are experiencing pain, instability, or other symptoms — Mr Kosuge offers specialist assessment and expert revision surgery. He is available privately at The Rivers Hospital, Sawbridgeworth, and on the NHS at The Princess Alexandra Hospital, Harlow.
To book an appointment, please call 01279 602675 or use the online booking link below.
NHS referrals to The Princess Alexandra Hospital, Harlow are also accepted via your GP.