Complex Revision Joint Replacement
Specialist management of failed, worn, loose, or infected hip and knee replacements — including peri-prosthetic fractures, severe bone loss, and complex reconstruction using the latest implant technology.
Book a Revision Consultation →What Is Revision Joint Replacement?
Revision joint replacement is a specialist surgical procedure to remove a hip or knee replacement that has failed, worn out, or developed complications — and replace it with new implant components.
Unlike a first-time (primary) joint replacement, revision surgery is more complex and technically demanding. It often involves dealing with bone loss, scar tissue from previous surgery, damaged soft tissues, and the need for specialised implants.
Revision surgery requires a surgeon with extensive experience in complex reconstruction, access to a wide range of implant options — including mega-prostheses and custom-made components — and a multidisciplinary team approach to achieve the best possible outcome.
Mr Hussain regularly performs complex revision procedures at the Royal Orthopaedic Hospital, one of the UK's leading specialist orthopaedic centres, with full access to high-dependency care facilities for patients who need additional post-operative monitoring.
Hip Revision
Replacement of failed acetabular (socket) and/or femoral (stem) components, addressing bone deficiency and restoring stability.
Knee Revision
Removal and replacement of tibial, femoral, and patellar components, often with augments, cones, or sleeves to address bone loss.
Why Might You Need Revision Surgery?
There are several reasons why an original hip or knee replacement may fail over time, leading to pain, instability, or reduced function.
Implant Loosening
Over time, the bond between the implant and bone can weaken due to wear debris, inadequate initial fixation, or bone loss. This causes pain and instability, particularly during weight-bearing activities.
Prosthetic Joint Infection
Infection around a joint replacement is a serious complication that may require a staged approach — first removing the infected implant, treating the infection with antibiotics, then implanting new components once the infection is eradicated.
Peri-Prosthetic Fracture
A fracture around the implant, often from a fall or trauma, may require revision surgery to stabilise the bone and replace damaged components. These fractures are increasingly common as the population ages.
Implant Wear & Bearing Failure
The bearing surfaces of any joint replacement will wear over time. This wear can generate particles that cause bone loss (osteolysis) and may eventually lead to component failure requiring replacement.
Instability & Dislocation
Repeated dislocation or persistent instability following a hip or knee replacement may indicate that the components are not optimally positioned, or that soft tissue support is insufficient, necessitating revision.
Adverse Reaction to Implant
Some patients develop reactions to metal debris (metallosis) or other implant materials, causing pain, swelling, and soft tissue damage. This is particularly seen with certain metal-on-metal bearing surfaces.
Mr Hussain's Revision Expertise
Mr Hussain has extensive experience in complex revision hip and knee surgery, managing some of the most challenging cases referred from across the region. His practice encompasses the full spectrum of revision arthroplasty, from straightforward single-component exchanges to highly complex reconstructions involving severe bone loss.
He regularly uses mega-prostheses, segmental femoral replacements, and custom-made implants for patients with massive bone deficiency, and has a special interest in the management of prosthetic joint infection (PJI) — one of the most demanding areas in orthopaedic surgery.
His expertise in PJI was further enhanced by his British Hip Society Travelling Fellowship at the ENDO-Klinik Hamburg, Germany — one of the world's foremost centres for the treatment of infected joint replacements, where he trained under Professor Thorsten Gehrke and Professor Mustafa Citak.
High-Dependency Care Access
Mr Hussain operates at hospitals with full HDU facilities, ensuring that patients undergoing complex, lengthy revision procedures receive the appropriate level of post-operative monitoring and critical care support when needed.
Multidisciplinary Team Approach
Every complex revision case is discussed within a structured MDT, bringing together orthopaedic surgeons, microbiologists, radiologists, physiotherapists, and specialist nurses to develop a tailored surgical plan.
Types of Revision Procedures
Mr Hussain offers the full range of revision procedures for both hip and knee joints, tailored to each patient's specific needs.
Aseptic Loosening & Wear
When an implant loosens or wears out without infection, the failed components are removed and replaced in a single operation. Bone grafting or augmentation may be required to address any bone deficiency before the new implant is secured.
- Single-stage procedure in most cases
- Bone grafting for defects where needed
- Specialist implants for significant bone loss
Two-Stage Revision for Infection
Prosthetic joint infection typically requires a two-stage approach: in the first operation, the infected implant is removed and an antibiotic-loaded spacer is inserted. After a course of targeted antibiotics (usually 6–12 weeks), a second operation is performed to implant the new joint.
- First stage: removal, debridement, antibiotic spacer
- Targeted antibiotic therapy between stages
- Second stage: new implant insertion
- MDT collaboration with microbiology
Fracture Around an Implant
A fracture near an existing joint replacement may require fixation of the bone, revision of the implant, or both. The approach depends on whether the implant remains well-fixed or has loosened as a result of the fracture.
- Plate and cable fixation for stable implants
- Implant revision if loosened by fracture
- Long-stem revision components when needed
Mega-Prosthesis & Custom Implants
In cases of massive bone loss — whether from multiple previous surgeries, infection, or tumour — Mr Hussain has extensive experience using mega-prostheses for segmental replacement of the femur, as well as custom-made implants designed to reconstruct severely deficient joints.
- Segmental femoral replacement
- Custom 3D-printed implants
- Augments, cones, and sleeves for bone defects
- Acetabular reconstruction with cages and rings
The Revision Journey
Revision surgery requires careful planning and a personalised approach. Here is what you can expect at each stage.
Initial Consultation & Investigation
Your journey begins with a thorough consultation, including a detailed history and examination. Mr Hussain will review your previous surgical records and arrange advanced imaging (X-rays, CT scans, MRI) and blood tests to identify the cause of implant failure and assess bone stock. If infection is suspected, aspiration of the joint fluid may be performed for microbiological analysis.
MDT Discussion & Surgical Planning
Complex cases are discussed within a multidisciplinary team (MDT) meeting, involving orthopaedic surgeons, microbiologists, radiologists, and specialist nurses. A detailed surgical plan is developed, including implant selection, the need for bone graft or augmentation, and whether a single-stage or staged approach is appropriate.
Surgery
Revision surgery is typically longer than primary joint replacement, often taking 2–4 hours depending on complexity. It is performed under general or spinal anaesthesia. The failed implant is carefully removed, bone is prepared — with grafting or augmentation if needed — and new components are implanted. Patients requiring complex reconstruction may be transferred to the high-dependency unit for close monitoring after surgery.
Post-Operative Care & Rehabilitation
Most patients stay in hospital for 3–7 days following revision surgery, depending on the complexity of the procedure. Physiotherapy begins the day after surgery to restore mobility and strength. A structured rehabilitation programme is tailored to your specific procedure and recovery needs.
Follow-Up & Long-Term Monitoring
Regular follow-up appointments are scheduled at 6 weeks, 3 months, 6 months, and annually thereafter. X-rays are taken to monitor the implant and bone healing. Mr Hussain's team provides ongoing support to ensure the best long-term outcome.
Recovery After Revision Surgery
Recovery from revision surgery is typically longer than after a first-time replacement. Every patient's journey is different, but here is a general guide.
Early Mobilisation
Physiotherapy begins. Standing and walking with support (frame or crutches).
Wound Review
Sutures/staples removed. Gentle exercises at home. Walking with crutches.
Clinic Review
X-ray review. Gradually reducing crutch use. Increasing activity levels.
Progressing Well
Most patients walking independently. Returning to daily activities and light duties.
Full Recovery
Maximum improvement expected. Ongoing follow-up to monitor implant performance.
Case Gallery
A selection of revision cases performed by Mr Hussain. Each case shows the pre-operative x-ray and the final reconstruction. Some staged cases include three x-rays, taking you through the stages from the original problem to the final result.
Revision Cases
Two-stage revision for infected hip with complex acetabular reconstruction
Chronically infected hip replacement, treated with a two-stage revision. The infected implant was removed and the joint thoroughly cleaned (debridement), with a temporary articulating antibiotic spacer placed to maintain limb length and allow partial weight-bearing during a course of antibiotics (Stage 1). Once the infection had cleared, the spacer was removed and the hip rebuilt with a complex acetabular reconstruction using multiple augments (Stage 2).
Custom acetabular implant after failed revision
Patient referred to Mr Hussain after a failed hip revision elsewhere, with massive bone loss of both the thigh bone (femur) and the hip socket (acetabulum). Reconstructed in stages: a custom-made acetabular implant on the left, followed by a total hip replacement on the right.
Proximal femoral replacement for chronic infection
Patient presented with severe bone loss of the upper thigh bone (femur) from a chronic infection. Treated by Mr Hussain by clearing the infection and reconstructing the hip with a proximal femoral replacement, a specialised implant that replaces the upper portion of the thigh bone.
Knee revision for aseptic loosening with bone loss
Aseptic loosening of a 12-year-old knee replacement, with severe deformity and medial bone loss in the shin bone (tibia). Treated by Mr Hussain with a complex revision: the loose components were removed, the bone defect reconstructed using a large trabecular metal augment, and the alignment corrected.
Staged revision for infected hip implant
Patient who had a hemiarthroplasty for a neck of femur fracture, with bone weakened by a brown's tumour from underlying hyperparathyroidism. The implant subsequently became infected with severe associated bone loss. Treated by Mr Hussain with a staged revision: removal of the infected implant and treatment of the infection, followed by implantation of a new hip.
Complex hip reconstruction after multiple failed procedures
Patient initially had a fall and sustained a neck of femur fracture, which was fixed with a DHS screw. The DHS failed and he received a hemiarthroplasty (half hip replacement). He subsequently developed an infection in his hip shortly after that procedure. He was offered revision surgery in another hospital, and all implants were removed to treat the infection. The infection was successfully treated and an attempt was made to reconstruct his hip. The procedure was abandoned due to the difficult reconstruction and medical complications. He had very limited mobility from bed to chair and mainly mobilised in a wheelchair. His right leg was 8 cm short.
A successful reconstruction was carried out by Mr Hussain using a dual mobility socket, screw fixation and proximal femoral replacement. The patient is now able to walk with sticks with equal leg length.
What Patients Say
"I would recommend Mr Hussain 100% — he is utterly professional and an excellent surgeon. He is a very good listener and explains procedures very well. Mr Hussain performed a very successful 2-in-1 revision surgery."
Multidisciplinary Team & Critical Care Support
Complex revision surgery demands more than surgical skill alone. Mr Hussain's practice is supported by the full resources of a specialist centre.
Multidisciplinary Team (MDT)
Every complex revision case is discussed at a structured MDT meeting. This brings together consultant orthopaedic surgeons, consultant microbiologists, radiologists, specialist physiotherapists, occupational therapists, and dedicated arthroplasty nurses. The MDT ensures that the surgical plan, antibiotic strategy, rehabilitation, and post-operative care are fully coordinated for each patient.
High-Dependency Unit (HDU) Access
The hospitals where Mr Hussain operates have full high-dependency care facilities. For patients undergoing lengthy or complex revision procedures — particularly those with significant medical comorbidities — HDU admission provides enhanced post-operative monitoring, including closer observation of cardiovascular, respiratory, and renal function during the critical early recovery period.
Revision Surgery FAQs
Book a Revision Surgery Consultation
If you are experiencing problems with a previous hip or knee replacement, Mr Hussain and his team can help. Contact us to arrange a specialist consultation.