Hip Revision Surgery in Birmingham
Specialist revision of failed hip replacements, including complex cases with bone loss, infection, instability, and periprosthetic fracture. Mr Hussain trained at ENDO-Klinik Hamburg, one of Europe's foremost centres for revision arthroplasty.
Total procedures
498 verified reviews
ENDO-Klinik Hamburg
Overview
What Is Hip Revision Surgery?
Hip revision surgery replaces one or more components of a failed primary hip replacement. Unlike a first-time (primary) hip replacement, revision surgery must contend with the remnants of the original implant, bone loss caused by wear or infection, scar tissue from the previous operation, and the need for more complex reconstruction techniques.
Revision hip arthroplasty is significantly more demanding than primary surgery. Operations typically last longer, blood loss is greater, and the range of possible complications is wider. The outcome is heavily influenced by the experience of the surgeon and the resources available, including access to a broad implant inventory and a specialist multidisciplinary team.
Mr Hussain holds a subspecialty fellowship from ENDO-Klinik Hamburg, training directly under Professor Thorsten Gehrke and Professor Mustafa Citak, who lead one of the world's highest-volume revision arthroplasty programmes. He brings this experience to his practice at the Royal Orthopaedic Hospital Birmingham, Priory Hospital Edgbaston, and Harborne Hospital, where he manages the full spectrum of revision hip cases.
- Revision of all hip replacement components, including cup, stem, head and liner
- Management of complex bone defects with grafting and augmented implants
- Dual mobility cup reconstruction to reduce dislocation risk
- Close collaboration with specialist infection and microbiology teams
- CT-based pre-operative templating for every complex revision case
Causes of Failure
Why Do Hip Replacements Fail?
Hip replacements do not always last a lifetime. Understanding the reason for failure is essential before planning revision surgery, as each cause requires a different surgical strategy.
Aseptic Loosening
The most common cause of hip replacement failure. The bond between the implant and surrounding bone breaks down over time without any infection. This can result from initial inadequate fixation, stress shielding, or gradual bone loss (osteolysis) caused by microscopic wear particles. Patients experience progressive pain on weight-bearing and activity, confirmed by X-ray or CT imaging showing component migration or lucent lines around the implant.
Periprosthetic Joint Infection
Bacterial infection around the hip implant is a serious complication requiring urgent specialist assessment. It may present early (within weeks of primary surgery) or late (months or years later, often from a distant source such as dental work or a skin infection). Symptoms include persistent pain, swelling, warmth, wound discharge, and fever, though some infections are indolent with minimal signs. Treatment requires surgery and a prolonged course of targeted antibiotics.
Instability and Dislocation
Recurrent dislocation of the hip replacement is distressing and functionally limiting. It may result from component malposition (incorrect cup or stem angle), soft tissue insufficiency around the hip, or nerve damage affecting muscle control. After the first dislocation most are managed non-surgically, but recurrent instability or a structural cause usually requires revision surgery, often with a dual mobility cup to significantly reduce the dislocation rate.
Implant Wear and Osteolysis
Bearing surface wear generates microscopic particles that trigger an inflammatory reaction in the surrounding bone (osteolysis), progressively destroying bone stock. Modern ceramic and highly cross-linked polyethylene bearings have greatly reduced this problem, but older metal-on-polyethylene or metal-on-metal implants remain susceptible. Osteolysis detected early may be managed with liner exchange alone; advanced bone loss requires augmented reconstruction.
Periprosthetic Fracture
A fracture around or below the hip implant, most commonly following a fall or low-energy injury in older patients with osteoporotic bone. Depending on the fracture pattern and implant stability, treatment ranges from fixation around the existing implant (if it remains well fixed) to full revision with a longer bypass stem. Complex fractures with bone loss or unstable implants are best managed by a revision specialist.
Unexplained Pain and Stiffness
A small proportion of patients experience persistent pain or stiffness after hip replacement without an identifiable mechanical or infective cause. This category requires thorough investigation to exclude infection, loosening, nerve injury, referred pain from the spine, and trochanteric bursitis before considering revision surgery. Revision for unexplained pain alone has a more guarded prognosis and is reserved for carefully selected cases.
The Operation
The Hip Revision Procedure
Every hip revision is planned individually. Pre-operative workup includes blood tests (CRP, ESR, white cell count), hip aspiration if infection is suspected, weight-bearing X-rays, and CT scanning for templating. The surgical approach takes into account the location of previous incisions, the condition of soft tissues, and the planned reconstruction.
Implant Removal and Bone Preparation
Careful explantation of all loose or infected components is performed, with the goal of preserving as much viable bone as possible. Well-fixed components in the context of isolated failure (for example, cup loosening with a well-fixed stem) may be left in place if clinically appropriate.
Membrane and granulation tissue are removed from the bone surface. Areas of osteolysis are debrided, and bone defects are classified using the Paprosky system to guide the reconstruction strategy. Bone grafting, using morselised allograft (impaction grafting) or structural allograft, is used where the defect requires biological restoration of bone stock.
In infected cases, all cement, biofilm and necrotic tissue are excised and the wound is copiously lavaged before reconstruction or spacer insertion.
Reconstruction with Revision Implants
The reconstruction uses implants specifically designed for revision surgery, with a wider range of sizes, modularity, and fixation options than primary implants.
On the femoral side, longer cementless revision stems bypass areas of bone deficiency to achieve fixation in healthy diaphyseal bone. Modular stems allow independent adjustment of length, offset and version. In cases of severe proximal femoral bone loss, a proximal femoral replacement (megaprosthesis) may be required.
On the acetabular side, revision cups with multiple screw fixation options address cavitary defects. Metal augments fill contained defects and restore the normal centre of rotation. Cages or trabecular metal constructs are used for more severe column deficiency. A dual mobility cup is routinely considered to reduce the elevated dislocation risk inherent in revision surgery.
Revision Surgery in Birmingham
Why Choose Mr Hussain for Revision Surgery?
Mr Hussain holds a subspecialty fellowship from ENDO-Klinik Hamburg, one of the world's leading centres for revision arthroplasty, and has contributed 33 peer-reviewed publications to the orthopaedic literature. His practice at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, and Harborne Hospital is built on a foundation of 5,000+ procedures and a Doctify rating of 4.98 from 498 verified reviews.
Patient Questions
Frequently Asked Questions
Ready to Discuss Your Revision Surgery?
Book a private consultation with Mr Hussain at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, or Harborne Hospital.