What if your hip fails?

Although hip replacements are very successful operations, life-long success can not be guaranteed and, although it is not unusual for a good hip replacement to last in excess of thirty years, early failure can also unfortunately occur.

By far the commonest cause of failure of hip replacements in the longer term is aseptic loosening (loosening in the absence of infection). This occurs when the socket or stem (or both) of the hip replacement loses its solid fixation to the host bone. The reason for this is not clearly understood but is often related to wear of the bearing surfaces. Loosening is also more common in younger active patients.

When a hip replacement comes loose the person will usually notice some pain around the hip joint and a feeling of instability or weakness. However this is not always the case and artificial hip joints can fail without clinical symptoms. When a hip replacement is loose and is not treated, bone loss can occur around the joint making redo surgery very difficult. Long-term review of artificial joints is therefore essential.

In the short term artificial hip joints can fail because of infection or recurrent dislocation (repeated slipping of the ball out of the socket).

If an artificial hip joint fails by any of the above mechanisms re-do (revision) surgery is usually necessary but not invariably so. If a hip joint keeps dislocating, requiring regular hospital attendances, then surgical repair should be performed. In the case of infection the person’s general health is often affected, with pain being a feature, and therefore redo surgery is normally required. In the early stages of infection eradication of the infection can sometimes be achieved by a joint wash-out but, more commonly, the infected joint needs to be removed with a temporary joint containing high dose antibiotics inserted. A definitive new joint is  inserted when the infection has resolved. Very occasionally infection around an artificial joint can be managed by long-term antibiotics.

If the joint fails by aseptic loosening revision surgery can usually  be planned over a period of months as the process is seldom rapidly progressive and catastrophic failure is rare. Indeed if symptoms are only mild and there is no evidence of bone loss, a conservative approach can be followed with clinical review and Xrays at intervals with revision planned should symptoms increase or should bone loss become evident on Xrays.