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Retired lady with a completely worn through hip replacement socket and loose stem producing renewed pain and stiffness and shortening of the leg 18 years after the hip replacement was first inserted. The hip replacement was successfully revised to uncemented components with restoration of function.

Despite all the latest developments, a hip replacement can still loosen or wear out and this may occur without any pain or symptoms whatsoever. It is for this reason that periodic xrays of hip replacements is recommended so that problems may be spotted early, in much the same way as a car is serviced regularly. Those most to gain from regular xrays are patients likely to outlive their implants, those with untested implants, and those whose hip was replaced more than ten years ago. If loose or worn implants are identified then early revision surgery is usually appropriate even in the presence of relatively minor symptoms. This is because the results of revision surgery are directly related to the amount of host bone remaining to support the revision implants.

Loose hip replacements may only come to light when there has been a disaster such as complete dislodgement of the implant, fracture, or dislocation. This leaves the surgeon with a considerable revision challenge because of the severe bone loss associated with such failures as well as the need for urgent surgery. It is for this reason that any new symptoms in a previously well functioning hip replacement should be taken seriously with new xrays and an opinion sought from an expert. Arthritis does not come back in a hip with a replacement and so renewed pain is almost always loosening. Modern blood management strategies can keep blood transfusion to a minimum with a combination of pre-operative blood donation, iron therapy and recombinant erythropoietin. Spinal or epidural anaesthesia, intra-operative blood salvage, and reinfusion drains are also very helpful.

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