What Is Revision Surgery and How Common Is It?

Part of The Joint Replacement Guide — Phase 6: The Bigger Picture · Article 40 of 42 · Hip & Knee

Key Points

  • Revision surgery means replacing or adjusting some or all of a previous joint replacement.
  • Most joint replacements do not need revision — the great majority remain well-functioning at 10, 15, and even 20 years.
  • The most common reasons for revision are loosening, infection, instability, and wear, in roughly that order of frequency.
  • Younger age at the time of primary surgery is one of the strongest predictors of eventually needing revision, simply because implants are used for longer.

What Revision Surgery Means

Revision surgery refers to any operation that replaces or significantly adjusts one or more components of a previous joint replacement. This ranges from relatively contained procedures — such as exchanging a worn liner — through to major reconstructions involving most or all of the original implant, discussed in detail in the earlier article on revision surgery risks. This article focuses on the bigger picture: how common revision is, and why it happens, rather than the specifics of the operation itself.

How Common Is It?

National Joint Registry data consistently shows that the great majority of hip and knee replacements do not require revision — most remain well-functioning at 10 years, and the majority are still functioning well at 15 to 20 years. Revision rates are somewhat higher for knee replacement than hip replacement, and vary meaningfully depending on factors including patient age at the time of surgery, implant type and fixation method (discussed in earlier articles), and the underlying reason for the original operation.

Why Revision Happens

NJR data consistently identifies a similar hierarchy of causes across both hip and knee replacement: aseptic loosening (the implant becoming loose without infection, often related to wear or bone changes over time) is generally the most common reason, followed by infection, then instability or dislocation (more relevant to hip replacement), and implant wear or fracture. Pain without a clearly identifiable cause is a less common, but recognised, reason for revision, and is generally approached particularly cautiously given the more uncertain outcomes involved.

Why Age at Primary Surgery Matters

Younger age at the time of the original operation is one of the most consistent predictors of eventually needing revision — not because younger patients’ surgery is done any less well, but simply because a joint replacement performed at, say, 50 has considerably more years of use, activity, and cumulative load ahead of it than one performed at 75. This is part of the reasoning behind the age-related fixation guidance discussed earlier in this guide, and is a genuine, important factor in the shared decision-making conversation about timing of surgery.

In More Depth

The National Joint Registry’s long-term data, now spanning over two decades, has been central to understanding revision risk factors at a population level, and has directly informed national guidance on implant selection, fixation choice, and follow-up protocols referenced throughout this guide. It’s worth noting that a joint requiring revision is not a marker of anything having gone “wrong” in most cases — it more often reflects the expected, gradual, cumulative effects of time, activity and biology on any mechanical implant, much as any other implanted device has a finite working life.

This article is general information and does not replace individual clinical advice.

Sources

  • National Joint Registry — Annual Report, revision rates and causes
  • GIRFT (Getting It Right First Time) — National Report on Orthopaedics
  • NICE guideline NG157 — Joint replacement (primary): hip, knee and shoulder

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