What Is Revision Surgery and How Common Is It?

Part of The Joint Replacement Guide — Phase 6: The Bigger Picture · Article 42 of 44 · Hip & Knee

Key Points

  • Revision surgery is a further operation in which part or all of a previous joint replacement is added to, removed, exchanged or modified.
  • Most primary hip and total knee replacements are not revised during the first 10 to 15 years.
  • The reasons for revision differ between hips and knees and also depend on how long ago the original operation was performed.
  • Younger patients have a higher lifetime likelihood of revision, partly because their replacement must function for longer.
  • Registry “survival” means that the implant has not been revised; it does not necessarily mean that every patient is pain-free or completely satisfied.

What Revision Surgery Means

The National Joint Registry defines revision broadly as an operation in which one or more components of a joint replacement are added to, removed or modified. Its reporting also includes certain operations for infection known as debridement, antibiotics and implant retention—or DAIR—even when the main fixed components are retained.[1]

Revision surgery therefore covers a wide range of procedures. At one end, it may involve exchanging a modular liner or femoral head. At the other, it may require removal of the whole replacement, reconstruction of damaged bone and implantation of specialised revision components.

A further operation near a joint replacement is not always classified as a revision. For example, some fractures around an implant can be fixed without changing the replacement itself. This distinction matters when interpreting registry figures.

How Common Is Revision?

The outlook is generally reassuring. National Joint Registry data shows low revision rates for many commonly used primary total hip and total knee replacement constructs. The latest NJR analysis reports an overall cumulative hip revision rate of under 5% at 15 years, while many established total knee replacement options have revision rates below 3% at 10 years and below 5% at 15 years.[2]

These are population averages, not a guarantee for an individual patient. Revision risk varies according to:

  • whether the operation is a total or partial replacement;
  • the patient’s age and underlying diagnosis;
  • implant design, bearing and fixation;
  • previous surgery and anatomical complexity;
  • infection and fracture risk; and
  • the length of follow-up.

Partial knee replacement, hip resurfacing and some less commonly used implant constructs may have different revision profiles from conventional total hip or total knee replacement.

Long-term systematic reviews provide additional context. Based largely on historical operations and implants, researchers estimated that approximately 58% of total hip replacements and 82% of total knee replacements remained unrevised at 25 years.[3,4] Modern implants and techniques continue to evolve, so these figures should not be treated as exact predictions for a replacement performed today.

What “Implant Survival” Means

In registry studies, an implant is generally described as surviving until a revision operation is recorded. This is an important and measurable outcome, but it does not capture every aspect of success.

A patient may have pain or reduced function without undergoing revision. Conversely, revision may be recommended for a complication even where the implant itself has not worn out. “Ninety-five per cent survival” therefore means that approximately 95 in every 100 replacements had not been revised by that point—it does not mean that 95 in every 100 patients had a perfect or completely pain-free joint.

Why Hip Replacements Are Revised

Common indications recorded for hip revision include:

  • aseptic loosening, where fixation is lost without infection;
  • dislocation or recurrent instability;
  • infection;
  • fracture around the replacement;
  • wear and the effects of wear debris;
  • implant breakage or other mechanical problems; and
  • adverse reactions to implant materials in certain older designs.

The pattern changes over time. Infection, dislocation and some fractures may lead to early revision, whereas wear and aseptic loosening have traditionally been more prominent later. More than one reason may be recorded for the same operation, so these categories should not be treated as completely separate.[2]

Why Knee Replacements Are Revised

Common indications for knee revision include:

  • infection;
  • aseptic loosening;
  • instability;
  • stiffness;
  • pain;
  • wear or damage to a component;
  • problems involving the kneecap; and
  • fracture around the replacement.

Again, the relative frequency depends on the implant, the patient and the time since surgery. It is therefore inaccurate to give one universal ranking of loosening, infection, instability and wear that applies equally to both hip and knee replacement.

Revision for pain without an identifiable mechanical, infective or soft-tissue cause is approached cautiously. When the cause of pain remains uncertain, further surgery has a less predictable chance of helping and may introduce additional risk.

Why Age Matters

Younger age at primary joint replacement is consistently associated with a greater lifetime likelihood of revision. A replacement inserted at 50 may need to tolerate several more decades of activity than one inserted at 80. Younger patients may also place greater cumulative demand on the joint and live long enough for late wear or loosening to become relevant.

This does not mean that younger patients should automatically be denied or advised to postpone beneficial surgery. Timing should be based on symptom severity, quality of life, reasonable alternatives, general health and the likely benefits and risks—not age or revision risk alone.

It is also important not to interpret age-group registry figures too simplistically. Older patients may appear to have lower recorded revision rates partly because they have fewer remaining years in which revision could occur or may be less able to undergo another major operation.

If Revision Is Recommended

The likely scale and outcome of revision depend heavily on why it is needed. Exchanging a worn modular component is very different from treating a deep infection, major bone loss or a complex fracture.

Useful questions include:

  • What is the established or suspected reason for failure?
  • Are further tests needed to exclude infection?
  • Which components need to be changed?
  • Is specialist equipment, bone graft or a custom implant likely to be required?
  • What improvement is realistically expected?
  • What are the alternatives to revision?
  • Should the procedure be performed in a specialist revision unit?

Where the cause is uncertain, obtaining a second specialist opinion may be appropriate before proceeding with major revision surgery.

In More Depth

Registry data has greatly improved understanding of implant longevity and has helped identify poorly performing implant designs. However, it cannot predict exactly how long one person’s replacement will last.

Needing revision does not, by itself, establish that the original operation was performed incorrectly. Revision may become necessary because of infection, injury, changes in bone, implant wear or other recognised complications. Equally, revision should not be described as an inevitable consequence of every joint replacement: most patients will never require one.

NICE recommends discussing the possible need for future surgery as part of informed decision-making before primary joint replacement.[5] This should be presented alongside the substantial likelihood of long-term pain relief and improved function, rather than as a reason to create unnecessary fear or delay appropriate treatment.

This article provides general information and does not replace individual clinical advice. Revision risks vary considerably between patients and implants; your surgeon can explain the figures most relevant to your particular circumstances.

References

  1. National Joint Registry. Accountability and Transparency Model: frequently asked questions and definition of revision.
  2. National Joint Registry. Annual Report 2025: Executive Summary.
  3. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis. The Lancet. 2019;393:647–654.
  4. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis. The Lancet. 2019;393:655–663.
  5. National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder—recommendations. NICE guideline NG157.

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