Is it time to have your joint replacement checked?
Most hip and knee replacements work well for many years. Sometimes, though, a replacement becomes painful, feels unstable or stops working as it should. Revision surgery means removing some or all of the original implants and replacing them.
Mr Ashwin Unnithan is a Consultant Orthopaedic Surgeon with fellowship training in infected and complex joint replacement at the Bristol Hip Unit, and in complex knee and revision surgery at St Albans City Hospital and the Royal National Orthopaedic Hospital. He sees patients whose replacement was carried out by him and by other surgeons.
The first step is finding out why the joint is troublesome. Not every painful replacement needs another operation, and Mr Unnithan will explain what the investigations show before discussing any treatment.
You might recognise these signs
- New or worsening pain in a hip or knee that has been replaced
- A joint that feels loose, unstable or gives way
- Repeated hip dislocation
- Swelling, warmth, redness or wound problems around the replacement
- A clunk, grinding or change in how the joint moves
- A knee replacement that remains very stiff
These signs have several possible causes. They are reasons to have the joint assessed, not proof that revision is needed. Sudden pain, fever or a hot, swollen joint after a replacement needs urgent medical review – contact your surgeon, GP or NHS 111.
What is revision hip and knee surgery?
Revision surgery replaces part or all of an existing hip or knee replacement. Common reasons include loosening of the implants, infection, instability or dislocation, wear of the bearing surfaces, a fracture around the implant, and persistent stiffness.
Revision is usually a more complex operation than the first replacement. It can involve removing well-fixed implants, rebuilding lost bone and using specialist implants designed for revision. Where infection is the cause, treatment may be carried out in one operation or in two stages, several weeks or months apart.
The National Joint Registry records hip and knee revisions in the UK. Its data shows revision rates continuing to fall, but revision remains an important part of hip and knee care.
Why choose Mr Ashwin Unnithan for revision surgery?
- Revision-specific training
Fellowships in infected and complex joint replacement at the Bristol Hip Unit, and in complex knee and revision surgery at St Albans City Hospital and the Royal National Orthopaedic Hospital.
- Cause before cure
A structured investigation of why the joint is failing, before any surgical decision is made.
- Hip and knee
Revision of both hip and knee replacements within one practice.
- Honest advice
A clear explanation when non-surgical care or monitoring is the better choice.
- Senior experience
Over ten years as a Consultant Orthopaedic Surgeon, in NHS and private practice.
- Accessible
Appointments usually available within days, and no GP referral needed for an initial consultation.
- Professional standing
Fellow of the Royal College of Surgeons and member of the British Orthopaedic Association.
Benefits and risks
Revision surgery aims to reduce pain, restore stability and improve function when a replacement is no longer working well. Results vary more than after a first replacement and depend on the reason for revision, bone quality and general health.
Risks are generally higher than for a first joint replacement. They include infection, blood clots, dislocation, fracture, nerve or blood vessel injury, leg length difference, stiffness, persistent pain and the possibility of further surgery. Mr Unnithan will talk through your individual risks and how they are reduced before you decide.
At a glance
Your treatment journey
Consultation and investigations
A review of your history, previous operation records and implant details, with an examination. X-rays, blood tests and other scans are arranged where needed, and sometimes a sample of joint fluid to check for infection.
Planning
If revision is appropriate, the plan covers which components need replacing, any bone reconstruction, implant choice, anaesthesia and your recovery. For infection, it sets out whether one or two stages are recommended.
Surgery and early recovery
Your hospital team supports pain relief, wound care and getting back on your feet. You go home when you can move safely and the team is happy with your recovery.
Rehabilitation and follow-up
Physiotherapy and regular reviews, including X-rays, track your progress. Any limits on weight-bearing or movement are explained clearly.
- COMMON QUESTIONS
Frequently asked questions about revision hip and knee surgery
What is revision joint replacement?
It is an operation to replace some or all of an existing hip or knee replacement. It is used when the original implant has loosened, become infected, worn, dislocated repeatedly or been affected by a fracture. The operation is planned around the specific cause.
How do I know if my replacement needs revising?
Pain, instability, swelling or a change in how the joint feels are reasons to have it checked. Mr Unnithan will examine you and arrange X-rays, blood tests or other scans to find the cause. Some problems are managed without further surgery.
I had my replacement with another surgeon. Can I still be seen?
Yes. Mr Unnithan sees patients whose original operation was carried out elsewhere. It helps to bring your operation notes, implant details and any previous scans. With your consent, he can share his findings with your GP or previous surgeon.
Is revision surgery more difficult than the first operation?
Usually, yes. It can involve removing fixed implants, rebuilding bone and using specialist revision implants. The operation, hospital stay and recovery are often longer. Your plan will reflect the reason for revision and your general health.
What happens if my replacement is infected?
Infection is investigated with blood tests and often a joint fluid sample. Treatment may involve one operation or two stages several weeks or months apart, together with a course of antibiotics. Mr Unnithan will explain which approach is advised and why.
How long does recovery take after revision surgery?
Recovery varies with the operation and your health, and is often slower than after a first replacement. Many patients need walking aids for several weeks. Mr Unnithan will give you an individual timeline for returning to driving, work and activities.
Will my insurance cover revision surgery?
Cover depends on your policy and on when and where the first operation took place. Check with your insurer before booking. If you are paying for yourself, you will receive an itemised quote after assessment.
Do I need a GP referral?
No GP referral is needed for an initial consultation. If you are using medical insurance, check whether your insurer requires a referral or authorisation.
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