A revision is a further operation to change part or all of a hip or knee replacement. Most joint replacements never need one, but some do — sometimes early, sometimes many years later. Revision surgery is usually more involved than a first replacement, and the British Orthopaedic Association describes revision knee replacement as technically challenging.
Why a replacement may need revision
National Joint Registry data show that some reasons tend to appear early after surgery, such as dislocation, infection and fracture around the implant, while others, such as loosening of the implant from the bone, tend to appear later. Across the registry, aseptic loosening (loosening without infection) is the largest single reason for hip revision, at 39.8% of all hip revisions, falling to 31% in the last five years, while the share due to infection has risen from 16.2% to 22.9%.
For a painful or problematic knee replacement, the British Orthopaedic Association lists recognised causes including stiffness, component position, problems with the kneecap mechanism, loosening, infection, fracture, instability and wear.
When to seek review
NICE advises that people who develop new or worsening pain, a limp or loss of function related to a joint replacement should be referred to an orthopaedic service. Seek urgent advice for a high temperature, oozing from the wound, or a hot, red, increasingly painful joint, as these can be signs of infection.
How it is assessed
The British Orthopaedic Association recommends that assessment starts with clinical examination, X-rays and blood tests to screen for infection, with further tests when needed. A key principle is that revision should be based on identifying a specific problem. When no clear cause is found, surgery is less likely to help, and discussion at a multidisciplinary meeting is recommended. Complex cases are discussed within regional revision networks.
What the operation involves
Revision may involve changing one component or the whole implant, sometimes with additional support where bone has been lost. Infection may be treated in a single operation or in two stages. In the National Joint Registry, most first knee revisions (87.8%) were single-stage, and more than half of hip revisions for infection were done as a single operation.
Realistic expectations
Registry data show that people improve after revision surgery, though on average by less than after a first replacement. In the National Joint Registry, the average Oxford Hip Score after revision hip replacement rose from 19.9 to 33.9, and the Oxford Knee Score after revision knee replacement from 15.8 to 29.0 (higher scores are better). I completed a fellowship in revision arthroplasty at Northumbria NHS Trust, and I discuss the likely benefits and risks of revision openly and in plain language.
Questions worth asking
- What is the specific cause of my symptoms, and how certain is it?
- Has infection been looked for?
- Would revision involve one part or the whole implant, in one or two stages?
- What improvement is realistic for me, and what are the risks?
The right choice depends on your history, examination and investigations. If you would like a clear assessment, you can arrange a private consultation or discuss a referral with your GP.
Frequently asked questions
What is revision joint surgery?
A further operation to change part or all of a hip or knee replacement.
Why do joint replacements need revising?
Common reasons include loosening of the implant from the bone, infection, dislocation, fracture around the implant, instability, stiffness and wear. National Joint Registry data show that aseptic loosening is the largest single reason for hip revision.
When should I have a joint replacement checked?
NICE advises referral to an orthopaedic service for new or worsening pain, a limp or loss of function related to a joint replacement. Seek urgent advice for signs of infection such as a high temperature or oozing from the wound.
Will I need revision if my replacement is painful?
Not necessarily. The British Orthopaedic Association advises that revision should be based on identifying a specific problem; when no clear cause is found, surgery is less likely to help.
References
- National Joint Registry. 23rd Annual Report (2026): Executive Summary. https://reports.njrcentre.org.uk/AR-Executive-Summary
- British Orthopaedic Association. BOASt: Investigation and management of patients with problematic knee replacements. https://www.boa.ac.uk/resource/boast-investigation-and-management-of-patients-with-problematic-knee-replacements.html
- British Orthopaedic Association. BOASt: Revision total knee replacement surgical practice guidelines. https://www.boa.ac.uk/resource/revision-total-knee-replacement-surgical-practice-guidelines.html
- NICE. Joint replacement (primary): hip, knee and shoulder (NG157), recommendations. National Institute for Health and Care Excellence, 2020. https://www.nice.org.uk/guidance/ng157/chapter/Recommendations
- NHS. Complications of a hip replacement. https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/
- NHS. Complications of a knee replacement. https://www.nhs.uk/conditions/knee-replacement/risks/