Hip replacements can fail for multiple reasons: (1) Aseptic loosening (40-50% of revisions) - most common cause, where implant gradually loosens from bone due to wear particles causing bone resorption (osteolysis), typically occurs 10-20 years after primary surgery. (2) Infection (15-20%) - bacteria colonize implant surface creating biofilm, can occur early (within 3 months) or late (years later), requires extended antibiotic treatment and often two-stage revision. (3) Dislocation (10-15%) - recurrent hip instability, more common with posterior surgical approach, certain patient anatomy, or component malposition. (4) Wear and osteolysis - polyethylene liner wears creating particles that trigger bone destruction around implant. (5) Periprosthetic fracture - bone breaks around or near implant, more common with osteoporosis or trauma. (6) Implant failure - breakage of components (rare with modern implants). (7) Leg length inequality or pain from malpositioned components. (8) Metallosis - metal debris from metal-on-metal bearings (less common with newer ceramics). Risk factors for failure: younger age at primary surgery, high activity level, obesity, infection, poor bone quality, technical errors during primary surgery. Modern implants and techniques have improved longevity - current primary hip replacements typically last 20-25+ years in most patients.

Revision is significantly more complex than primary replacement in multiple ways: Surgical challenges: (1) Scar tissue makes dissection difficult, (2) Anatomy is distorted from previous surgery, (3) Bone quality is often poor with significant bone loss, (4) Removing well-fixed implants risks fracturing bone, (5) Infection must be ruled out or treated. Technical differences: Longer surgery time (3-6 hours vs 1.5-2.5 hours), specialized revision implants needed (long stems, augments, custom components), often requires bone grafting to fill defects, extended trochanteric osteotomy may be needed, constrained liners or dual mobility to prevent dislocation, blood loss typically greater. Recovery differences: Longer hospital stay (5-10 days vs 2-4 days), slower recovery timeline, stricter weight-bearing restrictions initially (6-12 weeks protected vs immediate full weight bearing), higher complication risk, more extensive rehabilitation. Outcomes: Good but not quite as predictable as primary - 85-90% success vs 95%+ for primary, implant longevity somewhat shorter (10-15 years vs 20-25+ years), some permanent functional limitations. Despite complexity, revision surgery is highly successful in experienced hands and dramatically improves quality of life for patients with failed primary replacements. Dr. Kumar's specialized revision training and experience optimize outcomes even in challenging cases.

Two-stage revision is used specifically for infected hip replacements and involves two separate surgeries. Stage 1 (removal/debridement): Failed implants completely removed, all infected tissue and cement thoroughly debrided, antibiotic-loaded cement spacer placed to maintain leg length and deliver high-dose antibiotics locally, deep tissue cultures sent, patient started on IV antibiotics (typically 6 weeks) based on culture results. Interval period (6-12 weeks): Patient ambulates with spacer in place (partial weight bearing), continues antibiotic therapy, inflammatory markers (ESR, CRP) monitored for normalization, hip aspiration may be repeated to confirm infection clearance. Stage 2 (reimplantation): Once infection cleared (proven by normalized labs and negative aspiration), new permanent implants inserted, bone grafting performed if needed, patient continues oral antibiotics for weeks to months. Why two stages? Single-stage revision (removing infected implant and inserting new one same day) has higher re-infection rates. Two-stage allows: thorough infection treatment, identification of causative organism, targeted antibiotic therapy, confirmation of infection clearance before new implant, better long-term success (90-95% infection cure vs 80-85% for single-stage). Downsides: requires two major surgeries, longer overall treatment (6-9 months), temporary disability with spacer, higher cost. However, for infected hip replacements, two-stage revision remains gold standard with best outcomes. Dr. Kumar carefully evaluates each case to determine optimal approach.

Revision hip replacement success rates and longevity depend on several factors: Overall success rate: Dr. Kumar achieves 88% excellent functional outcomes at 5-year follow-up. Pain relief achieved in 85-90% of patients. Complication rate approximately 15-20% (higher than 5-10% for primary). Implant survival rates: 10-year survival: approximately 85-90%. 15-year survival: approximately 75-80%. 20-year survival: approximately 60-70%. Compare this to primary hip replacement which has 95% survival at 20+ years. Factors affecting outcomes: Reason for revision - aseptic loosening has better outcomes than infection. Bone stock quality - severe bone loss worsens prognosis. Patient factors: age (younger patients wear implants faster), weight (obesity increases stress), activity level, overall health. Surgeon experience - complex revisions benefit from specialized expertise. Quality of bone grafting and implant fixation. Important considerations: Revision implants generally don't last as long as primary implants due to: compromised bone quality, larger implants creating more stress, scar tissue affecting healing, patients already demonstrated tendency for implant failure. Future re-revision may be needed, especially in younger patients. Despite shorter longevity than primary replacements, revision surgery dramatically improves quality of life for patients suffering with failed primaries - most patients experience significant pain relief and functional improvement. With proper technique and implant selection, many revision hip replacements provide excellent function for 10-15+ years.

Revision hip replacement is more expensive than primary replacement due to complexity, longer surgery time, and specialized implants. At Arthoscenter Patna under Dr. Gurudeo Kumar, approximate costs are: Simple revision (single component, minimal bone loss): ₹3,50,000-4,50,000. Standard revision (both components, moderate bone loss): ₹4,50,000-6,50,000. Complex revision (severe bone loss, custom implants, bone grafting): ₹6,50,000-9,00,000. Two-stage revision for infection: ₹8,00,000-12,00,000+ (includes both surgeries and interval antibiotics). Package typically includes: Comprehensive pre-operative evaluation and imaging, aspiration for infection screening, all surgical charges, specialized revision implant system, bone graft materials if needed, anesthesia, extended operating room time, ICU care if needed, hospital stay (5-10 days), physiotherapy consultation, blood transfusion if required, follow-up visits for 6 months. Additional costs may include: Pre-operative CT scan (₹8,000-12,000), bone density scan (₹3,000-5,000), extended antibiotics for infection cases, outpatient physiotherapy (₹1,000-1,500 per session, 15-20 sessions typical), assistive devices (walker, elevated toilet seat), medications. Cost factors: Extent of bone loss (more grafting = higher cost), Infection requiring two-stage vs single-stage, Custom vs standard revision implants, Femoral vs acetabular vs both components, Need for advanced imaging or specialized consultations. Insurance: Most insurance policies cover revision surgery, Prior authorization required, Coverage varies - verify benefits. Despite higher cost than primary replacement, revision surgery transforms quality of life for patients with failed hip replacements. Dr. Kumar provides transparent cost breakdown during consultation. ₹999 initial consultation includes examination, X-ray review, treatment planning, and accurate cost estimate.