Failure of Total Hip Arthroplasty

Most Total Hip Replacements (THA/THR) will last many years. With the latest implant technology, surgical skill and the right surgeon a THA can last 25 years or more. Some THAs however, do fail.

How does my Total Hip Replacement fail?

Dr. Thornton-Bott is sub-specialised in revision hip surgery and will use imaging techniques and other tests to identify the cause of failure of your hip replacement. These include-

• Aseptic Loosening

The implant ball and socket joint is a bearing and, like all bearings, it eventually wears out as the ball continually rubs against the socket. In an average active person, the hip moves through two million cycles per year!

If there is bearing wear it creates ‘wear debris’, tiny particles of material. These particles can create a reaction in the human body called osteolysis, which causes the bone surrounding the hip replacement to be replaced with a soft, granular tissue. This tissue has no structural support so, the weaker the surrounding bone around the implant. When this gets beyond a certain point, the implant becomes loose, and the patient feels pain. Eventually, the remaining weak bone can fracture.

• Acetabular cup loosening will often present as groin pain, and again, may be painful first thing in the morning or rising from a chair and ease slightly later in the day. This is called ‘Start-Up pain’.

• Implant Wear and Failure

It is important to remember that the joint can wear out! The bearing surfaces as discussed above will eventually wear. In some implant designs, loosening puts extra stress on the implant and the implant itself can break. Some implants have been shown to have a higher rate of failure, either a design fault or material fault.

• Peri-Prosthetic Fracture

With loosening and/or osteolysis the underlying bone can become weakened and can fracture around the implant. This can happen with minimal force. Simple trauma, e.g. a fall, can also cause a fracture around a total hip replacement.

• Infection of the Joint.

An infection that is deep within the hip joint and in and around the components of the joint is very rare. If this happens, then the patient usually feels pain and may become clinically unwell. Some infections can grumble on for years undetected and can cause damage to the bone surrounding the implants. Something as simple as a urinary tract infection or dental work can cause the joint to become infected.

• Dislocation

Dislocation of the hip can be through wear of the bearing, poorly positioned implants at the original surgery, fracture of the bearing, damage to the ligaments and capsule surrounding the hip joint, infection, trauma. Dislocation of the THA may require a revision operation. Initially, Dr Thornton-Bott or an Emergency Doctor will ‘reduce’ the dislocated hip in ED or the operating theatre and assess its stability. Depending upon the cause of the dislocation, some joints can be treated with hip precautions and gentle physiotherapy to allow the tissues around the hip to settle down. If there is more than one dislocation or the hip is identified as very unstable or the dislocation has been caused by other factors such as poor implant position, then revision will be required. Revision of the hip will correct the underlying cause of the dislocation.

• Surgical Factors

Unfortunately, a total hip replacement can fail simply because the original surgeon did not do a very good job at putting it in! All orthopaedic surgeons are taught to perform Total Hip Replacement and Total Knee Replacement during their training. However, as with any skill, the more training you have in a certain area and the more you do it the better you will become and the better your results. Dr. Thornton-Bott is a Sub-Specialist in this field and has extensive experience and Fellowship training specifically in Joint replacement Surgery and Revision Joint replacement surgery and his experience has been focused predominantly in this area since 2006.