Revision Total Hip Arthroplasty: Surgical Technique

  • Ana Cruz-PardosEmail author
  • Ricardo Fernández-Fernández
  • Eduardo García-Rey


Revision total hip arthroplasty is a procedure that, nowadays, is frequently performed due to numerous causes such as loosening, dislocation, polyethylene wear, periprosthetic fracture, or infection. Preoperative planning is mandatory. The surgeon must consider the previous approach, the acetabular and femoral bone defects, and the type of implant to be removed. Several approaches have been described for revision hip surgery, and there are specific techniques to remove both cemented and uncemented implants, as well as those that are loose or well-fixed.


Revision hip Approach Surgical technique 


  1. 1.
    Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–19.CrossRefGoogle Scholar
  2. 2.
    Evans BG, Cuckler JM. Evaluation of the painful total hip arthroplasty. Orthop Clin North Am. 1992;23:303–11.PubMedGoogle Scholar
  3. 3.
    Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33:1309–14 e2.CrossRefGoogle Scholar
  4. 4.
    Harris WH, MCcarthy JC Jr, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063–7.CrossRefGoogle Scholar
  5. 5.
    Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res. 1990;261:63–81.Google Scholar
  6. 6.
    Moore MS, McAuley JP, Young AM, Engh CA Sr. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res. 2006;444:176–83.CrossRefGoogle Scholar
  7. 7.
    Schmalzried TP, Kwong LM, Jasty M, Sedlacek RC, Haire TC, O’Connor DO, et al. The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Analysis of specimens retrieved at autopsy. Clin Orthop Relat Res. 1992;274:60–78.Google Scholar
  8. 8.
    Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg. 1987;69B:45–55.CrossRefGoogle Scholar
  9. 9.
    Merkel KD, Brown ML, Dewanjee MK, Fitzgerald RH Jr. Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. A prospective study. J Bone Joint Surg Am. 1985;67:465–76.CrossRefGoogle Scholar
  10. 10.
    D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–37.Google Scholar
  11. 11.
    Telleria JJ, Gee AO. Classifications in brief: paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471:3725–30.CrossRefGoogle Scholar
  12. 12.
    Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9:33–44.CrossRefGoogle Scholar
  13. 13.
    Saleh KJ, Holtzman J, Gafni AL, Jaroszynski G, Wong P, Woodgate I, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19:50–6.CrossRefGoogle Scholar
  14. 14.
    Gustilo RB, Pasternak HS. Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res. 1988;235:111–9.Google Scholar
  15. 15.
    Gross AE, Allan DG, Catre M, Garbuz DS, Stockley I. Bone grafts in hip replacement surgery. The pelvic side. Orthop Clin North Am. 1993;24:679–95.PubMedGoogle Scholar
  16. 16.
    Parry MC, Whitehouse MR, Mehendale SA, Smith LK, Webb JC, Spencer RF, Blom AW. A comparison of the validity and reliability of established bone stock loss classification systems and the proposal of a novel classification system. Hip Int. 2010;20:50–5.CrossRefGoogle Scholar
  17. 17.
    Engh CA, Culpepper WJ II, Kassapidis E. Revision of loose cementless femoral prostheses to larger porous coated components. Clin Orthop Relat Res. 1998;347:168–78.CrossRefGoogle Scholar
  18. 18.
    Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1692–702.CrossRefGoogle Scholar
  19. 19.
    D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK, et al. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;296:133–9.Google Scholar
  20. 20.
    Ibrahim DA, Fernando ND. Classifications in brief: the Paprosky classification of femoral bone loss. Clin Orthop Relat Res. 2017;475:917–21.CrossRefGoogle Scholar
  21. 21.
    Engelbrecht E, Heinert K. Klassifikation und Behandlungsrichtlinien von Knochensubsanzverlusten bei Revisionsoperationen am Huftgelenk mittelfrsige Ergebnisse. In: Primare und Revisionsalloarthroplastik Hrsg-Endo-Klinik. Hamburg: Springer; 1987. p. 189–201.Google Scholar
  22. 22.
    Onyemaechi N, Anyanwu E, Obikili E, Ekezie J. Anatomical basis for surgical approaches to the hip. Ann Med Health Sci Res. 2014;4:487–94.CrossRefGoogle Scholar
  23. 23.
    Moore AT. The self-locking metal hip prosthesis. J Bone Joint Surg Am. 1957;39A:811–27.CrossRefGoogle Scholar
  24. 24.
    Watson Jones R. Fractures of the neck of the femur. Br J Surg. 1936;23:787.CrossRefGoogle Scholar
  25. 25.
    Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg. 1982;64B:17–9.CrossRefGoogle Scholar
  26. 26.
    Younger TI, Bradford MS, Magnus RE, Paprosky WG. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty. 1995;10:329–38.CrossRefGoogle Scholar
  27. 27.
    Lieberman JR, Moeckel BH, Evans BG, Salvati EA, Ranawat CS. Cement-within-cement revision hip arthroplasty. J Bone Joint Surg. 1993;75B:869–71.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ana Cruz-Pardos
    • 1
    Email author
  • Ricardo Fernández-Fernández
    • 1
  • Eduardo García-Rey
    • 1
  1. 1.Department of Orthopedic Surgery, Hip Unit“La Paz” University HospitalMadridSpain

Personalised recommendations