Loosening of total hip prosthesis
What is total hip replacement loosening?
Loosening of a total hip replacement is a complication that occurs when the implant used to replace the hip joint loses its attachment to the surrounding bone. This means that one or both parts of the implant (either the acetabular cup in the pelvis or the femoral stem in the femur) no longer remain securely in place. This compromises the stability and function of the hip joint, often causing pain and dysfunction.

Loosening of total hip prosthesis



Causes of Unsealing
The main causes of total hip replacement loosening include:
Mechanical Wear
Over time, wear of the prosthesis components can lead to degradation of the implant material (metal, ceramic, or polyethylene), which causes inflammation and bone resorption around the prosthesis, leading to loosening.
Peri-prosthetic infection
Infection around the prosthesis can lead to bone destruction, compromising the fixation of the implant.
Bad Initial Fixation
If the implant is not properly fixed to the bone during the initial operation, this can lead to early loosening.
Osteolysis
The inflammatory reaction to debris particles from prosthesis wear can cause osteolysis, a progressive resorption of the bone around the implant.
Peri-prosthetic fracture
A fracture of the bone around the implant can destabilize the prosthesis and cause loosening.
Overuse
Excessive physical activity, especially after prosthesis fitting, can lead to premature wear and loosening.
Symptoms of Loosening
Symptoms of a loosened total hip replacement include:
Pain
Persistent pain in the hip or groin, often increased by physical activity or weight bearing.
Instability
Feeling of instability or weakness in the hip, which may cause difficulty walking.
Lameness
Progressive lameness due to pain and instability.
Decreased Mobility
Reduced ability to move the hip normally.
Swelling and Inflammation
In some cases, swelling and inflammation may be present.
Possible treatments
Treatment for total hip replacement loosening depends on the extent of the loosening, the underlying cause, and the patient's general condition.
Non-Surgical Treatment
For cases of minimal loosening or in the presence of contraindications to surgery, conservative options such as anti-inflammatories, walking aids (cane, walker) and activity modification can be used, although they are rarely sufficient in the long term.
Prosthesis Revision
Revision Surgery: The most common procedure is prosthesis revision, where the old prosthesis is removed and replaced with a new, better fitting and secure one.
Bone Reconstruction Gesture
If significant bone loss is present, bone grafts or special implants may be needed to rebuild the bone before the new prosthesis is placed.
Infection Management
If an infection is the cause of the loosening, it must be treated with antibiotics and sometimes by temporary removal of the prosthesis (two-stage replacement).
Physiotherapy
After prosthesis revision, rehabilitation is essential to restore mobility, strengthen muscles and ensure optimal recovery.
Loosening of a total hip replacement is a serious complication that requires prompt evaluation and management. Although loosening may be inevitable in some cases over time, advances in implant materials and surgical techniques continue to extend the life of implants and reduce the risk of complications. Regular monitoring and follow-up care are essential to detect and treat problems before they become serious.
Total Hip Replacement Revision Surgery
Total hip replacement surgery is a surgical procedure that involves replacing an existing hip prosthesis with a new prosthesis. This procedure is necessary when the first prosthesis has failed due to complications such as loosening, excessive wear, infection, recurrent dislocation, or fractures around the implant.



Indications
Revision of total hip replacement is indicated in several situations:
Loosening of the prosthesis
Loss of fixation of the prosthesis at bone level, which can cause pain and instability.
Wear of Components
The prosthesis materials can wear out over time, causing loss of function and inflammation.
Peri-prosthetic infection
An infection around the prosthesis that does not respond to antibiotic treatment and requires removal of the implant.
Recurrent Dislocation
Repeated displacement of the femoral head out of the acetabular cup, leading to joint instability.
Peri-prosthetic fractures
Bone fractures around the prosthesis, requiring reconstruction and replacement of the implant.
Implant Deformation or Dysfunction:
Mechanical failure of the prosthesis, such as fracture of the femoral stem or deformation of the cup.
Procedure of Revision Surgery
Preoperative Evaluation
Medical Examinations: Blood tests, X-rays, and possibly an MRI or CT scan to assess the condition of the bones and prosthesis.
Surgical Planning
The surgeon assesses the complexity of the revision, including bone graft requirements, and chooses the type of revision prosthesis to use.
Anesthesia
The procedure is performed under general anesthesia or spinal anesthesia, depending on the patient's medical condition and the anesthesiologist's preferences.
Removal of the Old Prosthesis
Incision: An incision is made to access the hip joint.
Extraction
The surgeon removes the defective prosthesis. This process can be complex, especially if the implant is firmly fixed or if there is significant bone loss.
Bone Preparation
The bone is prepared to receive the new prosthesis. If necessary, bone grafts are used to reconstruct areas where bone has been lost or damaged.
Insertion of the New Prosthesis
Femoral and Acetabular Components: The surgeon inserts a new femoral stem, a new acetabular cup, and a new articular head. Fixation can be achieved with or without surgical cement.
Stability and Adjustment
The surgeon checks the stability of the new joint, making sure it functions properly and that the components are properly aligned.
Closing
The muscles and tissues are sutured, and a dressing is applied.
Postoperative Recovery
Initial Monitoring: The patient is monitored in the recovery room before returning to his or her room.
Pain Management
Painkillers and anti-inflammatory drugs are administered.
Rehabilitation
Physical therapy begins promptly to restore mobility and muscle strength. Proper rehabilitation is crucial to prevent complications and optimize results.
Risks and Complications
As with any major surgery, hip replacement surgery carries risks, including:
Infection
More risk of infection than with a first prosthesis fitting.
Deep vein thrombosis
Increased risk of blood clots.
Peri-prosthetic fractures
Risk of additional fractures when inserting the new prosthesis.
Healing Problems
Slower recovery or complications in healing, especially if bone grafting is involved.
Less Optimal Functional Result
The results of the revision are sometimes not as good as those of a first prosthesis placement, especially if the condition of the bone is compromised.
Revision total hip replacement surgery is a complex procedure, often required for patients whose first implant has failed. It requires careful planning and advanced surgical expertise to manage potential complications and restore hip function as best as possible. Although riskier and more technically demanding than initial hip replacement, revision can significantly improve patients’ quality of life by relieving pain and restoring mobility.