​​​​Revision (Re-do) Hip Replacement

Total hip replacement is one of the most successful operations known. In the vast majority of cases it enables people to live a more active life with significantly less pain. However, it is an artificial joint and will wear out with time and fail. This can occur over a variable period of time. We can say with some certainty approximately 90 to 95% of hip replacement last over 10 years.

In revision hip surgery, a variety of different surgical techniques can be used, varying in the complexity and length of surgical time. For example in some cases only the liner of the socket needs to be replaced whilst at the other end of the spectrum both components (the socket and the stem) need to be removed. Upon removal there may be missing bone requiring substitution with a bone graft from a donor, or the use of metal implants and augments to restore the hip joint to where it should be.

Why would you need a revision total hip replacement?

Loosening and implants wearing out

In order for a hip replacement to function well the implants on both sides (the socket and the stem) must remain firmly attached to the bone. At the time of the initial operation the components were either firmly adhered to the socket or the thigh bone (femur) with cement or with out. The cause of the loosening is not always obvious. Usually, repetitive high impact activities, excessive bodyweight (body mass index), and wearing away of the plastic liner between the ball and socket are all contributing factors. Younger patients typically use the hip joint more and therefore are likely to need revision surgery in the future.

​The space between the bone and cement indicates the cement and the stem has become loose from the bone

Infection

Infection is a potential complication of any surgery. If it does occur following a hip replacement it can be superficial or deep. Deep infection occurs when the bacteria attach to the surface of the implants or artificial joint. Infection can occur early (within the first 30 days of an operation) or late, many years after an operation. The infection process can lead to loosening of one or both components of a hip replacement. There can be issues with wound healing too with the development of persistent discharge.

There are different ways that infection can be managed and a number of factors need to be considered when approaching how to deal with this difficult problem. A multidisciplinary team (MDT) comprising of microbiologist, radiologist, physiotherapist, and other surgeons are used to tackle this problem and to determine the best way to deal with this. This wil be discussed in detail with you if this is the cause for the revision surgery. I work with some leading microbiologists and radiologists in the field and we hold weekly MDTs to discuss difficut cases.

Dislocation

In a hip replacement, the artificial ball is smaller than your native hip. For a hip replacement to work well the ball must remain inside the socket for the entire functional range of movement the individual has. The position of instability depends on how the hip joint is approached during the initial operation. The greatest risk of dislocation after the first operation is usually the first 12 weeks. As the hip gets worn out, there is a higher incidence of late dislocation further on down the line (10 or more years). If you experience recurrent dislocation especially more than three times in a short period of time, then you may need to have revision surgery. This will involve removing one or both components of your hip replacement and putting in more specialised implants that lower the risk of dislocation.


Fracture

When the thigh bone breaks around the stem of the hip replacement, it is called a periprosthetic fracture. This can typically occur with a fall from a standing height in frail bone, or trauma with high energy (e.g. a road traffic accident). Not all periprosthetic fracture require revision surgery (the stem to be taken out and the new one put in). Sometimes these fractures can be fixed with plates and screws and the old implant retained.

In the case on the right the broken thigh bone (femur) has been fixed so well that the fracture line cannot be seen. The femur is held with plates and screws around the implant. This 90 year old lady was then walking with all her weight on her leg the next day.

Reaction to metal ions and metal allergy

Metal on metal hip replacements have been implanted in the past and you may have heard about them in the media. This is when both the socket and the ball of the artificial joint are made of metal. This can generate metal ions locally around the hip joint, which then causes an inflammatory reaction leading to loosening and local destruction of tissue such as muscle and bone around the hip. Very rarely, patients can be allergic to some types of metal used in implants. This can cause pain. ​There is no definite consensus among orthopaedic experts regarding this; further research into this area needs to be conducted.

What if you need a revision total hip replacement?

The prospect of having revision surgery can be very daunting for you. Rest assured, I will perform a thorough medical evaluation to determine your fitness for surgery. A number of tests will be performed to ensure we have the right diagnosis and meticulously plan the surgery.

Your mobility will often be temporarily limited after surgery. Depending on the surgery performed, crutches will be required usually for a period of 6 weeks and sometimes 12 weeks. Therefore you may need help with tasks of daily living, such as cooking, shopping, and bathing.

​Why choose Mr. Jaiswal?

​As result of my dual fellowship training and extensive Consultant experience in a tertiary hospital (where other orthopaedic consultants refer patients with complex problems), I perform, revision surgery regularly, using cutting edge surgical techniques and the latest, innovative prosthesis. I have an excellent team which help me achieve the best possible results. We regularly discuss cases in a weekly MDT with other consultants to ensure we have a consensus on how best to treat these often very challenging problems. I closely monitor the results of all my cases, and to date, every revision procedure I have performed has been successful.

​Testimonials

What they say

“Fully recommend Mr. Jaisawal”

I first met Dr Jaiswal at Guy’s hospital in March 2017 & from our first encounter he was pleasant & immediately likable. He gave me the opportunity to fully explain exactly what issues I had & how they were affecting my daily life, he was very sympathetic, patient & I felt that he could empathise with me. He then used charts & diagrams etc to explain to me exactly what was causing my condition & how it could be repaired, what the pros & cons were, also the success rate for the procedure. He gave me enough information to make an informed decision to go ahead with surgery asap. The surgery carried out was a right hip arthroscopy & repair to labral tear, since surgery all the pain I had previously endured has totally gone & my recovery has been very good so far. I commend & fully recommend Dr Jaiswal, may I take this opportunity to thank you & all the staff who gave me excellent care during my short stay at Guy’s.

“Attentive and understanding at all times”

I have been massively impressed with Mr Jaiswal throughout my treatment (I first saw him in Feb 17). Attentive and understanding at all times; he explained things extremely clearly, outlined my options and I always felt that the patient came first. I was particularly impressed with the amount of time he gave all his patients during ward rounds (he seemed to visit more often than other consultants). My surgery was, apparently, not straight forward but I have made a good recovery and I am delighted with the treatment I have received. I can not recommend Mr Jaiswal highly enough.

“So glad I saw Mr. Jaiswal”

Mr Jaiswal has a great manner and talks to you with respect and compassion. I had wanted to see a colleague of his who specialised in my hip condition. His waiting list was over 9 months so I was referred to Mr Jaiswal instead. I am so glad. He immediately recognised my problem after 5 years of it being missed or ignored by other NHS professionals. He performed a total hip replacement under local anaesthetic and within hours I was able to use the toilet (no bedpan!) and go home the next day. He did a great job and 7 weeks later I am able to walk, stand up straight and get out of a sitting position without pain or restriction

“An excellent surgeon”

Mr Jaiswal is an excellent surgeon. The competency & dedication of him and his team was exemplary when I suffered an injury in December. As a trainee doctor, it is inspiring to see how a caring attitude together with excellent clinical practice directly results in the best clinical outcomes. I am sure, the fact that I am almost ready to consider running again after breaking my hip less than four months ago, is due to the fantastic care I received whilst an inpatient and continue to receive during follow-up.

“Eternally grateful to Mr. Jaiswal”

My husband and I are eternally grateful to Mr Jaiswal for the care he took in replacing both of my hips in two separate surgical procedures over two years. I can now walk painfree and can go on to enjoy our retirement as we would wish. I would not hesitate in recommending him as an excellent orthopaedic surgeon who is technically competent, very professional in manner and someone who gives you close personal attention even when he has a waiting room brimming with patients. He was patient in answering all our concerns, he addressed the risks and limitations of the new joint, he explained in detail everything that the surgery would entail and how the recovery process might unfold. Mr Jaiswal turned my traumatic procedure into an everyday experience tossed in with humour. Now that both of my hips have been “done”, we shall miss him and wish him every success in his career going forward.

I admire Mr. Jaiswal greatly as a surgeon and as a person”

When I first met Mr Jaiswal in the outpatients department at Guys he heard that I had been dieting and had lost 2 stone in weight. He got up from his chair and came over to me to shake my hand and congratulate me. He was extremely courteous. He discussed the operation with me taking time to talk to me and explained everything in simple English that I was able to understand. When I arrived in the operating theatre I could see Mr Jaiswal talking to his team in a relaxed friendly way and this helped a great deal to give me confidence. At my post op assessment Mr Jaiswal was very caring. My operation as been a great success and I admire Mr Jaiswal greatly as a surgeon and as a person.

“I cannot praise this surgeon enough”

I cannot praise this surgeon enough, I have suffered for many years with arthritic hips and at the age of 44, classed as a “young patient” I was very nervous that this was the right option for me but Mr Jaiswal was/is a fantastic man ! From the very first time I saw him and my issues were discussed, I knew that I was in the best hands possible. All aspects of the operation were explained to me so I was made to feel like I mattered. Mr Jaiswal was also very considerate when carrying out the operation, taking great care to preserve a memorial tattoo I have of my Mum. I was “awake” for the op and I would definitely recommend it – what an experience, I also feel that my recovery time has been quicker – I went in on the Thursday afternoon and was home on the Saturday afternoon. Amazing care on Sarah ward too.

“Mr. Jaiswal is delightful and approachable”

I had a total hip replacement just over a year ago and have just been discharged. Since I had the operation, progress has been swift and recovery total. It was a complete success. I cannot fault the after care which was regular and thorough. I was in hospital after the operation for just 3 days. During that time the staff were helpful and friendly. Mr Jaiswal himself is delightful and approachable, answering any questions that one may want to ask; and he is obviously a highly skilled surgeon. I had complete trust.

“Significant improvement”

After nearly two years of struggling to find a diagnosis for my pain at a different hospital, I was finally referred to Mr Jaiswal at Guys,who very quickly organised a range of scans, found a diagnosis and arranged hip arthroscopy and labral repair. 3 months later and I already have a significant improvement in the movement in my hip and the pain has drastically reduced.

“I would recommend him completely”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“Our family cannot thank Mr. Jaiswal enough”

Mr. Jaiswal operated on my father , prior to this every other surgeon that had seen him back so many words said that his condition was inoperable. Until that is he was seen by Mr. Jaiswal. I cannot thank this man enough. After completing an extremely complex surgery on my father he now is not in any pain and actually has an extremely good chance of being able to walk with a walking stuck and not crutches. Our family cannot thank Mr. Jaiswal and his team at the Royal Free enough.

A. Ward

“I cannot speak highly enough of the care I received from Mr. Jaiswal”

Dr. Parag Jaiswal is without doubt a first class Orthopaedic surgeon. I have been “under” him on two occasions and with each procedure he was caring, re-assuring and very understanding to his patients needs and would always listen to his patients. The total hip replacement he gave me in November was perfect in every detail. The speed of my recovery has also been enhanced by Mr. Jaiswal’s technique of making the smallest incision, a scar of about 6 inches, to perform the procedure and therefore healing time and discomfort have been kept to a minimum. Not only has he given me back a painfree life, I can now start attending events, social gatherings and family parties without the worry or stress of being in pain and discomfort. Dr. Jaiswal opted for the best prosthetic to suit bot my life style and job role (printroom manager) which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal, fellow Doctors, nurses and all the background staff at Guy’s hospital. Without doubt this great NHS is full of wonderful caring people like Mr Jaiswal and his team. Thank you for giving back my life.

 

Anthony Chaplin

“I cannot recommend him highly enough”

Mr Jaiswal operated on my leg following a fall, he was extremely kind and gentle. He explained step by step everything I needed to know, which not all surgeons will do. I found him very professional and he had a very good bedside manner. I was very anxious about being able to walk in the future, he reassured me through explaining all details. I felt he really cared, and my future rehabilitation mattered to him personally. Anybody that needs an orthopaedic operation would be very lucky to have him. I can not recommend him highly enough.

L. Blackman

“Mr. Jaiswal did a superb job”

I saw Mr Jaiswal for a full hip replacement when in great pain. He was sympathetic in the initial consultation and went to trouble to explain the procedure, discuss the hip replacement and out me at ease. I opted for general anaesthetic and suffered no poor consequences on the first day I was up and walking with crutches. People had warned me to expect a long have recovery but I was off the crutches inside 2 weeks and walking to my local village an back with shopping in a back pack, no crutches no pain from my hip. Of course there was some pain from the operation but that soon went. I was climbing stair again straight away on return home of course slowly at first but no crutches. The physiotherapist said my recovery was remarkable but I am confident it is because Mr Jaiswal did a superb job leaving me the easy part of getting on my feet. I plan to return to tennis now. Whilst I can only give my personal experience I happily recommend Mr Jaiswal and consider myself fortunate to have had his services.

“The most amazing work”

One year from having total hip replacement well I’ve had no pain from my hip. I can do single leg pistol squats also I’ve climbed stairs for half an hour with ease. The best test I’ve done for my hip was going snowboard and had no problems with it. Dr. Paraj Jaiswal done the most amazing work on me he even cut into my hip which he done around my tattoo you can hardly see the scar. I thank him and his team for what I consider was the best job they could have done as I also can walk correctly now once again big thanks to all.

Jason Hinton

“Very glad to have been treated by Mr. Jaiswal”

My 24 year old artificial hip snapped and Mr Jaiswal was very enthusiastic about redoing the hip. He actually tweeted the xray with my permission and I noted that it was commented on by a Professor of Orthopaedics at Harvard!. He explained to me {and both my daughters individually!} the whole procedure outlining the possible difficulties and risks. He was very patient about this and I felt informed and confident that I was in very good hands. I did have to wait nearly a week for the operation but that was partly because the hospital was particularly busy and also because specialist equipment had to be acquired. In the event the operation was relatively straight forward. It did not take as long as it might have done if he had had to break the femur to remove parts of the old prosthesis. It did involve a bone donation. I did not need a period in the ICU where a place had been reserved. I made a speedy recovery with the help of the hospital physios and was glad to be sent to a rehab unit for a couple of weeks. I had several conversations before and after the operation with Mr Jaiswal and other members of the team. All were positive. Mr Jaiswal also rang me this week to enquire about my progress during the lockdown and we discussed exercises and the problem of my other hip. He was constructive and made several suggestions. I hope to have a follow up appointment after lockdown I am very glad to have been treated by Mr. Jaiswal and his team and I feel confident he will help with any future orthopaedic problems I have. I hope he stays at the Royal Free!

Irene Woodworth

“Delighted in the outcome of surgery”

I required total hip replacement after longstanding distortion to pelvis from an accident. The op enabled early mobility and discharge less than 48 hours afterwards. Mr Jaiswal understood my ambition to return to sport and corrected unequal leg length, also arranged for long physio programme which enabled an early return. A feature of his care was his obvious delight in both the outcome of the surgery and my success in resuming my sport.

“Fantastic job”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“First class orthopaedic surgeon”

Dr. Parag Jaiswal is first class Orthopaedic surgeon. The total hip replacement he gave me is perfect in every detail. The speed of my recovery has also been enhanced by Mr. Parags’ technique of making the smallest incission to perform the the proceedure and therefore healing time and discomfort have been kepto a minimum.. My occupation as a full time Firefighter can now continue and with this in mind Dr. Jaiswal opted for the best prosthetic to suit my life style which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal and all the staff Doctors and nurses at Guy’s hospital. Thank you.

R.J. Cummings

You DON'T Have to put up with the

Pain & Stiffness.

Get Seen by an Expert Without Delay.