Table of ContentsView AllTable of ContentsHip Replacement OverviewHow Long They LastWhy They LoosenJoint Revision SurgeryPrevention
Table of ContentsView All
View All
Table of Contents
Hip Replacement Overview
How Long They Last
Why They Loosen
Joint Revision Surgery
Prevention
A loosening hip replacement implant can be painful. Symptoms of a loose hip replacement include pain in the groin or upper thigh, new popping or clicking noises, joint instability, and dislocation or subluxation (partial dislocation) of the joint.
Hip replacements usually last at least 20 years. Carrying excess body weight or doing high-impact activities and exercise can put excess strain on the artificial joint and cause it to wear out early. An accident, fall, or another impact injury can also cause the hip replacement to come loose.
This article discusses hip replacement loosening and its causes. It also explains why hip replacements may fail and require joint revision surgery.
Reasons for Hip Replacement Failure
Brianna Gilmartin / Verywell
Hip replacement surgeryis among the most commonorthopedic proceduresand is performed more than 300,000 times in the United States every year.It has a proven track record for safety and for improving the quality of life and life expectancy in those with the functional loss of mobility.
One of the key concerns about hip replacement surgery is the loosening of thehip prosthetic. It is a normal consequence of implant surgery, sometimes requiring revision surgery to correct the problem.
Unfortunately, the revision process is often less successful than the first surgery. Of equal concern is the risk of infection or breakage of the implant when joint loosening occurs, both of which can lead to potentially severe and, in some cases, life-threateningcomplications.
Life Span of Hip Prosthetics
Most hip replacements last an average of 20 to 25 years. Some implants last longer, while others fail much sooner. Occasionally, the implant will fail immediately after surgery, but, in other cases, an implanted joint may last for 30 or more years with no problems whatsoever.
Decades ago, when joint replacement surgery was considered new, there were different factors that determinedhow long a hip implant would last. Some of the earliest implants failed because the metals were susceptible to breakage or the plastics quickly shattered.
Due to improvements in the strength of hip prosthetics and fixation techniques, current implants tend to hold up well once implanted. Furthermore, with improvements in sterile surgical protocols and infection control, serious complications ofjoint prosthesis infectionhave also been reduced.
List of the Most Common Orthopedic Procedures
Why Hip Replacements Loosen
When a hip replacement is placed in the body, it is either pressed or cemented into place so that it fits tightly into the pelvis and the bone of the thigh (femur).Although the implant may be stable at first, it can sometimes loosen over time. This is typically a gradual process that increasingly impedes the normal function of the prosthesis.
There are several factors that may contribute to hip replacement loosening, including a person’s age, sex, weight, and activity levels. A study published in theJournal of Orthopedic Surgeryconcluded that hip replacements are less likely to loosen in the following groups:
Beyond these risk factors, the most common cause of joint replacement loosening is the wearing of the implant surfaces and the subsequent weakening of the surrounding bone. This is known as osteolysis.
A Word From VerywellTypically, hip replacement implant loosening occurs very slowly, so conservative measures should be used to delay replacement surgery as long as possible. An orthopedic surgeon will discuss what type of implant is best to reduce long-term complications, including loosening.—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Typically, hip replacement implant loosening occurs very slowly, so conservative measures should be used to delay replacement surgery as long as possible. An orthopedic surgeon will discuss what type of implant is best to reduce long-term complications, including loosening.—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
Typically, hip replacement implant loosening occurs very slowly, so conservative measures should be used to delay replacement surgery as long as possible. An orthopedic surgeon will discuss what type of implant is best to reduce long-term complications, including loosening.
—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
Osteolysis
Osteolysis is a problem that causes the bone surrounding the implant to seemingly “melt away.” When viewed on anX-ray, it will look as though there are holes in the bone around the implant. Because of the weakened bone, the hip replacement can become loose and begin to wobble over time. Pain and limitations in the motion of the hip are also common.
After years of use, microscopic fragments of the hip replacement cause irritation to the tissues around the implant and begin to weaken the bone. Even though modern hip implants are made of materials that can withstand wear, even small amounts of these particles can damage the bone and cause the implant to loosen.
What Is Cement Disease?In years past, healthcare providers used the term “cement disease” to describe the holes seen on the X-rays in hip implant recipients. It was wrongly assumed that the cement adhesive used to fix the implant caused bone weakening, a conceit that has since been disproven.
What Is Cement Disease?
In years past, healthcare providers used the term “cement disease” to describe the holes seen on the X-rays in hip implant recipients. It was wrongly assumed that the cement adhesive used to fix the implant caused bone weakening, a conceit that has since been disproven.
Hip implant loosening is an issue of particular concern because revision surgery is a much more difficult operation than the initial procedure. If and when revision surgery is needed, the hip joint is more likely to be worn and the femur and pelvis are more likely to be unstable or brittle.
Generally speaking, people tend to recover lessrange of motion (ROM)of the joint following revision surgery. The longevity of the implant will also decrease, increasing the risk of asecond revision surgery.
Therefore, healthcare providers tend to avoid joint replacement surgery until absolutely necessary and try to get as much mileage out of each replacement as possible.
Generally Accepted Values for Joint Range of Motion (ROM)
Urgent Cases
Hip replacements can fail for reasons other than loosening. For example, the ball of the joint may slip out of the socket in the weeks following surgery, leading todislocation.
Aninfectioncan also occur, either due to the loosening of the joint or a complication from the initial surgery itself. An infection can be detrimental to surrounding muscles, ligaments, cartilage, and bones and in rare cases becomesystemic. In such cases, prompt revision surgery is needed to maintain the structural integrity of the joint and prevent the cataclysmic loss of mobility.
In recent years, researchers have begun to investigate whether or nottraditional metal-on-polyethylene implantsare ideal choices for hip replacement.
Newer implants made of ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal are largely believed to have improved longevity compared to these traditional implants. They tend to have much smaller wear particles and debris accumulating around the joint. The overall volume of wear in these implants is also less than that of traditional metal-on-polyethylene implants.
However, it is not yet known if these newer models will actually lower the rate of loosening over time. Furthermore, there may be other complications associated with differenttypes of hip implantsthat may not occur with metal-on-polyethylene models.
The U.S. Food and Drug Administration warns that metal-on-metal hip implants can cause metal ions (e.g., cobalt and chromium) to leach into the bloodstream over time. The long-term impact of this remains unknown.
Why the Material Used for Hip Replacement Implants Matters
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hessels AJ, Agarwal M, Liu J, Larson EL.Incidence and risk factors for health-care associated infections after hip operation.Surg Infect (Larchmt). 2016 Dec 1; 17(6): 761-5. doi:10.1089/sur.2016.062Karachalios T, Komnos G, Koutalos A.Total hip arthroplasty: survival and modes of failure.EFORT Open Rev. 2018;3(5):232-9. doi:10.1302/2058-5241.3.170068Evans J, Evans J, Walker R, Blom A, Whitehouse M, Sayers A.How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019;393(10172):647-54. doi:10.1016/s0140-6736(18)31665-9Varacallo M, Luo TD, Johanson NA.Total hip arthroplasty (THA) techniques. In: StatPearls.Melloh M, Eggli S, Busato A, Roder C.Predictors of early stem loosening after total hip arthroplasty: a case-control study.J Orthop Surg (Hong Kong). 2011;19(3):269-73. doi:10.1177/230949901101900301Rysinska A, Skoldenberg O, Garland A, et al.Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study.PLoS One. 2018;13(11):e0204391. doi:10.1371/journal.pone.0204391Sukur E, Akman Y, Ozturkmen Y, Kucukdurmaz F.Particle disease: a current review of the biological mechanisms in periprosthetic osteolysis after hip arthroplasty.Open Orthop J.2016;10:241-51. doi:10.2174/1874325001610010241Kenney C, Dick S, Lea J, Liu J, Ebraheim N.A systematic review of the causes of failure of revision total hip arthroplasty.J Orthop. 2019;16(5):393-395. doi:10.1016/j.jor.2019.04.011Sukeik M, Haddad F.Periprosthetic joint infections after total hip replacement: an algorithmic approach.SICOT J.2019;5:5. doi:10.1051/sicotj/2019004Merola M, Affatato S.Materials for hip prostheses: a review of wear and loading considerations.Materials (Basel). 2019;12(3):ma12030495. doi:10.3390/ma12030495U.S. Food and Drug Administration.Concerns about metal-on-metal hip implants.Additional ReadingMaradit kremers H, Larson DR, Crowson CS, et al.Prevalence of total hip and knee replacement in the United States.J Bone Joint Surg Am. 2015;97(17):1386-97. doi:10.2106/JBJS.N.01141
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hessels AJ, Agarwal M, Liu J, Larson EL.Incidence and risk factors for health-care associated infections after hip operation.Surg Infect (Larchmt). 2016 Dec 1; 17(6): 761-5. doi:10.1089/sur.2016.062Karachalios T, Komnos G, Koutalos A.Total hip arthroplasty: survival and modes of failure.EFORT Open Rev. 2018;3(5):232-9. doi:10.1302/2058-5241.3.170068Evans J, Evans J, Walker R, Blom A, Whitehouse M, Sayers A.How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019;393(10172):647-54. doi:10.1016/s0140-6736(18)31665-9Varacallo M, Luo TD, Johanson NA.Total hip arthroplasty (THA) techniques. In: StatPearls.Melloh M, Eggli S, Busato A, Roder C.Predictors of early stem loosening after total hip arthroplasty: a case-control study.J Orthop Surg (Hong Kong). 2011;19(3):269-73. doi:10.1177/230949901101900301Rysinska A, Skoldenberg O, Garland A, et al.Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study.PLoS One. 2018;13(11):e0204391. doi:10.1371/journal.pone.0204391Sukur E, Akman Y, Ozturkmen Y, Kucukdurmaz F.Particle disease: a current review of the biological mechanisms in periprosthetic osteolysis after hip arthroplasty.Open Orthop J.2016;10:241-51. doi:10.2174/1874325001610010241Kenney C, Dick S, Lea J, Liu J, Ebraheim N.A systematic review of the causes of failure of revision total hip arthroplasty.J Orthop. 2019;16(5):393-395. doi:10.1016/j.jor.2019.04.011Sukeik M, Haddad F.Periprosthetic joint infections after total hip replacement: an algorithmic approach.SICOT J.2019;5:5. doi:10.1051/sicotj/2019004Merola M, Affatato S.Materials for hip prostheses: a review of wear and loading considerations.Materials (Basel). 2019;12(3):ma12030495. doi:10.3390/ma12030495U.S. Food and Drug Administration.Concerns about metal-on-metal hip implants.Additional ReadingMaradit kremers H, Larson DR, Crowson CS, et al.Prevalence of total hip and knee replacement in the United States.J Bone Joint Surg Am. 2015;97(17):1386-97. doi:10.2106/JBJS.N.01141
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hessels AJ, Agarwal M, Liu J, Larson EL.Incidence and risk factors for health-care associated infections after hip operation.Surg Infect (Larchmt). 2016 Dec 1; 17(6): 761-5. doi:10.1089/sur.2016.062Karachalios T, Komnos G, Koutalos A.Total hip arthroplasty: survival and modes of failure.EFORT Open Rev. 2018;3(5):232-9. doi:10.1302/2058-5241.3.170068Evans J, Evans J, Walker R, Blom A, Whitehouse M, Sayers A.How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019;393(10172):647-54. doi:10.1016/s0140-6736(18)31665-9Varacallo M, Luo TD, Johanson NA.Total hip arthroplasty (THA) techniques. In: StatPearls.Melloh M, Eggli S, Busato A, Roder C.Predictors of early stem loosening after total hip arthroplasty: a case-control study.J Orthop Surg (Hong Kong). 2011;19(3):269-73. doi:10.1177/230949901101900301Rysinska A, Skoldenberg O, Garland A, et al.Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study.PLoS One. 2018;13(11):e0204391. doi:10.1371/journal.pone.0204391Sukur E, Akman Y, Ozturkmen Y, Kucukdurmaz F.Particle disease: a current review of the biological mechanisms in periprosthetic osteolysis after hip arthroplasty.Open Orthop J.2016;10:241-51. doi:10.2174/1874325001610010241Kenney C, Dick S, Lea J, Liu J, Ebraheim N.A systematic review of the causes of failure of revision total hip arthroplasty.J Orthop. 2019;16(5):393-395. doi:10.1016/j.jor.2019.04.011Sukeik M, Haddad F.Periprosthetic joint infections after total hip replacement: an algorithmic approach.SICOT J.2019;5:5. doi:10.1051/sicotj/2019004Merola M, Affatato S.Materials for hip prostheses: a review of wear and loading considerations.Materials (Basel). 2019;12(3):ma12030495. doi:10.3390/ma12030495U.S. Food and Drug Administration.Concerns about metal-on-metal hip implants.
Hessels AJ, Agarwal M, Liu J, Larson EL.Incidence and risk factors for health-care associated infections after hip operation.Surg Infect (Larchmt). 2016 Dec 1; 17(6): 761-5. doi:10.1089/sur.2016.062
Karachalios T, Komnos G, Koutalos A.Total hip arthroplasty: survival and modes of failure.EFORT Open Rev. 2018;3(5):232-9. doi:10.1302/2058-5241.3.170068
Evans J, Evans J, Walker R, Blom A, Whitehouse M, Sayers A.How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.Lancet. 2019;393(10172):647-54. doi:10.1016/s0140-6736(18)31665-9
Varacallo M, Luo TD, Johanson NA.Total hip arthroplasty (THA) techniques. In: StatPearls.
Melloh M, Eggli S, Busato A, Roder C.Predictors of early stem loosening after total hip arthroplasty: a case-control study.J Orthop Surg (Hong Kong). 2011;19(3):269-73. doi:10.1177/230949901101900301
Rysinska A, Skoldenberg O, Garland A, et al.Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study.PLoS One. 2018;13(11):e0204391. doi:10.1371/journal.pone.0204391
Sukur E, Akman Y, Ozturkmen Y, Kucukdurmaz F.Particle disease: a current review of the biological mechanisms in periprosthetic osteolysis after hip arthroplasty.Open Orthop J.2016;10:241-51. doi:10.2174/1874325001610010241
Kenney C, Dick S, Lea J, Liu J, Ebraheim N.A systematic review of the causes of failure of revision total hip arthroplasty.J Orthop. 2019;16(5):393-395. doi:10.1016/j.jor.2019.04.011
Sukeik M, Haddad F.Periprosthetic joint infections after total hip replacement: an algorithmic approach.SICOT J.2019;5:5. doi:10.1051/sicotj/2019004
Merola M, Affatato S.Materials for hip prostheses: a review of wear and loading considerations.Materials (Basel). 2019;12(3):ma12030495. doi:10.3390/ma12030495
U.S. Food and Drug Administration.Concerns about metal-on-metal hip implants.
Maradit kremers H, Larson DR, Crowson CS, et al.Prevalence of total hip and knee replacement in the United States.J Bone Joint Surg Am. 2015;97(17):1386-97. doi:10.2106/JBJS.N.01141
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