The replacement of a worn or failed implant is called revision surgery. It involves removing the original implant, preparing the surrounding tissue or bone, and inserting a new device. Revision surgery is more complex than the original procedure because the surgeon must work with tissue that has already been altered by the first implant, and bone or soft tissue loss is common. The term applies broadly to orthopedic joints (hips, knees, ankles), dental implants, and soft tissue implants like breast implants.
Why Implants Fail
Implants don’t last forever, and the reasons they fail depend on the type. For orthopedic implants like hip and knee replacements, the most common cause of failure is a biological process triggered by microscopic wear particles. As the implant’s surfaces grind against each other over years of use, tiny debris particles shed into the surrounding tissue. The body’s immune cells try to clean up these particles, but in doing so, they release signals that activate bone-destroying cells while simultaneously suppressing the cells that build new bone. Over time, this creates a zone of bone loss around the implant, a process called osteolysis, which causes the implant to loosen. Wear rates greater than 0.2 mm per year have been reported to cause 100% failure of total hip replacements.
Instability is the single most common reason for revision in joint replacements, accounting for about 34% of cases in one large study of ankle implants. Aseptic loosening (loosening without infection) follows at 28%, then unexplained pain, cyst formation, deep infection, and surgical error.
For dental implants, failures split into early and late categories. Early failures happen because of overheating during surgery, contamination, poor bone quality, or lack of initial stability. Late failures typically stem from peri-implantitis, a chronic infection of the tissue around the implant, or from excessive biting forces over time. Breast implants can fail through rupture, capsular contracture (where the scar tissue around the implant tightens painfully), or, rarely, a type of lymphoma associated with certain textured implant surfaces.
Signs That an Implant Is Failing
The hallmark symptom of a loosening joint implant is “start-up pain,” the pain you feel when standing up from a seated position and taking your first few steps. Some people instinctively stomp or firmly strike their foot against the ground several times to shake off the discomfort before walking normally. A pain-free period after the original surgery followed by gradually returning pain is a classic pattern that points to loosening or late infection. Progressive shortening of the leg can indicate the implant stem is sinking into the bone.
For dental implants, warning signs include increasing mobility of the implant, swelling or bleeding around the gum line, and persistent pain. A failing breast implant may cause changes in shape, firmness, or size of the breast, along with pain or a feeling of rippling under the skin.
How Failure Is Diagnosed
X-rays are typically the first step. For orthopedic implants, weight-bearing X-rays can reveal gaps forming between the implant and bone, changes in the implant’s position, or bone loss around the device. For breast implants, MRI is the gold standard for detecting rupture because of its high sensitivity and specificity. On MRI, a characteristic finding called the “linguine sign,” multiple wavy lines within the silicone, confirms that the implant shell has collapsed inward. Ultrasound is more useful than mammography for finding ruptures but still less accurate than MRI.
How Long Implants Typically Last
Modern hip and knee replacements are remarkably durable. A large study published in The Lancet tracking over 115,000 patients found that only 4.4% of hip replacements and 3.9% of knee replacements needed revision within the first 10 years. By the 20-year mark, those numbers rose to 15% for hips and 10.3% for knees. This means the vast majority of people will get two decades or more from their implant, but younger, more active patients face higher odds of eventually needing a revision simply because they put more years and more stress on the device.
Dental implants generally last 10 to 25 years depending on oral hygiene and bone health. Breast implants are not considered lifetime devices, and many manufacturers suggest evaluating them every 10 to 15 years.
What Revision Surgery Involves
Revision surgery is substantially more involved than the original implant placement. The surgeon must remove the old device, clear away any damaged or infected tissue, and address bone loss before placing a new implant. For orthopedic revisions, bone loss is often the central challenge. When the body has resorbed bone around the old implant, that missing bone needs to be rebuilt.
Surgeons fill bone defects using several approaches. For gaps up to about 2 cm, bone grafts harvested from the patient’s own body (commonly from the pelvis, shinbone, or thighbone) are the preferred option. These grafts integrate with the surrounding bone and eventually become living tissue. For larger defects exceeding 5 cm, more complex techniques are required. One approach, known as the Masquelet technique, uses a two-stage process: a temporary spacer is placed first to encourage the body to form a biological membrane rich in growth factors, then the spacer is removed weeks later and replaced with bone graft material contained within that membrane. Synthetic bone substitutes made from calcium-based ceramics can also fill certain defects, gradually dissolving as new bone grows in their place.
For dental implant revision, the failed implant is removed and all infected or granulation tissue is carefully cleaned from the site. The standard protocol calls for letting the bone heal for 9 to 12 months before placing a new implant. However, some cases allow for immediate replacement if the socket can be properly cleaned, a wider implant is used, and enough healthy bone remains.
Breast implant revision may involve removing the scar tissue capsule that forms around every implant, a procedure called capsulectomy. This is a more difficult operation than the original placement, carrying higher risks of bleeding, nerve injury, and in rare cases, puncturing the chest cavity. In cases involving the implant-associated lymphoma known as BIA-ALCL, complete removal of the capsule along with the implant and any adjacent affected tissue is essential. When the goal is simply swapping an aging implant for a new one without complications, some surgeons opt to leave the capsule in place and work within the existing pocket, which reduces surgical risk.
Recovery Takes Longer Than the First Time
Recovery from revision surgery is consistently longer and less predictable than recovery from the original procedure. For hip revisions, physical therapy typically begins about four weeks after surgery, compared to days or a couple of weeks after a primary hip replacement. Knee revision patients can usually start physical therapy about two weeks post-surgery. Most people are encouraged to stand and walk with a walker or crutches the day of or the day after surgery, but weight-bearing restrictions are stricter and last longer than after primary surgery.
The overall recovery timeline varies significantly from person to person because revision surgeries differ so much in complexity. Someone who needed extensive bone grafting will have a longer recovery than someone whose revision was relatively straightforward. Your surgeon will tailor weight-bearing restrictions and therapy progression to the specifics of your procedure.
Outcomes Compared to Primary Surgery
Revision surgery works, but outcomes are generally not as strong as the first time around. A meta-analysis of nearly 7,600 patients found that people undergoing revision hip arthroscopy achieved a meaningful improvement in symptoms 47% to 90% of the time, compared to 67% to 92% for primary surgery. The gap widens further when looking at the percentage of patients who reach a state they consider acceptable: 20% to 64% after revision versus 53% to 79% after primary surgery. Complication rates and the likelihood of eventually needing a full joint replacement are both significantly higher after revision procedures.
These numbers don’t mean revision surgery isn’t worthwhile. For someone living with a painful, unstable, or infected implant, revision offers a path back to functional daily life. The results simply reflect the reality that surgeons are working with compromised tissue and bone the second time around, making precision in planning and execution even more critical.