What revision joint replacement involves
Revision joint replacement removes a failed or failing implant and rebuilds the joint. It is a bigger operation than the first, with specialized implants, bone-loss repair, and a surgeon who does it regularly. Here, Dr. Paul Chin and Dr. Brian Flowers share the team with Dr. Rohan Gheewala, who is fellowship-trained in adult reconstruction at Baylor College of Medicine and focuses on revision and complex reconstruction, including replacements done elsewhere.
Why replacements fail
- Loosening and wear — the most common reason. The implant outlives its fixation, or the plastic bearing wears through.
- Infection — the hardest problem, handled in stages.
- Instability — a knee that buckles or a hip that dislocates has a mechanical cause.
- The never-right replacement — pain that outlasted every follow-up. Sometimes the implant is fine and the cause is elsewhere.
Failure is uncommon. In the American Joint Replacement Registry's 2024 report, covering 3.7 million cases, total knee revision ran 0.83% at one year and 2.60% at ten years (AJRR, 2024). About 58% of hip replacements and 82% of total knees are still in place at 25 years (Evans et al., 2019, hips; Evans et al., 2019, knees).
Why a revision is harder than the first surgery
- Bone loss. A loose or worn implant erodes the bone around it, so rebuilding often needs bone graft, augments or longer-stemmed implants.
- Implant removal. Well-fixed parts that must come out have to be freed without taking good bone with them.
- Workup. X-rays, infection labs, often CT and sometimes a joint aspiration answer why the first implant failed. If infection is present, treatment is staged: remove, treat, then rebuild.
- Scar and soft tissue. Prior incisions and stretched ligaments change the exposure and the implant choice.
Why the surgeon's revision experience matters
Outcomes in revision surgery track with how often the surgeon and center do it; the numbers are in the questions below. Sterling Ridge is one of the leading joint replacement practices in the Houston area, and revision cases stay within a small fellowship-trained team rather than spread across everyone.
Primary vs. revision: what changes
- Operating time
Longer, and planned for
Your surgeon gives you the estimate for your case.
- Setting
Selected cases outpatient; complex cases in a hospital
It depends on the revision, your health and your home support.
- Recovery
Longer and more particular
Weight-bearing limits and therapy depend on what was rebuilt. Our in-house rehab team runs it on the same chart as your surgeon.
Signs your replacement may need a revision
- Pain that is new, worsening, or never went away after the first surgery
- A knee that buckles, or a hip that has dislocated or feels like it might
- Swelling, warmth, redness or drainage, especially with fever
- Clicking or grinding that comes with pain
- A new limp, a leg that feels shorter, or a joint that feels loose
- Trouble bearing weight that used to be fine
None of these means you need surgery. All of them mean you need an exam and X-rays.
What a second opinion involves
No referral is needed. Book a revision consult with Dr. Chin, Dr. Flowers or Dr. Gheewala at The Woodlands, Spring or Woodforest. Bring your operative report, imaging (X-rays, CT, MRI) and implant list if you have them; if not, we request records and take new X-rays. The visit covers whether the implant is the source of your pain, whether infection needs ruling out, and your options. You leave with a plan either way.
Where revisions happen
Selected revision and complex primary cases are same-day surgery at the Sterling Ridge / Woodforest Ambulatory Surgical Center, built with Memorial Hermann, with PT and aquatic therapy on the same campus. Larger rebuilds, infection cases and patients who need an overnight stay are done in a hospital. The AAHKS position statement calls outpatient joint replacement safe and effective for properly selected patients, based on health conditions, home support and complexity.
Who performs this at Sterling Ridge
Dr. Chin and Dr. Flowers lead primary knee replacement, Dr. Flowers leads primary hip replacement, and Dr. Gheewala focuses on revision and complex reconstruction alongside primary replacement, and complex cases move between the three in-house. Together they make Sterling Ridge one of the leading joint replacement practices in the Houston area, with most cases done outpatient at the Woodforest surgery center. Our surgeons also hold privileges at several area hospitals, so when your insurance plan or your medical history calls for a hospital setting, surgery is scheduled there instead. Offices in The Woodlands, Spring, and Woodforest, Monday–Friday 8:00 AM–5:00 PM. No referral needed.
Paul C. Chin, MD, PhD, FAAOS, FAANA
Brian Flowers, MD, FAAOS
Rohan Gheewala, MDQuestions patients ask about revision surgery
Why would a joint replacement need to be redone?
Usually because the implant loosened, the plastic parts wore out, an infection developed, the joint became unstable, or pain never went away after the first surgery. Revision surgery replaces or rebuilds the implant, and it belongs with a surgeon who does it regularly.
My joint replacement doesn't feel right. Can I get a second opinion at Sterling Ridge?
Yes, and no referral is needed. Persistent pain, new instability, clicking with pain, or swelling years after a replacement all deserve X-rays and an exam. Second opinions on painful or failed replacements are a core part of Dr. Gheewala's practice. Many problems have non-surgical answers, and when revision is needed, earlier evaluation preserves more bone and more options.
Does it matter how many revisions my surgeon does?
Yes. Centers doing 12 or fewer revision hips a year had 2.1 times the 90-day mortality of centers doing 53 or more (Jeschke et al., 2019). In U.S. Medicare data, complications fell as surgeon and hospital volume rose (Pappas et al., 2022), and low-volume hip surgeons recorded a 9.8% dislocation rate (Kishimoto et al., 2020). Ask any surgeon how often they do revisions.
Is revision surgery outpatient?
Sometimes. Selected revisions are done at the Woodforest surgery center, and patients go home the same day. Larger rebuilds, infection cases and patients with significant health conditions are treated in a hospital. Your surgeon decides the setting with you.
Sources
- Jeschke E, et al. Volume-outcome relationship in revision total hip arthroplasty. 2019.
- Pappas MA, et al. Surgeon and hospital volume and complications after joint replacement in Medicare patients. 2022.
- Kishimoto Y, et al. Surgeon volume and dislocation after total hip arthroplasty. 2020.
- American Joint Replacement Registry. 2024 Annual Report highlights.
- Evans JT, et al. How long does a hip replacement last? Lancet, 2019.
- Evans JT, et al. How long does a knee replacement last? Lancet, 2019.
- AAHKS Position Statement on Outpatient Joint Replacement (2024 update).
Medically reviewed by Keith W.V. Johnson, MD, FAAOS · Updated October 21, 2026