Hip Replacement Loosening Symptoms

Why Implants Can Wear out Over Time

In This Article

Hip replacement surgery's proven track record for safety and improving quality of life and life expectancy in patients is well-known. What may be less so is that the loosening of a hip replacement is a normal consequence associated with hip implants, and patients who experience it may require revision surgery to correct it.

Unfortunately, the revision process is sometimes less successful than the first surgery. And hip replacement loosening can lead to infection or breakage of the implant, which are potentially severe—though uncommon—complications.

Hip replacement surgery is among the most common orthopedic procedures. This operation is performed more than 300,000 times in the United States every year.

Life Span of Hip Replacements

Most hip replacements last an average of 20 to 25 years. Some hip replacements will last longer, while other hip implants can fail much sooner. Occasionally hip replacement implants will fail immediately after surgery, but in other cases, patients may have implanted joints for 30 or more years with no problems.

Decades ago, when joint replacement surgery was new, there were different factors that determined how long a hip replacement implant would last. Some of the earliest implants failed because the metals were susceptible to breakage or the plastics quickly shattered.

Because of improvements in the strength of the hip replacement prosthesis and the strength of the fixation of the implant, current hip replacements tend to hold up very well once implanted. Furthermore, with improvements in sterile technique and medical treatment of infections, the serious complication of joint prosthesis infection has also been reduced.

Why Hip Replacements Loosen

When a hip replacement is placed in the body, it is either pressed or cemented into position so that it fits tightly into the bone of the thigh (femur) and pelvis. While it may not move at first, that does not mean it will not over time. This is typically a gradual process that leads to issues with the normal function of the prosthesis.

There are several factors that may contribute to hip replacement loosening, including the patient's age, sex, weight, and activity levels. One study has shown that hip replacements tend to loosen less in the following cases:

  • In women (related to anatomical differences)
  • People over 60, with lower risk each increasing year (most likely related to decreased activity levels)
  • People with a body mass index (BMI) under 25: Each BMI unit over 25 is associated with a 3 percent increased risk of loosening.

The most common cause of joint replacement loosening is the wearing of the implant surfaces and the subsequent weakening of the surrounding bone. This problem is called osteolysis.

Osteolysis

Osteolysis is a problem that causes the bone surrounding the implant to seemingly 'melt away.' The weakening of bone around the hip replacement is seen on X-rays, and it appears as though there are holes in the bone around the joint replacement. Because of the weakened bone, the hip replacement becomes loose and begins to wobble. Patients experience symptoms of pain and limitations in the motion of the hip.

Over years of use, microscopic fragments of the hip replacement cause irritation to the tissues around the implant and begin to cause weakening of bone. Even though modern hip replacements are made of materials that can withstand wearing out very well, even small amounts of these microscopic particles can damage the bone around the hip replacement.

A.K.A. Cement Disease

In years past, doctors used this name to refer to the holes in the bone seen on X-rays done on hip replacement patients. The cause of the bone-weakening was wrongly assumed to be the cement that was used to position the implants (hence, the name). This, however, has been disproven.

Revision Surgery

Hip implant loosening is an issue because a hip replacement revision surgery (a procedure to place a new implant) is a much more difficult operation than the initial one.

After revision operations, patients tend to recover less overall motion of the joint. Also, the longevity of the implant decreases with each revision, due to increased wear on the bone site.

Therefore, physicians tend to avoid joint replacement surgery until absolutely necessary and try to get as much mileage out of each replacement as possible.

Urgent Cases

Hip replacements can fail as a result of reasons other than loosening. For example, the joint may fail and the ball may slip out of the socket in the weeks following surgery. Additionally, an infection may develop either related to loosening or due to a complication from the initial surgery itself.

An infection could be detrimental to the tissue surrounding the joint, including the muscles, ligaments, and even the hip bone. In these cases, you may require prompt revision surgery to treat the infection and repair the hip to restore normal function.

Prevention

In recent years, experimentation has started to investigate whether or not alternatives to the traditional metal-on-plastic (polyethylene) hip replacements would lead to less loosening. New implants made of ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal are being investigated to determine their longevity compared to the traditional metal-on-polyethylene.

The new implant devices tend to have much smaller wear particles—the debris particles that accumulate as the joint wears, much like the rubber wears off your car tires. In addition to this, the overall volume of wear in these implants is also less than the traditional metal-on-polyethylene implants.

However, it is not known yet if these different types of implants will actually lower the rate of loosening of the implants over time. Furthermore, there may be other complications associated with the use of these different types of hip replacement implants.

A Word From Verywell

Unfortunately for patients, there is no definitive answer as to which type of implant is "best." The reason for this is in order to evaluate the long-term success of these newer types of implants, studies need to continue for many more years and include more patients.

Many surgeons have a strong preference for one type of hip replacement implant and may use this in all patients because of their familiarity with that particular implant. If you have questions about which type of implant is being used in your hip replacement, you should discuss this with your doctor.

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Article Sources

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