Revision endoprosthetics is a highly specialised subspecialty of orthopaedics dealing with the exchange or correction of existing artificial joints. Even though modern implants often last a long time (approximately 20–25 years), they do not last forever. Over the years, wear particles can trigger inflammatory reactions. As a result, the prosthesis may lose stable fixation in the bone and become loose—affecting either individual components (e.g., cup or stem) or the entire system.
To prevent serious secondary bone damage, timely evaluation and—when indicated—revision surgery are essential at the first signs of instability. Prof. DDr. Faschingbauer places strong emphasis on early action to clarify whether bacteria are involved in the loosening (septic) or not (aseptic).
Services: Diagnostics of prosthesis failure (e.g., loosening), insert/liner exchange, septic and aseptic revision procedures
Treatment location: Wiener Privatklinik or Evangelisches Krankenhaus Wien
Surgery duration: depends on cause and complexity; typically longer than primary joint replacement
Hospital stay: usually several days, approx. 7–11 days
Recovery: longer than after primary implantation; structured aftercare is essential
Revision becomes necessary when an existing joint replacement loses function or causes symptoms that significantly impair everyday life. Unlike primary implantation, the goal is not to replace a natural joint but to correct or exchange an implant.
Typical indications include persistent pain, functional decline, instability, radiological signs of loosening, or the need to maintain long-term function after years of use. Because inflammation-related bone loss can compromise fixation, timely action is important.
The reasons are diverse and often develop over time. Clinically, we distinguish:
Aseptic loosening: wear particles and bone loss without bacterial involvement
Septic loosening: bacterial infection requiring prompt revision to prevent spread
Additional causes:
Mechanical problems (malposition, instability)
Material wear of implant components
Dislocation (recurrent “popping out”)
Bone loss / poor bone quality
Prior surgeries affecting joint mechanics
New or increasing load-related or resting pain
Instability / “wobbling” sensation
Reduced range of motion and function in everyday life
Swelling and warmth (especially if infection is suspected)
Perceived leg shortening or deformity
Clicking or grinding sensations during movement
If loosening or dysfunction is due to bacterial infection, treatment must address both the implant and the infection. This is among the most demanding tasks in revision endoprosthetics.
Usually performed as a two-stage procedure:
First stage: complete removal of infected components and insertion of an antibiotic-loaded spacer to maintain mobility and deliver local antibiotics; followed by targeted antibiotic therapy for several weeks
Second stage: once infection eradication is confirmed, implantation of the definitive revision prosthesis
If no bacteria are detected, symptoms are often due to mechanical issues or aseptic loosening. Revision can then often be performed in a single procedure. Only the loosened or damaged components are exchanged where possible, aiming to preserve healthy bone stock and restore stable function.
Typical steps:
Pre-operative planning: digital analysis of loosening and selection of suitable revision implant
Removal: careful extraction while preserving healthy bone
Implantation: deeper fixation and/or specialised augments for stable anchorage
Aftercare: intensive mobilisation to activate function as early as safely possible