Loosening of a hip replacement

A hip replacement is firmly anchored in the bone, with or without cement. With aseptic loosening, that anchorage is gradually lost and the implant starts to move minimally within the bone. This causes pain and, over time, bone loss.

The main causes are:

• Wear particles from the bearing surface that trigger a reaction in the bone
• Insufficient ingrowth of the implant into the bone during the first months
• Reduced bone quality, for example with osteoporosis
• A hidden infection, which can present as loosening (periprosthetic infection)

Typically the pain returns after a period in which the replacement worked without problems for years.

• Pain in the groin or thigh, especially with the first steps
• Start-up pain after prolonged sitting or after the night
• A feeling that the leg is shortening or that the hip is sinking
• Increasing pain on stairs and during longer walks

An X-ray often shows a line around the implant or a shift compared to earlier images.

The first step is a thorough analysis: X-ray, blood tests and, if needed, a CT scan or joint aspiration to rule out infection.

• With limited complaints, follow-up imaging is sometimes sufficient
• With confirmed loosening, a revision hip replacement is indicated, replacing the loose component
• Bone loss can be filled with bone graft or bridged with dedicated implants during the revision

Not sure where your complaints come from? Use the symptom explorer or book an appointment with one of our hip surgeons.