Infections, fractures increasingly lead to repeat hip replacement surgeries, study says

A 15-year study conducted in two tertiary care hospitals in Karnataka and Telangana found that infection and fracture-related complications are increasingly important reasons for revision hip replacement surgery in India. This shift reflects the large number of young patients with demanding lifestyles who undergo these surgeries and subsequently experience such complications.

Studiesrecently published in the Journal of Clinical Orthopedics and Trauma, analyzed 252 revision total hip arthroplasty (rTHA) procedures performed between 2011 and 2025 at SPARSH Hospital for Advanced Surgeries, Bengaluru, and KIMS Sunshine Hospital, Hyderabad. Both of these institutions are tertiary referral centers that routinely receive complex cases of failed hip replacements performed in different hospitals and regions of the country. The study therefore reflects the broader pattern and complexity of revision hip arthroplasty cases in India, the authors said.

Why revision surgery

Revision hip arthroplasty refers to additional surgery that is performed when a previously implanted artificial hip develops complications such as loosening, infection, instability, or fractures around the implant.

The researchers noted that aseptic loosening—where implants gradually lose their fixation without infection—continues to be the single most common reason for revision surgery. However, its relative benefit has steadily declined over the years due to the availability of better implants and techniques. At the same time, infection, instability, and fracture-related complications are becoming more significant causes of complex revision procedures.

The authors emphasized that modern hip replacement surgery remains one of the most successful procedures in orthopedics, with most patients experiencing excellent pain relief, mobility, long-term implant survival, and quality of life. However, with the increasing number of young and elderly patients undergoing joint replacement surgery and their longer lifespans with implants, it is naturally expected that the total number and complexity of revision surgeries will increase over time.

Ravikumar Mukartihal, Consultant Orthopedic Surgeon at SPARSH Hospital and one of the study’s lead authors, said revision surgeries today are technically much more advanced than in the past, as techniques and the variety of implants available have improved dramatically. “We are now increasingly managing infections, instability and fractures that often require advanced reconstructive techniques and careful patient optimization,” said Dr. Mukartihal.

Comorbidities associated with the risk of infection

One important finding of the study was the higher risk of complications seen in medically vulnerable patients. The researchers found that patients with two or more uncontrolled comorbidities had a significantly higher risk of infection after revision surgery.

AV Guruva Reddy, chief joint replacement surgeon at KIMS Sunshine Hospital and co-author of the study, said careful preoperative medical optimization plays a major role in improving outcomes. “Conditions such as diabetes, nutritional deficiencies and cardiovascular disease can affect recovery and the risk of infection. Careful preparation before surgery is essential for good long-term results,” said Dr. Reddy.

Sharan S. Patil, chief orthopedic surgeon at SPARSH Hospitals and another study co-author, said the findings highlight the need to create centers of excellence for these highly specialized revision arthroplasty services.

The increasing availability of advanced reconstructive options, including Indian 3D printed acetabular implants and customized revision systems, is improving the management of severe bone loss and complex revision hip surgery in India. These technologies allow surgeons to perform difficult revision procedures more efficiently while improving accessibility and affordability for patients, he said.

The need for long-term follow-up

The findings underscored the importance of long-term follow-up after primary hip replacement surgery, as early detection of infection, implant loosening or instability could reduce complications and improve outcomes, the researchers said.

They added that advances in implant design, surgical techniques, infection prevention and perioperative care continue to increase the durability and success rate of modern hip replacements. Despite the increasing number of revision surgeries and their increasing complexity, the authors emphasized that primary hip replacement surgery continues to have a very high success rate, with most patients experiencing sustained pain relief, improved mobility, and improved quality of life many years after surgery.

Published – 02 Jun 2026 07:00 IST